AJGP retracts 2 ACCO manuscripts on melanoma

AJGP retracts ACCO articles on melanoma

In October 2019 the Australian Journal Of General Practice retracted two detailed updates on melanoma written by your ACCO team.

The Journal approached ACCO in November 2018 and asked us to prepare the updates for a special edition of the journal. 

We did so voluntarily. We ensured they were accurate, entirely evidence based and cited throughout. We stand by the accuracy of the articles. 

Prof. John Thompson from Melanoma Institute Australia (MIA) disagreed in an unpublished letter to the editor of the AJGP. The letter from Prof. Thompson was co signed by others living and / or working in Brisbane, Sydney and Melbourne. 

His main concern pertained to the role of sentinel lymph node biopsy (SLNB).  We had appropriately advised that "SLNB is not required in the management of any melanoma patient". 

We remain at a loss as to how Prof. Thompson claims our statement is incorrect. SLNB does not alter survival. A cancer patient should only be "required" to have an intervention if it is essential to their long term survival prospects. The only intervention that is "required" in managing primary melanoma is wide local excision. That alone maximises survival.  

Prof. Thompson does not explain why he thinks SLNB is also required. SLNB can provide added prognostic information. Our article explains this. Why should patients be "required" to have this added prognostic information? Some will choose to have the added information, others will choose otherwise. SLNB is an option, never a requirement. 

SLNB should be discussed with the patient. We explained this in our article. For Prof. Thompson to claim SLNB is "required" is inconsistent with all medical evidence and contrary to all international melanoma guidelines. Prof. Thompson heads Australia's biggest melanoma unit. We would hope that advice provided at the unit is consistent with the best available evidence rather than on the basis that SLNB is somehow required. 

We provide downloadable version of the 2 articles

Management of cutaneous melanoma

Melanoma latest developments

Indeed AJGP commissioned ACCO to write a third article on melanoma. Part 3 was commissioned by AJGP in response to a letter from Prof. Thompson. He declined to provide any letter in a format acceptable for journal publication. Given the journal was not going to publish the letter from Prof. Thompson, we had no reason or need to respond. However, AJGP Editor in Chief, Prof. Stephen Margolis commissioned us to submit a third melanoma update manuscript. This would provide us with an opportunity to expand on aspects we had to abbreviate in order to meet the word limits of Parts 1 and 2. 

He advised us that Part 3 required the full formal manuscript structure; including - a structured abstract (Background, Objective(s), Discussion) of no more than 150 words - a short summary of important points - the completed Assignment of Copyright form - the completed ICMJE Conflict of Interest form. We formally submitted Part 3 as per his requests for peer review. (AJGP-09-19-5065). As always, it was meticulously prepared and took 100s of hours of our collective voluntary time. 

We were pleased that we could further update Australian GPs on melanoma with more detailed information. For Part 3 we were allowed by the journal to use a much larger number of citations. We included 49 key references in this manuscript. We still await the peer review commentary on this manuscript. No independent blinded peer review on Part 3 has been provided to us. Peer review feedback is required for every formal journal manuscript submission, whether or not the journal chooses to publish the article. 

However, AJGP advises they will not publish part 3. No reasons have been provided to us. The required blinded independent peer review process has apparently never happened!

There is a formal Committee on Publication Ethics (COPE) process to retract an article. It cannot be done because of difference of opinion. The errors must be major. The errors must be pointed out to the authors who must be given an opportunity to respond. Retraction is a last resort. There are multiple options other than retraction. AJGP incorrectly claim that retraction is their only option. AJGP has failed all of the required COPE processes. The COPE guidelines can be downloaded here

AJGP should have advised us of the supposed errors, and offered us a chance to respond. We wrote several times to AJGP with such a request after the retraction. The reasons were never provided by the journal. Instead, we first find out about the full details of the claimed errors from a journalist several weeks after the retraction. 

