Our research plan focuses on translational projects that will enable better understanding of the immune mechanisms of skin cancer and inflammatory skin diseases, better ways to prevent and to treat these disorders, and better understanding of the impact of skin disease on quality of life. A key area of focus is on groups at extreme risk of skin cancer.

In 2023 the results of the RPA-led multicentre Phase 3 trial of nicotinamide (vitamin B3) for skin cancer chemoprevention in transplant recipients were published in the New England Journal of Medicine. Work using the novel technology of imaging mass cytometry is ongoing in keratinocyte cancers and melanomas arising in immune suppressed and immune competent individuals. Collaborations with The Charles Perkins Centre (CPC) and the RPAH Department of Tissue Pathology and Diagnostic Oncology have enabled this work to be undertaken with MPhil student Dr Catherine Zilberg supervised by Professor Damian, Associate Professor Ruta Guta (Tissue Pathology and Diagnostic Oncology) and Dr Angela Ferguson (CPC). 

Ongoing work in human oral squamous cell carcinoma is examining the role and nature of epithelial plasticity in cancer development and progression. We have established monoclonal cell lines from individual tumours and demonstrated that they interact with respect to cell growth and drug resistance. This suggests that a novel mechanism involving symbiosis between clones might promote tumour malignancy and resistance to therapy. 

Studies with the Sydney Melanoma Diagnostic Centre are assessing the utility of new ex-vivo confocal microscopy for ensuring clear surgical margins and enabling rapid diagnosis of skin cancers, and a Medical Research Futures Fund supported clinical trial of topical sirolimus to reduce skin cancer incidence in transplant patients will commence soon. 

Investigator initiated trials include intralesional triamcinolone for lower leg squamous cell carcinomas in elderly patients, and perioperative propranolol and celecoxib to modify the tumour microenvironment and reduce recurrence in patients with nodal and cutaneous metastatic melanoma.

Our Department's psoriasis research program continues with an evaluation of Drug survival of biologic treatments in patients with psoriasis. Investigators in this collaborative RPAH/Westmead project include Associate Professor Patricia Lowe, MPhil candidate Samantha Ting, Professor Pablo Fernandez Penas and Dr Annika Smith. The PSoHO study of adults with moderate to severe plaque psoriasis has completed recruitment. The PSoHO study, an international observational study of health outcomes in the biological treatment of moderate to severe plaque psoriasis has now completed recruitment. The main purpose of the study is to compare how effective different biologic therapies are at treating plaque psoriasis over time, and to gain a better understanding of how plaque psoriasis affects overall health and quality of life.

Our Research Team

Professor Diona Damian

Diona Damian is Professor of Dermatology at The University of Sydney, Clinical Academic in Dermatology at Royal Prince Alfred Hospital and Associate of the Melanoma Institute Australia. Her research over the past 27 years has focussed on the role of the skin's immune system in the causation, prevention and treatment of skin cancer. This work has been funded primarily by a range of Cancer Institute NSW, Cancer Council NSW and NHMRC Project Grants and Fellowships. Professor Damian's findings in the fields of skin cancer chemoprevention with nicotinamide (vitamin B3), the effects of UV radiation on the skin's immune responses and the use of topical immunotherapy with diphencyprone for metastatic melanoma have been translated into clinical practice in Australia and internationally.

Current research is examining skin cancer prevention in organ transplant recipients, and the immune microenvironment within skin cancers in transplant recipients and in people with normal immunity. Professor Damian and Drs Moreno, Lin and Ge are also working with the Sydney Melanoma Diagnostic Centre to assess the use of a new ex-vivo confocal microscope (first in Australia) that will let them examine the microscopic edges of skin cancers in clinic to check whether there are clear margins (microscopically controlled excision).

Clinical Associate Professor Guy Lyons

Clinical Associate Professor Guy Lyons' research group uses a combination of mathematical modelling and novel laboratory-based models to follow the fate of cells during carcinogenesis in the skin, eye and mouth. They have found that the location of stem cells for the cornea at its perimeter, together with the limited lifespan of the cells that they give rise to, causes a flux of cells towards the centre of the cornea, and that UV radiation increases this. Professor Lyons' group has also used models of oral carcinogenesis, together with advanced image analysis techniques, to examine the evolution of clones of cells during the development of squamous cell carcinomas of the tongue. The group have shown that tongue cells exposed to a chemical carcinogen used as a surrogate for tobacco evolve much faster than those from untreated tongues. Cell lines have been established from the tumours that arise so that the gene mutations that underlie malignant behaviour can be understood, and new strategies for treating oral cancer can be devised and tested.

The group has also been elucidating the mechanisms by which squamous cell carcinomas develop in the skin and other tissues. Collaboration with investigators at the University of NSW and the Save Sight Institute, have found that UV radiation has dramatic effects on the mechanisms by which cell proliferation is maintained in the cornea. In collaboration with investigators at the Garvan Institute and University of California, San Diego, they have developed novel fluorescent cell lines for study of squamous cell carcinoma, determined the mutations that they have and identified a key pathway that drives malignancy in them.

Clinical Associate Professor Patricia Lowe 

Clinical Associate Professor Patricia Lowe is a Senior Staff Specialist. Recent research has included the Clinical Trial AMAGINE-3 - A Phase 3 Study to Evaluate the Efficacy and Safety of Induction and Maintenance Regimens of Brodalumab Compared With Placebo and Ustekinumab in Subjects With Moderate to Severe Plaque Psoriasis. This international multi-centre clinical trial looked at the effect and safety of a novel biologic agent, Brodalumab, in the treatment of psoriasis, a common skin disease. This agent is an inhibitor of an interleukin-17 receptor (IL-17R) and is given as a subcutaneous injection. Additionally, the trial compared the efficacy of this agent to a currently PBS listed biologic agent of another class, Ustekinumab (an IL-12/23 inhibitor).