PUBLICATIONS

The following is a list of Prof. Anthony Dixon's publications in peer reviewed journals:

1. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (April 2024). "Sentinel lymph node biopsy is unreliable in predicting melanoma mortality for both younger and older patients." J Eur Acad Dermatol Venereol 38(4): 741-751.

BACKGROUND: Melanoma disease patterns vary with patient age. AIM: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages. METHODS: Online prediction tools were applied to compare SLNB positivity (SLNB(+)) and survival risk at patient ages 20-80. Tubingen melanoma data were used to determine variations in the hazard ratio of SLNB(+) for mortality at different patient ages. RESULTS: Regardless of tumour thickness, predicted SLNB(+) rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite. DISCUSSION: If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB(+). ADT linked to SLNB(+) could deny treatment to 89% of these high-risk patients. LIMITATIONS: The authors relied on published risk data. CONCLUSION: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB(+) is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk.

2.  Athanassios Kyrgidis,  Anthony J Dixon, Howard K Steinman, Alexander Nirenberg , Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Aimilios Lallas, Samantha Schneider, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (September 2024). "Sentinel lymph node biopsy may no longer be a critical component of melanoma management." J Eur Acad Dermatol Venereol.

3. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, Zoe L Dixon, J Meirion Thomas. (March 2024). "Primary Cutaneous Melanoma-Management in 2024." J Clin Med 13(6). 

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

4. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (August 2024). "BAUSSS biomarker improves melanoma survival risk assessment." J Eur Acad Dermatol Venereol.

BACKGROUND: The American Joint Committee on Cancer (AJCC) method of staging melanoma is dated and inaccurate. It ignores important prognostic melanoma features, especially the patient's age. BAUSSS is more accurate in determining survival risk for primary cutaneous melanoma patients who have no clinical or imaging evidence of nodal or distant metastases. BAUSSS is an algorithm incorporating analysis of Breslow thickness, Age, Ulceration, Subtype of melanoma, Sex and Site. These are the six features from the patient history along with the details from the melanoma pathology report that are most predictive of mortality outcome. OBJECTIVE: To develop a single-page document that allows the clinician to determine BAUSSS biomarker-predicted prognosis in consultation with the patient. METHOD: From various data sources, we developed an algorithm to predict melanoma mortality using the BAUSSS biomarker system. The single-page algorithm was made available to download at https://globalmelanoma.net/bausss-survival-chart, thus being readily available without charge to all clinicians and their patients. RESULTS: BAUSSS method of determining melanoma prognosis is more accurate and less costly than the AJCC staging system. The only surgery the patient requires is wide local excision of the primary tumour. This method of ascertaining melanoma risk does not require added surgery, costs, hospitalization, tests and anaesthesia, such as would be required if sentinel lymph node biopsy was undertaken. BAUSSS can be a useful tool in determining which primary melanoma patients are at sufficiently high risk to be considered for adjuvant drug therapy. CONCLUSION: We encourage clinicians to download and print in colour this single-page BAUSSS mortality prediction tool, laminate it, and use it face to face with the patient in consultations. Not only will the patient be able to recognize his/her long-term prognosis but will also be able to see how their tumour severity compares with others.

5. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Samantha Schneider, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (September 2024). "BAUSSS biomarker further validated as a key risk staging tool for patients with primary melanoma." J Eur Acad Dermatol Venereol 38(9): e779-e781.

6. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Samantha Schneider, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (October 2023). "Online prediction tools for melanoma survival: A comparison." J Eur Acad Dermatol Venereol 37(10): 1999-2003.

BACKGROUND: Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. OBJECTIVE: To compare online melanoma survival prediction tools that request user input on clinical and pathological features. METHODS: Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. RESULTS: Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. LIMITATIONS: The authors did not have access to the base data used to compile various prediction tools. CONCLUSION: The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.

7. Anthony J Dixon, Howard K Steinman, Alexander Nirenberg, Christos C Zouboulis, Michael Sladden, Catalin Popescu,  Stuart Anderson, Caterina Longo, Athanassios Kyrgidis, Aimilios Lallas, Samantha Schneider, Harvey Smith, Giuseppe Argenziano, Thrasyvoulos Tzellos, J Meirion Thomas. (July 2023). "Improved methodology in determining melanoma mortality and selecting patients for immunotherapy." J Eur Acad Dermatol Venereol 37(7): e843-e845.

8. Zouboulis, C. C., Dixon, A. J., Steinman, H. K., Nirenberg A., et al. (August 2024). "Age-associated metastatic potential of melanoma in lymph nodes: A preliminary gene association study." J Eur Acad Dermatol Venereol 38(8): e701-e707.