AJGP advised us after our manuscripts were retracted that an investigation was undertaken regarding the tenure of our first two manuscripts. At no stage were we advised these manuscripts were being reviewed or even considered for amendment until after they were retracted. Consequently, we were not given an opportunity to, and hence could not provide any response to this secretive investigation. AJGP refuses to advise the names of any persons who were a part of this secretive process. COPE processes were ignored. 

ACCO has insisted on our melanoma articles being reinstated, a published formal apology from the journal, and the publication of our final part 3 update. 

John Thompson's other complaints - (as advised by a journalist)

Professor Thompson claimed we had further errors in our manuscripts. ACCO believes our only errors were typos that made no impact on the advice and conclusions. To be fair, we list Prof. Thompson's other complaints.

  1. "There were major inaccuracies in the articles discussion of the use of BRAF inhibitors, MEK inhibitors, Ipilimumab and Anti-PD-1 medications."

We disagree. We quoted and cited data accurately. We are aware of two typos. Neither unintended minor errors alter the substance or conclusions of our papers. We offered to provide a corrigendum to the journal to correct these two minor errors. We are not aware of any other error. No one has provided us with evidence of any other error. Dr. Thompson argues we should have cited other drug studies. The requirements of the journal limited the number of citations per article. We cited based on this limitation. We cited correctly. We stand by it. Had we had unlimited word count and unlimited citations, we could have also included references that Dr. Thompson would have liked to be added. Our information regarding melanoma drugs was factual. It accurately reflected the major drug trials cited. Our conclusions were evidence based and accurate.

 2. "There was a discrepancy between the statement that “melanoma spread to nodes or elsewhere can be managed with medication” and treatment guidelines that recommend surgery as the first line treatment."

This is a misinterpretation of the comments made in our articles. We were accurate. We did not suggest there was limited or no role for surgery. This manuscript was on latest developments and hence we focused on recent research. The manuscript section Prof. Thompson refers to was a discussion on new adjuvant drug therapy research. With greater word count, we could have added further commentary. It is absolutely true that melanoma spread to nodes or elsewhere can be managed with medication. Prof. Thompson asserts that writing accurately, but omitting a discussion on a matter not related to the topic of latest developments, somehow constitutes a major error in the paper. His assertion is clearly incorrect. 

 3. "It was inaccurate to state that since 2008, “no updated, formal evidence-based melanoma guidelines have been published in Australia”. He said that in fact, guidelines were available on the Cancer Council’s website which had been progressively updated since 2018."

We are fully aware of these Cancer Council guidelines produced by the Clinical Guidelines Network (CGN). We confirm there has been no evidence based quality Australian melanoma guidelines since the NHMRC guidelines in 2008. The current CGN guidelines under development are frequently well short of an evidence based valid set of guidelines. Frequently these CGN guidelines are based on expert opinion rather than evidence based medicine. As a consequence, ACCO advises members that these CGN guidelines are frequently not evidence based and have numerous errors. ACCO members are advised not to rely upon them. 

As an example of the recommendations in the CGN guidelines that we believe are inappropriate and incorrect, numerous GPs have written objecting to the guideline that, "Patients being considered for sentinel lymph node biopsy (SLNB) should be given an opportunity to fully discuss the risks and benefits with a clinician who performs this procedure." Why?. No explanation is given. No research evidence is provided to support the guideline. We are not aware of any study being completed that demonstrates that advice on those matters from one type of clinician is superior to advice from others. The guideline is merely expert opinion. It appears to be self-serving expert opinion.

We urge melanoma patients to have a discussion regarding SLNB with a doctor well versed in melanoma management. However, should that doctor be one who is still regularly doing the procedure and hence has a conflict of interest?. Many rural doctors have pointed out that requiring isolated and remote patients to travel some distance to have this discussion is unacceptable, if not absurd. 

In many cases, the patient can have their melanoma managed in their local town by their appropriately skin cancer trained GP or experienced local surgeon outside of a melanoma unit.  That doctor can provide the SLNB discussion. With guidelines like this on the CGN web site, it is little wonder that many GPs have objected. Indeed guidelines like this taint many other parts of the CGN guide that are accurate and evidence based. A chain is only as good as its weakest link. 

