Melbourne dermatologist Associate Professor John Kelly is Director of the Victorian Melanoma Service at the Alfred Hospital, a leading force in multidisciplinary cancer care. He also runs a specialist practice in Armadale.
“When I left school in 1970 I knew I wanted to study medicine, but I set out specifically to avoid becoming a dermatologist. I had strong medical role models in both grandfathers and my father. My paternal grandfather and father were both dermatologists. I was concerned that I might work forever in their shadow if I pursued dermatology.
There was no expectation that I should study medicine, but I admired the commitment that my role models gave to their vocation and their readiness to spend long hours with patients. After working as a medical registrar in various specialties I found myself drawn to dermatology. I liked the way in which an experienced eye could cut through to the diagnosis by recognising the pattern of presentation.
I also found appealing the mix of consulting and procedural work that dermatology offered. As a trainee in dermatology I looked for things that were likely to be important in years to come.
In the early 1980s, I spent time as a registrar with Professor Robin Marks, head of dermatology at the Alfred Hospital. He saw that skin cancer was an increasingly important area in Australia and focused on non-melanoma skin cancer.
Dermatologists in the US were focusing on melanoma and contributing new understanding. I could see a place for myself in melanoma work.
I was then fortunate to work in the melanoma clinic at the University of California in San Francisco, where I did my doctorate. They had a multidisciplinary approach, with pathologists, dermatologists, surgeons, oncologists and psychologists all working together in the clinic.
It became my ambition to establish something similar in Melbourne. The concept was initially met with some resistance; the idea of multidisciplinary cancer care was a new one. The sharing of decision making was a challenge to the way practice was conducted at the time.
Over several years, when I was running the dermatology unit at the Alfred, I got to know John Anstee (plastic surgery), Max Schwarz (oncology), Bill Johnson (general surgery) and John Dowling (pathology) who shared my enthusiasm for a multidisciplinary approach to melanoma. Together we started the Victorian Melanoma Service in 1994.
The most important role of the service is to give people who have been diagnosed recently with melanoma a full understanding of their particular situation. A lack of information and understanding frequently makes a diagnosis with cancer much more frightening than it need be. We aim to expose patients to all the specialists they need to hear from, so they can participate in decision making regarding their therapy.
Our patients are largely cared for in the community. They only come to us when management issues arise; for the most part they see their specialist or general practitioner in the community setting.
At the clinic I see patients. I also chair the multidisciplinary panel meetings. At the meetings, senior consultants in pathology, dermatology, plastic surgery, general surgery, medical oncology, radiation oncology, medical imaging and oncology nursing are present, along with registrars and residents.
After histopathology review and clinical assessment, our fellows present each case to the panel. Each case is discussed and a management plan agreed upon. I enjoy clinical research, identifying problems found in everyday practice. One can find a clinical question and design a study to shed light on it. Our extensive database of more than 6000 cases enables many of these studies.
Initially I did research myself, but more recently I’ve been mentoring others. Mentoring bright young people who want to engage with us in furthering their careers has been a highlight. We have students doing masters or PhD projects who keep me interested and enthusiastic about what I do.
I also have a private practice outside of the Alfred. I still enjoy the very visual, pattern recognition skills that dermatology requires. I enjoy the interaction with people in addressing a problem they care about.”
MJA 195 (7) • 3 October 2011 C5