There is a particular kind of knowledge that comes only from proximity. It comes from living at a latitude that delivers ultraviolet radiation in quantities that pale-skinned settlers were never evolved to absorb, from growing up in a culture that treated sun-bronzed skin as a mark of health and vitality, from watching fathers and grandfathers have lesions cut from their faces with a casualness that disguised the underlying danger. Queensland, more than any other place on earth, has accumulated that knowledge the hard way.

Australia and New Zealand have the highest rates of melanoma in the world, with Queensland the highest of all. That distinction is not a statistical curiosity. It shapes hospital admissions, shapes family histories, shapes the research agenda of every medical institution in the state. And for eight decades, no institution has taken that agenda more seriously — or prosecuted it more rigorously — than QIMR Berghofer Medical Research Institute, sitting in the Herston health precinct on Brisbane’s inner north, a few hundred metres from the hospital wards where melanoma patients receive their diagnoses.

QIMR Berghofer has devoted sustained effort to melanoma — one of the country’s most deadly, costly, and common cancers, claiming more lives each year than the national road toll. The comparison to the road toll is not rhetorical flourish. Melanoma deaths in Australia exceed the road toll — 1,384 versus 1,113 expected in 2020 — yet road safety funding dramatically exceeds melanoma awareness and prevention funding. That disproportion speaks to something durable and slightly perverse in the national psyche: the dangers of speed are visible and acute, while the danger of sunlight accumulates silently over decades.

The research programme at QIMR Berghofer represents Queensland’s most sustained institutional response to that disproportion. It spans population epidemiology, molecular genetics, genomics, clinical translation, and health economics. Its findings have informed public health policy, changed clinical practice, and opened new lines of inquiry that are now pursued by research groups on multiple continents. qimr.queensland serves as the permanent onchain civic address anchoring that institutional identity — a recognition that the work done here belongs not only to scientific literature but to the identity of Queensland itself.

THE SCALE OF THE PROBLEM.

Understanding what QIMR Berghofer’s melanoma work means requires first understanding the scale of the burden it addresses. In 2021, there were 15,034 new cases of melanoma diagnosed in Australia. By 2025, that figure is estimated to rise to 17,443 new cases. In 2023, there were 1,527 deaths from melanoma in Australia. In 2025, an estimated 1,455 deaths are projected. The slight projected decline in mortality reflects, at least in part, the impact of new immunotherapy treatments and the slow harvest of decades of prevention campaigns — both of which have QIMR Berghofer’s fingerprints on them.

Skin cancers, including melanoma, are one of the largest public health concerns in Australia, with two-thirds of Australians receiving a skin cancer diagnosis of some type in their lifetime. For melanoma specifically, it is estimated that 1 in 21 Australian women and 1 in 14 Australian men will be diagnosed with melanoma by the time they reach the age of 85. Those are extraordinary numbers. In most populations, cancer at those prevalence levels would prompt the kind of national screening infrastructure already deployed for bowel, breast, and cervical cancers. That melanoma does not yet have an equivalent national screening programme is one of the animating frustrations driving much of the work currently underway at QIMR Berghofer and its collaborating institutions.

A study by researchers from QIMR Berghofer has calculated the economic impact of melanoma on the nation’s healthcare system, with the cost increasing from approximately $30 million in 2001 to $201 million in 2017. More recently, QIMR Berghofer health economists have estimated the direct costs of treating melanoma via the Australian health system at more than $272 million per year and growing. Queensland has the highest rate of melanoma in the country, with treatment estimated to cost the state’s health system tens of millions of dollars annually. These costs do not include the indirect burden — the lost productivity, the carer impact, the psychological toll on patients and families. They represent only what the health system actually spends on diagnosis, surgery, pharmaceutical treatment, and follow-up care.

FOUR DECADES OF SCIENTIFIC COMMITMENT.

QIMR Berghofer has been researching melanoma for over 40 years, and during this time its scientists have provided scientific evidence to support primary prevention, policy and education. The institute’s engagement with skin cancer predates most of the major scientific advances in the field — predates BRAF mutation discovery, predates immunotherapy, predates the genomic era entirely. It began with the epidemiological observation that Queensland’s population had an unusual and alarming relationship with the sun, and that the consequences of that relationship were showing up in cancer registries at rates that demanded explanation.