Berlin Ultrasound and fine needle biopsy

Any discussion of a surgical operation between a clinician and a patient needs to include a discussion of non-surgical alternatives. Avoiding a discussion of the non-surgical options in any SLNB informed consent discussion with a melanoma patient would be viewed by ACCO as negligent practice. The consent process could not be seen as meeting AHPRA requirements. 

There is a non surgical alternative to SLNB called the Berlin Ultrasound and Fine Needle Biopsy (BUSFNB) of nodal basins. It has been validated in a large prospective study.There has been a landmark trial on BUSFNB. Voit C, Van Akkooi AC, Schafer-Hesterberg G, et al. Ultrasound morphology criteria predict metastatic disease of the sentinel nodes in patients with melanoma. J Clin Oncol 2010;28:847-52. 

The Berlin criteria hinges on assessing three features in nodal ultrasound; balloon shaping, loss of central echos and peripheral perfusion. All three have been shown to be independent predictors of survival. The three together have been validated as a reliable prognostic tool for melanoma patients. 

The breakthrough  BUSFNB trial included 400 melanoma patients. Each patient received BUSFNB and then SLNB. The survival predictability of SLNB negative and BUSFNB negative patients were similar. Further, the poorer survival predictability of SLNB positive and BUSFNB positive patients were comparable. BUSFNB is clearly a validated non-surgical alternative to SLNB. 

In 2017 the ten year outcomes of 1000 patients who underwent both SLNB and BUSFNB was evaluated. Oude Ophuis CMC, Verhoef C, Grunhagen DJ, et al. Long-term results of ultrasound guided fine needle aspiration cytology in conjunction with sentinel node biopsy support step-wise approach in melanoma. Eur J Surg Oncol 2017;43:1509-1516. The study confirmed that a single BUSFNB procedure around the time of primary melanoma excision provides ten year prognostic information for patients very similarly to SLNB surgery. The authors point out that SLNB could be reserved for patients in which the BUSFNB Ultrasound shows positive features but the fine needle biopsy is negative. The full text of this study is available here

Further details of the comparison between BUSFNB and SLNB are published in; - Voit CA, van Akkooi AC, Schafer-Hesterberg G, et al. Rotterdam Criteria for sentinel node (SN) tumor burden and the accuracy of ultrasound (US)-guided fine-needle aspiration cytology (FNAC): can US-guided FNAC replace SN staging in patients with melanoma? J Clin Oncol 2009;27:4994-5000. A full copy of this manuscript is available here.

This year Prof. Thompson published on ultrasound usage in melanoma patients. Thompson JF, Haydu LE, Uren RF, et al. Preoperative Ultrasound Assessment of Regional Lymph Nodes in Melanoma Patients Does not Provide Reliable Nodal Staging: Results from a Large Multicenter Trial. Ann Surg 2019. His study was an analysis of MSLT2 data. He claimed that,  "For accurate nodal staging to guide the management of melanoma patients, US is not an effective substitute for SN biopsy." The problem is that the MSLT2 trial did not use Berlin criteria. They used a completely different, long discredited, ultrasound protocol. They did not assess for balloon shaping and peripheral perfusion when performing ultrasound on their patients. 

This Thompson study merely confirms that you have to use the validated BUSFNB criteria to provide quality prognostic advice for patients. Why did Prof. Thompson claim such a sweeping and misleading conclusion to his study? Why did MSLT2 use discredited ultrasound criteria when the Berlin criteria has now been validated for over 10 years? Could it be that this was merely another attempt to mislead the community about the true limitations of SLNB? How many patients might have been denied an opportunity to access a non-surgical alternative to SLNB because of Prof. Thompson's misleading advice? How many cases of chronic lymphoedema and nerve damage, etc, could have been avoided? The full text of the Thompson study on non-BUSFNB can be found here

Discussing and offering non-surgical options has been and remains a required component in any appropriate consent process regarding SLNB. However, the CGN section on SLNB fails to even mention non-surgical options. The section advises clinicians that discussing SLNB is essential in the informed consent process. If a clinician followed the suggested CGN guidelines on SLNB, including a failure to mention non-surgical options, they would be acting unethically, failing in their requirements to obtain valid informed consent. 