9. Dixon, A., Steinman, H. K., Nirenberg A., et al. (June 2022). "Multicentre Selective Lymphadenectomy Trial 1: key primary data remain unavailable." The British journal of dermatology.

10. Steinman, H. K., Dixon, A. J., et al. (May 2021). "Commentary on Superficial Basal Cell Cancers Demonstrate Higher Rates of Mixed Histology on High-Risk Anatomical Sites." Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 47(5): 708-709.

11. Steinman, H. K., Dixon, A.J.; et al. (June 2022). "Reply to "Correlation of Basal Cell Carcinoma Subtype With Histologically Confirmed Subclinical Extension During Mohs Micrographic Surgery: A Prospective Multi-Center Study". Journal of the American Academy of Dermatology.

12. Nirenberg A, Steinman H, Dixon J, et al. Merkel cell carcinoma update: the case for two tumours. J Eur Acad Dermatol Venereol 2020;34:1425-1431.

13. Nirenberg A, Steinman H, Dixon A. Melanoma Extravascular Migratory Metastasis: An Important Underrecognized Phenomenon. J Eur Acad Dermatol Venereol 2020.

14. Steinman HK, Dixon A, Zachary CB. Mohs Appropriate Use Criteria for Superficial Basal Cell Carcinoma-Reply. JAMA Dermatol 2019;155:396-397.

15. Nirenberg A, Steinman H, Dixon J, et al. Merkel cell carcinoma update: the case for two tumours. J Eur Acad Dermatol Venereol 2019.

16. Dixon AJ, Dixon ZL, Anderson S, et al. Management of invasive melanoma. Aust J Gen Pract 2019;48:368-372.

17. Dixon AJ, Anderson S, Dixon JB, et al. Cutaneous melanoma: Latest developments. Aust J Gen Pract 2019;48:349-353.

18. Carley SK, Dixon A, Zachary CB, et al. Revised Mohs surgery care guidelines for squamous cell carcinoma in-situ are overdue. Dermatol Online J 2019;25.

19. Steinman HK, Dixon A, Zachary CB. Reevaluating Mohs Surgery Appropriate Use Criteria for Primary Superficial Basal Cell Carcinoma. JAMA Dermatol 2018;154:755-756.

20. Dixon A, Steinman H, Anderson S, et al. Authors' response to a reply to: Re: Routine usage of sentinel node biopsy in melanoma management must cease. Br J Dermatol 2017;177:579-580.

21. Steinman HK, Clever H, Dixon A. The characteristics of Mohs surgery performed by dermatologists who learned the procedure during residency training or through postgraduate courses and observational preceptorships. Proc (Bayl Univ Med Cent) 2016;29:119-23.

22. Dixon ZE, Dixon AJ, Anderson S, et al. Patients more likely to prefer surgery to novel photodynamic therapy. J Clin Exp Dermatol Res 2016;7:2155-2160.

23. Dixon A, Steinman H, Anderson S, et al. Routine usage of sentinel node biopsy in melanoma management must cease. Br J Dermatol 2016;175:1340-1341.

24. Dixon AJ, Anderson SJ, Dixon MP, et al. Post procedural pain with photodynamic therapy is more severe than skin surgery. J Plast Reconstr Aesthet Surg 2015;68:e28-32.

25. Dixon AJ, Nirenberg A, Anderson S, et al. Sentinel lymph node biopsy--reply. Aust Fam Physician 2014;43:665-6.

26. Dixon AJ, Anderson SJ, Mazzurco JD, et al. Novel photodynamic therapy does not prevent new skin cancers--randomized controlled trial. Dermatol Surg 2014;40:412-9.

27. Dixon A, Anderson S, Steinman HK. How to treat actinic keratoses. Aust Rural Doctor 2014;11:11-14.

28. Dixon A, Anderson S, Steinman H, et al. Sentinel lymph node biopsy now has a limited role in melanoma management. Aust Fam Physician 2014;43:479-80.

29. Anderson SJ, Steinman HK, Mazzurco JD, et al. Prolonged adverse events following photodynamic therapy: regulatory implications. J Drugs Dermatol 2014;13:62-6.

30. Dixon AJ. Is sentinel node biopsy in melanoma a test or a treatment? BMJ 2013;346:f677.

31. Rosengren H, Dixon A. Antibacterial prophylaxis in dermatologic surgery: an evidence-based review. Am J Clin Dermatol 2010;11:35-44.

32. Dixon AJ, Dixon MP, Dixon JB, et al. Prospective study of skin surgery in smokers vs. nonsmokers. Br J Dermatol 2009;160:365-7.

33. Dixon AJ, Dixon MP, Dixon JB. Prospective study of skin surgery in patients with and without known diabetes. Dermatol Surg 2009;35:1035-40.