During the 1960s, QIMR Berghofer established an oncology section to investigate cancer-causing viruses — a move that would eventually position the institute to engage with melanoma biology as the field matured. By the 1990s, the Cancer Research Centre at QIMR was conducting what its history records describe as a world-first human trial of a gene therapy for melanoma, which successfully demonstrated immune response in the body. That early experiment in what we now recognise as immunotherapy positioned the institute at the frontier of a paradigm that has since transformed melanoma treatment globally.

The accumulated scientific output is vast. Publications in Nature Genetics, the Journal of Investigative Dermatology, JAMA Dermatology, the British Journal of Dermatology, Cancer Cell, and dozens of other high-impact journals bear the Herston address. Citations run into the tens of thousands. QIMR Berghofer researchers have played key roles in the Australian International Cancer Genome Consortia projects and the Australian Melanoma Genome Project, publishing work in high-impact journals including Nature, Cancer Cell, Nature Communications and Nature Reviews in Clinical Oncology, with that work receiving more than 30,000 citations.

THE GENETICS OF SUSCEPTIBILITY.

One of the institute’s most sustained and consequential lines of melanoma research has focused on genetics — specifically, on why some people and some families face dramatically elevated risk of developing the disease. The Oncogenomics Laboratory’s principal focus is on the molecular genetics of melanoma, a topic it has researched for more than 35 years. The aim is to identify melanoma susceptibility genes and study the way in which defects, or variants, in these genes are associated with melanoma predisposition or development, with improved understanding potentially leading to better ways of diagnosing or treating these cancers.

Research in this laboratory is centred on several closely related themes, including the identification of high-penetrance germline mutations conferring susceptibility in families with multiple cases of melanoma. To address this aim, researchers have recruited more than 500 multiple-case melanoma families and have been systematically sequencing the exomes or genomes of affected family members to identify DNA variants that segregate with melanoma in each family. This is painstaking work, requiring the coordination of clinical recruitment, biobanking, genomic sequencing, and bioinformatic analysis across a cohort that spans multiple generations of affected families. The payoff — the identification of specific gene variants that substantially elevate risk — is not merely academic. It opens the possibility of identifying at-risk individuals before disease develops.

The Oncogenomics Group has played key roles in the identification of CDK4, MITF, POT1, ACD and TERF2IP as familial melanoma susceptibility genes. Each of these identifications represents a piece of the puzzle: a specific biological mechanism through which the risk of melanoma is inherited and amplified. Researchers have also identified two new gene faults that dramatically increase the risk of melanoma, findings that extend the map of genetic susceptibility and point toward the possibility of targeted prevention for high-risk individuals.

The Oncogenomics team has contributed to the understanding of key somatic mutations that drive melanocytic neoplasia, including roles in the seminal findings of BRAF mutations in naevi, and novel driver mutations in cutaneous, acral, mucosal and uveal melanoma. The BRAF mutation story is one of the pivotal chapters in modern oncology — the discovery that a specific genetic alteration drives a large proportion of melanomas opened the door to targeted therapies that have saved thousands of lives. QIMR Berghofer’s contribution to that story, and to subsequent work characterising the genomic landscape of melanoma subtypes, has been substantial.

READING THE GENOME OF A TUMOUR.

Alongside the work on inherited susceptibility, a parallel research programme at QIMR Berghofer has focused on the somatic mutations present in melanoma tumours themselves — the genomic changes that drive cancer development and determine how tumours will respond to treatment. Led by Dr Nic Waddell, the Medical Genomics laboratory uses next-generation genetic sequencing to understand how melanomas develop and how the immune system responds, with the aim of shortening the pathway to personalised medicine to improve the diagnosis, management, and treatment of melanoma patients.

The Medical Genomics team works on a variety of tumour types to gain a better understanding of disease biology, drug responses and to identify novel therapeutic strategies. Using whole-genome, RNA sequencing and methylation technologies allows the study of disease heterogeneity and identification of genomic signatures that can be used as biomarkers of treatment response. The tumour types studied include melanoma, oesophageal cancer, breast cancer, ovarian cancer, mesothelioma and lung cancer.