It is ACCO's view that, in regard to this advice, the CGN guidelines on SLNB promote inappropriate and unethical medical practice. 

Country patients

The authors of the ACCO melanoma articles all have extensive rural practice experience. Prof. John Dixon worked for many years in Phillip Island, rural Victoria.  Dr. Stuart Anderson works full time in the rural town of Maffra, Victoria. Prof. Anthony Dixon has resided and worked in rural Griffith NSW, Leongatha Victoria and Naracoorte South Australia. Prof Howard Steinman has resided and worked in rural Temple Texas, USA. Dr. Alex Nirenberg has extensive experience providing pathology services in the Victorian towns of Bendigo, Ballarat, Wangaratta and Albury. We are all aware that rural melanoma patients may not have a melanoma unit around the corner. We need to ensure that best possible skin cancer services are provided to all Australian patients, whether or not they live in a big city near a melanoma unit. We wrote our manuscripts with this in mind. 

CGN Systematic review ??

The authors of the CGN SLNB section claim they have completed a "systematic review" of SLNB and offer their summary of same in their CGN web site section. This is a false claim. A systematic review is a particular entity in medical research. It is rigorous, highly structured and typically published in a high level journal. Commonly a team of researchers may take up to a year to complete a systematic review. It is only completed when published. It must be available to scrutiny by all. If it is not published, it is not considered completed. 

ACCO has frequently checked. The authors of this SLNB section have not completed such a systematic review as of January 20, 2020. They have published in the Australasian Journal of Dermatology a piece they claim is a summary of their "performed" systematic review. They were not able to cite their review.  In claiming a systematic review has been completed, the authors inaccurately claim the chapter is based on a level of evidence it has not nearly met.

There has been a Cochrane analysis of SLNB. Kyrgidis A, Tzellos T, Mocellin S, et al. Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev 2015:CD010307. The CGN section on SLNB fails to cite this analysis. This Cochrane review concludes that, "Currently this evidence is not sufficient to document a benefit of SLNB when compared to observation in individuals with primary localised cutaneous melanoma."

A proper systematic review would select data based on levels of evidence. The Cochrane review and two large prospective randomized controlled trials analysed on an intention to treat basis are the highest level of evidence we have thus far on SLNB. The two high level trials published on SLNB thus far are MSLT1 and MSLT2. 

The CGN review fails to cite the Cochrane review or MSLT2. It mentions MSLT1 only to focus on secondary subanalyses rather than the intention to treat data and the trial's primary outcomes. Instead of CGN claiming it has completed a "systematic" review on SLNB, a "superficial" review would be accurate. Their claim of a systematic review is misleading to doctors and the community. It is also minimises the efforts of the many scientists that actually have completed systematic reviews in their fields.

Australian melanoma patients deserve better

We might assume that Prof. Thompson acts on his assertion that we are wrong to say that SLNB is not required in the management of a melanoma patient. If so, we may assume that Australian melanoma patients are being told they are required, obligated, demanded, necessitated to have such surgery beyond wide local excision despite it being recognized that such SLNB surgery does not alter survival. Are we also to assume that these same patients are not receiving valid informed consent for the procedure by failing to discuss and offer non-surgical alternatives?

Some melanoma patients are being urged to have SLNB surgery known not to improve survival, and risk adverse events, in order to receive drugs that might. It concerns us that some drug trials were set up with such a protocol. These patients have anecdotally reported that a non-surgical alternative to SLNB was never discussed or offered.  In developing these trials, ACCO believes that the system forgot about the "first do no harm" principle we all learnt in early medical school days. If the intent is to assess a patient's eligibility for adjuvant drugs, informed consent would require that a non-surgical option must be explained and offered as an alternative to surgery. 