34. Dixon AJ, Dixon MP, Dixon JB. Skin surgery to the ear risks increased bleeding complications--a prospective study. J Plast Reconstr Aesthet Surg 2009;62:123-5.

35. Dixon A, Rosengren H, Connelly T, et al. Education in skin cancer management--assessing knowledge and safety. Aust Fam Physician 2009;38:557-60.

36. Connelly T, Mones J, Dixon A. Ulcerated malignant spindle-cell neoplasm of the finger: malignant peripheral nerve sheath tumor or desmoplastic malignant melanoma? Dermatol Surg 2009;35:2013-8.

37. Connelly T, Dixon A. Delineating curettage as an adjunct to excision of Basal cell carcinoma: results in 334 cases. Plast Reconstr Surg 2009;123:59e-60e.

38. Dixon A. Sentinel lymph node biopsy: Let's get back to basics in managing melanoma. BMJ 2008;336:1033.

39. Dixon AJ, Dixon MP, Dixon JB. Prospective study of long-term patient perceptions of their skin cancer surgery. J Am Acad Dermatol 2007;57:445-53.

40. Dixon AJ, Dixon MP, Dixon JB. Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy. Br J Surg 2007;94:1356-60.

41. Dixon A. Melanoma management in 2007. Aust Fam Physician 2007;36:488-9.

42. Dixon A. Check Program. Aust Fam Physician 2007;36:583; discussion 583-4.

43. Dixon A. Treating actinic keratoses with imiquimod. Aust Fam Physician 2007;36:341-2.

44. Dixon A. Managing bleeding complications in skin surgery. Aust Fam Physician 2007;36:435-6.

45. Dixon A. Rare skin cancers in general practice. Aust Fam Physician 2007;36:141-3.

46. Dixon A. Arc welding and the risk of cancer. Aust Fam Physician 2007;36:255-6.

47. Dixon A. High risk squamous cell carcinoma. Aust Fam Physician 2007;36:49-50.

48. Connelly T, Dixon A. Surgical pearl: Use of digital Vernier calipers for measurement of lesional and excisional dimensions. J Am Acad Dermatol 2007;56:146.

49. Wilkinson D, Bourne P, Dixon A, et al. Skin cancer medicine in primary care: towards an agenda for quality health outcomes. Med J Aust 2006;184:11-2.

50. Wilkinson D, Askew DA, Dixon A. Skin cancer clinics in Australia: workload profile and performance indicators from an analysis of billing data. Med J Aust 2006;184:162-4.

51. Dixon AJ, Dixon MP, Dixon JB. Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing. Br J Surg 2006;93:937-43.

52. Dixon AJ, Dixon MP, Askew DA, et al. Prospective study of wound infections in dermatologic surgery in the absence of prophylactic antibiotics. Dermatol Surg 2006;32:819-27.

53. Dixon A, Dixon JB, Dixon MP. Reducing Opposed Multilobed Flaps Results in Fewer Complications Than Traditional Repair Techniques When Closing Medium-Sized Defects on the Leg after Excision of Skin Tumor. Dermatol Surg 2006;32:935-42.

54. Dixon A. The Multicenter Lymphadenectomy Trial Spells a Halt to Sentinel Node Biopsy. CML Dermatology 2006;11:1-5.

55. Dixon A. Micronodular basal cell carcinomas. Aust Fam Physician 2006;35:965-6.

56. Dixon A. Melanoma with cutaneous melanoma secondaries. Aust Fam Physician 2006;35:871-2.

57. Dixon A. Managing skin cancer below the knee. Aust Fam Physician 2006;35:785-6.

58. Dixon A. Skin cancer in patients with multiple health problems. Aust Fam Physician 2006;35:717-8.

59. Dixon A. Dysplastic melanocytic naevus syndrome. Aust Fam Physician 2006;35:601-2.

60. Dixon A. One lump or two? A case study of infiltrating BCC on the nose. Aust Fam Physician 2006;35:505-6.

61. Dixon AJ, Hall RS. Managing skin cancer--23 golden rules. Aust Fam Physician 2005;34:669-71.

62. Dixon AJ. Multiple superficial basal cell carcinomata--topical imiquimod versus curette and cryotherapy. Aust Fam Physician 2005;34:49-52.

63. Dixon AJ, Dixon MP. Reducing opposed multilobed flap repair, a new technique for managing medium-sized low-leg defects following skin cancer surgery. Dermatol Surg 2004;30:1406-11.

64. Dixon AJ, Dixon BF. Ultraviolet radiation from welding and possible risk of skin and ocular malignancy. Med J Aust 2004;181:155-7.