This work sits at the intersection of genomics and clinical practice, and its implications for melanoma treatment are significant. The central challenge in treating advanced melanoma is not the absence of effective therapies — immunotherapy and targeted therapy have transformed outcomes for many patients — but the unpredictability of treatment response. Many patients do not respond to existing treatments for BRAF-mutated melanoma. While targeted therapies and immunotherapy have improved outcomes, ongoing issues with drug toxicity and resistance hinder their overall success. Understanding, at a genomic level, which tumours will respond to which treatments — and why — is one of the central problems that QIMR Berghofer’s genomics work is designed to address.

In early 2025, researchers from the institute’s Cancer Program published preprint work applying machine learning to the identification of molecular features predictive of immunotherapy response in melanoma and other cancers — working to address the limitations of established biomarkers such as tumour mutation burden and PD-L1 expression, which have shown limitations in accurately categorising treatment responders versus non-responders. Because immunotherapy response is shaped by complex cancer-intrinsic and extrinsic features within the tumour microenvironment, using a single biomarker to predict response is insufficient.

THE QSKIN STUDY: A POPULATION IN THE LABORATORY.

One of QIMR Berghofer’s most ambitious and enduring contributions to melanoma research is the QSkin Sun and Health Study — a longitudinal cohort study of the Queensland population that has generated some of the most detailed epidemiological data on skin cancer risk ever assembled. QSkin, described as the largest research study ever conducted on skin cancer, involves more than 45,000 Australians.

In 2010–11, a random sample of 193,344 men and women aged 40–69 years and resident in Queensland were identified from the compulsory electoral register and invited to participate; 43,794 agreed and completed the baseline survey. The study captures a remarkable depth of information: demographic data, phenotypic characteristics, sun exposure history, sun protection behaviours, past skin cancer treatments, and general medical history. Participants have been followed over time, with cancer registry linkage allowing researchers to track who develops melanoma and when.

The scientific productivity of QSkin has been extraordinary. Publications from the cohort have appeared in major journals across oncology, dermatology, epidemiology, and health economics. The study has been used to validate and develop melanoma risk prediction models, to examine the relationship between phenotypic characteristics and site-specific melanoma risk, and to investigate factors from smoking to hormonal status and their association with skin cancer outcomes.

QIMR Berghofer researchers have identified a dramatic rise in so-called pre-cancerous melanomas being treated in Australia, and have found strong evidence that similar trends are emerging across the globe. That finding has direct implications for clinical practice and health economics: if the number of lesions being treated is rising faster than the underlying incidence of invasive melanoma, there are questions to be asked about diagnostic thresholds and the potential for overtreatment. These are not comfortable questions, but they are necessary ones, and the quality of QSkin data allows them to be asked with scientific rigour.

FROM POPULATION RISK TO INDIVIDUAL PREDICTION.

QIMR Berghofer has developed a next-generation melanoma risk prediction calculator, built using a decade of data from more than 40,000 participants in the landmark QSkin Study. The original tool, first launched several years ago, has undergone a major upgrade to now include 16 self-reported factors, such as age, skin type, hair colour and sunspot history. Developed in collaboration with the QUT VISER team, it also accounts for regional differences in melanoma risk due to Australia’s diverse UV exposure levels.

This kind of risk calculator represents a bridge between population-level science and individual clinical decision-making. Tools such as the QIMR Berghofer Melanoma Risk Calculator are key resources in current discussions about whether Australia needs a targeted national melanoma screening programme, aligning with control strategies for other common cancers like cervical, breast, bowel and lung cancer. Cutaneous melanoma is highly treatable when detected early. However, population-wide skin screening of everybody is not currently recommended due to concerns around over-diagnosis and a lack of evidence that it reduces mortality.