It is not just ACCO that holds concerns that SLNB offers little added benefit to patients other than prognostic advice. In 2018, general surgeons approached Medicare Australia to approve a new item number for melanoma SLNB. The Medical Services Advisory Committee reviewed the literature and determined that it could not support an item number for melanoma SLNB. It determined that evidence that SLNB provided any patient benefit was doubtful. Download MSAC report here.

The Medicare expert panel, which was independent of any members of ACCO, reached the same conclusion on the role of SLNB as we did. ACCO notes that as far as we are aware, there have been no calls by Prof. Thompson to retract the MSAC findings and the results of the Cochrane analysis from being available to doctors and patients. It is unclear why he has taken this approach with our papers.  It is extraordinary that the AJGP has responded by complying. 

Previous publications & responses

It is noteworthy that we published on the SLNB controversy in the British Journal Of Dermatology in 2016. 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. That journal correctly managed the situation of some objections by allowing a counter view by way of letter to the editor. Saleh DB. Response to: Routine usage of sentinel node biopsy in melanoma management must cease. Br J Dermatol 2017;177:579.

In 2019, authors not associated with ACCO also published a similar analysis of SLNB in the Journal of the American Academy of Dermatology (JAAD). Bigby M, Zagarella S, Sladden M, et al. Time to reconsider the role of sentinel lymph node biopsy in melanoma. J Am Acad Dermatol 2019;80:1168-1171. This journal correctly managed an opposing view by accepting and publishing a letter from Dr. Thompson and colleagues. Faries MB, Cochran AJ, Thompson JF. Re: "Time to Reconsider the Role of Sentinel Lymph Node Biopsy in Melanoma". J Am Acad Dermatol 2019.

In his letter to JAAD,  Prof. Thompson makes another extraordinary misleading claim. He claims that MSLT1, of which he was the second author, found. ". .there is clear evidence of a survival benefit from early nodal treatment in patients with intermediate-thickness melanomas". 

In contrast, we directly quote the findings of his 10 year MSLT1 data as published in NEJM: -

"Among all patients with intermediate-thickness melanomas (with or without nodal metastases) there was no significant treatment-related difference in the 10-year melanoma-specific survival rates; the mean (±SE) rate was 81.4±1.5% in the biopsy group and 78.3±2.0% in the observation group (hazard ratio for death from melanoma in the biopsy group, 0.84; 95% confidence interval [CI], 0.64 to 1.09; P = 0.18). There was also no significant between-group difference in 10-year melanoma-specific survival rates among patients with thick melanomas." 

In the Figure 2 of the same MSLT1 final report published in NEJM, the full figures are provided for ten year outcomes of patients with thick melanoma. Observation patients had a 64.4±4.6% melanoma specific survival at ten years. In contrast the patients with a thick melanoma who underwent a SLNB had a lower 58.9±4.1% melanoma specific survival at ten years. The difference was not significant. Indeed the data for all thickness melanoma in the MSLT1 study demonstrated a non significant 10 year survival difference of 78.0% in the observation group versus 80.0% in the intervention group. 

Yet in his letter to JAAD Prof. Thompson claims that SLNB was shown to be "remarkably therapeutic". The comment has no basis. However, if true, then SLNB for patients with thick melanoma would have to be regarded as "remarkably dangerous". Of course neither claim is true. The full letter from Prof. Thompson to the JAAD is available here. The full text of the final report on MSLT1 published in the New England Journal Of Medicine can be found here

If SLNB was a drug, we would not even be talking about it. It would not seek nor would it ever gain a TGA listing. It would not be available to patients other than its role as a prognostic indicator. Yet it is being inappropriately used with therapeutic claims beyond its role as a prognostic indicator by patently misleading advice from Prof. Thompson and others. That same Prof. Thompson has the audacity to claim our manuscripts somehow have flaws.  Does Prof. Thompson actually think no one fully reads his studies? Or does he presume doctors will only listen to and believe his misleading claims about his studies? 

