The people behind the Professors
29 March 2017
Professor’s Georgina Long and Richard Scolyer are well known in the academic community and beloved by their patients. But we wanted to chat with them to get to know our new Conjoint Medical Directors a little more and find out how they plan on making an impact on melanoma.
Tell us about yourself and how you came to study melanoma?
Richard Scolyer (RS): I grew up in northern Tasmania. My mum had a series of strokes when I was five years old. I still vividly remember when it first happened and feeling very scared when my brother called the ambulance. My brother and I had to live with relatives in Tassie while Mum and Dad stayed in Melbourne for many months for her rehabilitation. I decided to become a doctor while I was at school, and I think Mum’s stroke is part of the reason why I decided on this career path. After high school, I went to medical school in Hobart. Before making the choice to become a surgeon or physician and before knuckling down for more years of study, I decided I wanted to see the world! So I moved to Adelaide, then Gosford (NSW) and then left Australia for the UK and Europe, where I worked and travelled.
While living in Adelaide, I became friends with a trainee pathologist who was loving it and suggested I try pathology as a career. I’d had excellent pathology teachers in Hobart who also inspired me. After living in the UK for a few years, I decided to apply for pathology training in Canberra. I worked there for a number of years and then needed to move on to complete my specialist training, so I worked out which were the best places to go. Royal Prince Alfred Hospital in Sydney was renowned as one of the best. I was offered a job there and so I moved to Sydney.
I worked hard as a registrar and worked closely with world renowned melanoma pathologist Stan McCarthy AO. I helped diagnose some things that others hadn’t which I think impressed my bosses at the time. When I finished my specialist training they made an effort to make a job combining clinical work with melanoma research that was perfect for me. That’s how my close association with the Sydney Melanoma Unit (now MIA) started more than 15 years ago and it’s blossomed from there.
Georgina Long (GL): I grew up in Sydney, as one of six children. My parents were academic and medical, and so I grew up with dinner-time conversations being quite medical, gory and analytical! Some of my formative years were spent living in Europe and the USA, and from a very young age I learnt that things are done differently in different countries; that you can peel an onion in different ways! Because my parents were doctors and academics, us kids shied away from it, but it is in my DNA. When I finished school, I didn’t think medicine was for me, so I decided to study a combined degree of science and law instead.
RS: My wife went to university with Georgina. She says that everyone at uni used to say "Georgina should be doing medicine, this is ridiculous!"
GL: Did they?! Yeah, I'd hang out with the medicos and I liked the scientists. So I finished off extra law credits but I then gave it up to do a double major in Science. I did Pure Maths and Chemistry, then a PhD in Organic Chemistry. Then I was awarded a Fulbright Scholarship and got a postdoctoral fellowship position at The Scripps Research Institute in California. When I came back I did medicine. I was just drawn to it.
Medical oncology made a lot of sense because of what I'd done in my PhD and because I was always very molecular: I was always thinking of atoms and how they interact to form molecules and how they interact in the body. And that's how I came to do medical oncology. Melanoma in particular was the most un-sexy cancer in medical oncology when I began my oncology training in 2005!
RS: Georgina might not remember this but I was riding my bike home from work one day and I rode past the back lane way of Georgina's house. Georgina was outside and we started chatting about what field to get into. I remember saying "You're crazy if you don't get into melanoma. It's the only common cancer that's got no effective systemic therapies. Something is going to happen!"
GL: Wow, I don't remember! But Richard has always been so supportive of me, so I'm not surprised. I already had a relationship with the Sydney Melanoma Unit (SMU) - which is now MIA - because one of my lecturers, Kerry Crotty, was involved with SMU and we presented at a conference together on head and neck melanomas. But I also had this relationship with melanoma because my Dad, who is fair and has auburn hair, was into melanoma prevention as soon as there was any information about UV and melanoma. He'd be wearing long-sleeved shirts while us teenagers were being foolish in the sun. So we were always very aware of melanoma and the risk. I was always a bit attracted to it because I knew a bit about it.
So I'd just had my third baby, I'd finished my training, I loved learning about melanoma, I liked studying cancer. There was a lot of opportunity in melanoma to make a difference: there was no systemic therapy, it was so unsexy that no-one wanted to touch it, so I thought "That'd be great!". There were lots of research opportunities, lots of treatment improvement opportunities, and so I wrote myself a grant and self-funded myself for the first four years of my career. Richard was instrumental in encouraging me to keep trying to create the position I wanted to create.
Each speciality in medicine needs a certain skill set to excel. What do pathologists have to be really good at?
RS: There are different types of pathologists; I’m a surgical pathologist. I diagnose melanomas and other tumours by examining patient’s tissues under a microscope. For my job, you need to have great knowledge of both the clinical and pathological aspects of human diseases. You need to be able to assimilate a lot of information, both clinical and pathological, and be able to synthesise all that to make the right diagnosis. You need to have a great visual memory and to be able to recognise patterns. It is important that you have great attention to detail and are very meticulous to ensure that you don't leave a stone unturned or take short cuts. A tissue detective is what you have to be! But these days it’s not just about making the right diagnosis. In many instances, it’s pathological features of the patient’s tumour that are key aspects in deciding what is the best treatment for them so you have to be able to communicate these important characteristics clearly and precisely. It also helps to be able to work well in a team. I spend many hours each week discussing problematic cases with my clinical colleagues. This frequent behind-the- scenes communication is a vital part of giving our patients the best possible care.
What about in medical oncology?
GL: You need to have good diagnostic skills – the ability to gather information from different sources, come up with the diagnosis and then implement the right treatment. You also need to be able to communicate really well with patients, explaining the risks and benefits of treatments. You have to be quite good at gathering information and making it simple for them to understand, as the decision always rests with them. However, they are guided by your interpretation. The challenge is that you have to take this massive cloud of information and then present it to someone who has never done medicine. And so it does require a bit of skill in communicating that to the patient, working out what they don't understand and adjusting your message as you go along.
You have been appointed as Conjoint Medical Directors at MIA. What is the collective benefit of having two great minds working together?
RS: We bring different perspectives to problems. We have different experiences and skill sets that help us see different angles for each problem. We keep each other accountable and ensure that tasks get completed. I think that's important because there is a lot to do!
GL: I find Richard a very good sounding board for ideas. It's easier to do it together. I think the teams we're working with like it too because of the different perspectives and collaborative nature of what we do. I think we complement each other well and we bring a very different view point.
RS: And we've worked in each other’s pockets for such a long time now... 90% of the time we're on the same page with things, and we know we can make decisions for each other about most things. We know what the other person would think, and we're comfortable about doing that. But we also know which issues or problems need the other person's advice.
What do you think is the key to tackling melanoma?
GL: Collaboration, communication and sharing. And thinking together about the problems and how to solve them.
RS: We know that ultimately prevention is better than cure, so we have to attack the disease at different levels from education, prevention, screening, early accurate diagnosis, and by providing the optimal treatment when the disease is at an early stage for the best outcomes. For people with advanced stage disease, we want to stop them from dying from the disease so we must improve their treatment.
GL: Can I just emphasise that prevention is so much better than cure. We learn a lot at the drug end but ultimately we want to understand early melanoma so that we can work out how to prevent it completely.
RS: People might not gather that the things we learn from the advanced end of the spectrum can actually translate into things that we can do earlier on in the disease that will change the management of patients. For example, most melanoma patients are diagnosed and treated at an early stage and are cured from it. However, there is still a subset of patients who initially present with early stage disease that you would not expect to progress, but who end up doing really badly. We are learning from studying the late stage disease from these patients how to identify them early on. By doing this, these previously unrecognised high risk patients may not only be followed up more closely but potentially can be offered effective treatments earlier.
GL: We are also learning what it is about a patient’s melanoma that makes them get advanced disease. Is there something we can do earlier or some risk feature we can identify earlier before they even get melanoma? If they do, what can we do to prevent it becoming Stage IV? I'd love to be able to not even have melanomas in our lives... to put ourselves out of a job!
You've been described as the next generation of melanoma luminaries. How do you juggle the demands of family with your work?
GL: I don't! It's really hard – I have to be frank. It's really hard to have an active productive career and be there as much as you would like for others in your family. I have a very supportive husband who does the lion's share of domestic duties and looking after the children, taking them here and there, etc. I don't get as much time as I would like with my kids, unfortunately. I'm trying really hard, but it's a really difficult juggling act. I'm often working late at night and going to bed late.
You've got to eat well, exercise and sleep well so that what time you do have with your family is good time, that you're not run ragged. Exercise is critical for me so that I can stay on top of things. Basketball is fun for me, but I also swim, run and have just started cycling. And I've just started classical dancing too!
RS: I don't juggle family and work very well. You do your best to try and fit everything in but it is impossible. Like Georgina, I have a supportive partner. Katie works part time so it is a challenge to try and run our household, keep our energetic three kids well, happy and engaged, and find time for ourselves and each other. Taking a family holiday together is a must to recharge the batteries and spend time together without the normal distractions of our daily lives.
Georgina and I are both very focused and driven people. To fit everything in you have to be organised, be able to multitask, make decisions and be able to move on from them. Otherwise you won’t fit things in.
In the last few years, I've got back into doing triathlons.
GL: Got back into it! He’s represented Australia at the World Championships!
RS: I used to do triathlons when I was younger, but then I had kids and stopped exercising. But then I decided I needed to get back to it. My kids are pretty sporty and I have fun competing against them and their friends at swim club and racing them at Parkrun on Saturdays. As a kid growing up in Tassie, Aussie Rules footy was my passion and I kept playing ‘til I was about 30. These days I barrack for the Sydney Swans (my family calls me a “turncoat”) and my kids and I love going to watch them play. My Dad played football at the top level, so sport is in the blood. In fact, he was disappointed that I did medicine instead of being a professional footballer (not that I was good enough)!
In five years’ time, where do you see melanoma research heading?
GL: At the moment, we think 30-40% of patients with Stage IV melanoma (melanoma that has spread to distant organs e.g. brain, liver or lungs) have excellent long-term survival. This is what we call the ‘plateau’ on the survival curve. I want to see this ‘plateau’ or long-term survivors increase to near 100%, but realistically, in five years I reckon we'll see it well above 50%.
RS: Even if we haven’t eradicated melanoma in the next five years, I’d like to think we can control it long term so people don’t die of this disease.
What would you like to be known for at the end of your career in melanoma research?
GL: Quite simply, I want to make a difference. Contribute, and make a difference.
RS: Making a difference to patients and to the disease globally. And also to your junior colleagues.