Despite his false claims, neither the Br J Dermatol or the JAAD managed the controversy by retracting and effectively banning one opinion. They allowed debate. 

AJGP has received the attached letter to the editor From Prof. Christopher Zachary, UC Irvine, California. Does the AJGP wish to demonstrate balance by publishing this letter in full?

AJGP also recieved the attached letter from 17 GPs practicing largely in rural and remote regions. They singled out the distance and practicality issues for country patients as of special concern. 

Debate is a cornerstone to medical advancement. This banning of debate is unacceptable. Australian melanoma patients deserve better.

Conflicts of interest

ACCO draws your attention to the conflict of interest declarations regarding those who prepared the melanoma guidelines for CGN. Details of some declarations are available here. Drs Thompson, Long, McArthur, Alexander Menzies and Matteo all signed the letter to AJGP demanding journal retraction of our articles. All of them have numerous drug company interests that they declare on the CGN website. Yet none of these five doctors declared such conflicts in their letter to AJGP. 

They demanded our independent analysis of melanoma drugs be withdrawn. In general they considered we painted a less favourable picture on some drugs than those drugs deserved. 

There was a specific complaint about the way we portrayed the drug vemurafenib. Prof. Thompson disputed our summary that BRAF drugs were broadly similar. He singled out vemurafenib as, in his opinion, being inferior to the other BRAF drugs. Roche, the company producing vemurafenib, is one of the few melanoma drug companies with which Prof. Thompson does not declare a conflict of interest.

In contrast to Drs Thompson, Long, McArthur, Alexander Menzies and Matteo, ACCO does not accept sponsorship, payment or incentive of any kind from any pharmaceutical company. We will not even take a pen or a sandwich from a pharmaceutical company. No drug company is allowed to attend any ACCO event. We insist that our commentary on drug managment be truly independent. This is a very different standard to that used by the Cancer Council CGN. 

ACCO refuses any and all Government or University funding. Yet the CGN is Government funded whilst some of its major contributors are accepting drug company sponsorship. ACCO is concerned that, without completely independent membership of the CGN, the dissemination of information to doctors and patients with melanoma may be influenced by pressure from pharmaceutical companies. 

The complete register of conflicts of interest on the CGN web site can be found here. A version of the CGN conflict of interest register without attachments can be found here.

ACCO provides the NHMRC code of conduct for research for download here.  ACCO draws your attention to clauses: 6, 6.2, 7, 7.1 7.2, and 10. There may be evidence of breaches of these clauses of the code of conduct.

The Cancer Council of Australia ?

The Cancer Council have a mess of their own making. They have melanoma guidelines available at present that are at times absurd, sometimes promote unethical practice, and that may be perceived to be influenced by authors with ties to pharmaceutical companies. 

The CEO of Cancer Council Australia is Professor Sanchia Aranda.ACCO finally recieved a copy of her letter in Janaury 2020. The only 'fault' identified by Prof. Aranda was that she had a difference of opinion regarding the evidence base of the CGN melanoma guidelines. Prof. Aranda must know that a difference of opinion is never grounds for manuscript retraction. She uses her influence in her position to manipulate appropriate COPE processes. 

Prof.Aranda needs to stand down as CEO of the Cancer Council for failing in her most core responsibility, - putting interests of Australia's cancer patients first. Among other aspects, Prof. Aranda should be aware of the importance of appropriate informed consent in medical practice. Prof. Aranda ought to be advocating for patient's to be making decisions on thier health service delivery, not surgeons deciding for them. 


ACCO stands by claims that our manuscripts had no major errors. Drs Thompson, Long, McArthur, Alexander Menzies, Matteo and others have a difference of opinion on some matters. They have been unable to identify any valid error in our manuscripts. Yet they persuaded AJGP to retract them. We again point out that differences of opinion are never reasons to retract manuscripts. 

Drs Thompson, Long, McArthur, Alexander Menzies and especially Dr. Matteo must immediately stand down from their roles with the Cancer Council and the Clinical Guidelines Network. They should remain stood down until a full external independent investigation of their activities in this matter are finalised. 

Cancer Council of Australia CEO, Professor Sanchia Aranda needs to stand down from the Cancer Council. In so doing, she should publicly invite Drs Thompson, Long, Alexander Menzies and Matteo to also stand aside. 

A new team without drug company conflicts is needed. A new approach with a foremost priority of non-conflicted, ethical melanoma care for all Australians is now urgently needed. The CGN guidelines on melanoma should be removed, pending a complete review and rewrite. A new team working on a new CGN melanoma guide needs to exclude any clinicians with a conflict or perceived conflict of interest. A new guidleines team needs to extend representation beyond the Melbourne, Brisbane and Sydney people whi signed ths complaint letter to AJGP.

Clinicans that have been doing a procedure for 25 years, and now find it has no effect on the intended benefit, must listen to the science. They have a moral obligation to stand backand reflect on their own clinical practice choices. Independent scientists, that have no drug conflicts of interest, work entirely voluntarily, do not perform SLNB nor ultrasound have a perspective that needs to be respected. Instead our team have been subjected to personal abuse, We see here a system failure through failure to recognise and declare conflicts, policy decisions by bullying and alternative view suppresssion. These science deniers must move on. Melanoma patients deserve better.

And Professor Margolis ?

AJGP Editor in chief, Dr. Stephen Margolis, in retracting our manuscripts, refers GPs to the error plagued Clinical Guidelines Network web page. Apparently AJGP considers that GPs cannot handle academic debate in the pages of the journal and instead should be educated by those who shout the loudest. Sound, quality education that is independent, evidence based with no conflicts of interest provided by voluntary internationally recognised experts is apparently inadequate for the AJGP. 

Dr. Margolis may have deceptively used our Part 3 melanoma submission as a response to the Prof. Thompson letter rather than for the agreed and intended purpose; an invited Part 3 submission for publication in AJGP. It was never written or intended as a response. It was written as melanoma education for a GP audience, expanding on the original two manuscripts. In preparing this new manuscript, we considered aspects the unpublished Prof. Thompson concerns that might need clarification for Australian GPs. If this manuscript submission was not managed as an independent manuscript submitted for publication on its own merits, but rather used by AJGP in their secret investigation, we would regard same as misleading and deceptive conduct by Prof. Margolis and the AJGP team. 

Dr. Margolis now points GPs to a CGN guideline on SLNB that promotes unethical practice by failing to include a detailed discussion of non-surgical options to SLNB. This section encourages clinicians to provide inadequate surgical consent for SLNB. Prof. Margolis' actions have been reckless and potentially harmful to melanoma patients. He has failed in his key responsibilities as an Editor in Chief of a journal bound by COPE standards. 

Dr. Margolis makes the absurd suggestion that it is our team who have compromised the safety of melanoma patients. Indeed our publications could never be seen as anything other than protecting and improving the welfare of melanoma patients through truly independent scientific analysis. His further tenure with AJGP is unacceptable. How did the RACGP and AJGP get this so wrong?!

Dr. Margolis must stand down from his role with the AJGP journal pending a full external independent investigation. 

Australian melanoma patients deserve better!

We once again call on AJGP to immediately reinstate our two articles, publish a formal apology, and publish our final Part 3 update on melanoma.

Your ACCO Board:- 

  • Professor Anthony Dixon PhD MB BS MAOCD FACRRM. - ACCO Director of dermatology education. Anglesea, Victoria. 
  • Dr. Stuart Anderson. - ACCO Chair, Rural GP with extensive skin cancer training and experience, Maffra, Victoria
  • Dr. Alex Nirenberg. Dermatopathologist. ACCO Director of dermatopathology education, Melbourne, Victoria.
  • Professor Howard Steinman. Dermatologist, Mohs College Fellow, Associate Professor of Surgery, International Director of ACCO, Dallas, USA.

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