The next frontier is the integration of genetic data into risk prediction. QIMR Berghofer researchers have secured Medical Research Futures Fund Genomics Health Futures funding to investigate whether personalised genetic risk information can improve skin cancer screening outcomes, bringing together leading experts in genomics, population health, and skin cancer research from QIMR Berghofer, The University of Queensland, the University of Sydney, and the Frazer Institute. The trial will investigate whether informing individuals of their genetically-based risk for developing melanoma can motivate adherence to screening best practices, with the goal of determining whether risk-tailored screening protocols can minimise unnecessary interventions and costs.

Research conducted through QSkin has quantified the scale of the behavioural challenge: nearly half of all Queensland adults and children are still getting sunburnt every year, and only one in five adults uses sun protection strategies when outside in summer. Those figures come from a state that has been running public sun protection campaigns since the 1980s. They speak to the limits of awareness campaigns alone, and to why the integration of personalised risk information into clinical and community practice may matter so much.

UNUSUAL SCIENCE: FROM OCTOPUS VENOM TO TARGETED TREATMENT.

Alongside the population studies and genomic programmes, QIMR Berghofer’s melanoma research occasionally produces findings that confound expectation. One striking example involves the venom of an Australian octopus. Researchers were surprised to discover that an octopus venom peptide selectively reduced the proliferation of melanoma cells and prevented tumour progression, while having little effect on healthy cells. While much more research is needed, the study showed this octopus venom compound has strong therapeutic potential, with its lack of toxicity offering hope that the compound may one day be used in combination with immunotherapy and other treatments to attack the cancer in a different way — potentially helping to tackle drug resistance and give any treatment greater effect.

It would be a mistake to read this as eccentric or peripheral. The history of pharmaceutical development is full of biologically active compounds discovered in unexpected natural sources, and melanoma’s documented tendency to develop resistance to existing targeted therapies makes the search for alternative mechanisms of action genuinely urgent. What makes QIMR Berghofer’s research culture distinctive is precisely this willingness to pursue biological questions wherever they lead — from family genetics to population cohorts to the biochemistry of marine life — in the service of a single clinical problem.

THE PREVENTION DIVIDEND AND ITS LIMITS.

One of the more nuanced stories in Queensland melanoma research concerns what prevention campaigns have and have not achieved. The melanoma incidence rate has recently plateaued in Australia, though trends differ by age group; it rose steeply in older people but steadily fell among younger Australians during 1997–2016. Public health practitioners view these changes as evidence of the success of campaigns that commenced decades ago. Incidence in Australia was found to be declining in the 20–44 age bracket and stable in the 45–64 age bracket, with the comparatively promising incidence trends attributed to prevention programmes, effective control of UV exposure and an increased use in high-quality sunscreens.

This is real progress, and much of the scientific evidence underpinning it was generated by QIMR Berghofer researchers — particularly through the QSkin cohort and associated epidemiological work. In 2017–2021, individuals diagnosed with melanoma had a 94% chance of surviving for five years compared to their counterparts in the general population, up from 88% in 1987–1991. That improvement reflects better detection, better surgical practice, and — from roughly 2011 onwards — the arrival of effective systemic therapies.

But while the study details favourable trends for Australia, the actual values of melanoma incidence and mortality rates in Australia remain some of the highest in the world. The gains are real but incomplete. Older Australians — those who grew up before the Slip Slop Slap campaign of the 1980s reached saturation, those who spent working lives outdoors without systematic protection — continue to drive incidence and mortality numbers that keep Queensland’s melanoma burden among the heaviest anywhere. Research published by QIMR Berghofer’s Professor David Whiteman found that, in terms of total numbers, more people die from thin melanomas — those less than one millimetre thick — than thick melanomas, examining Queensland Cancer Registry data from more than 4,000 melanoma deaths over two decades. The implication is important: even early-stage disease, in sufficient volume, generates a significant death toll, and vigilance cannot be relaxed simply because a melanoma appears small.

AN INSTITUTIONAL ADDRESS FOR ONGOING SCIENCE.

The work described in this essay is not finished. It is not close to finished. Queensland’s melanoma problem will not be resolved by a single discovery or a single intervention; it is the product of geography, demography, culture, and biology in combination, and addressing it requires sustained scientific effort across all of those dimensions simultaneously. That is precisely the kind of work that requires permanent institutional infrastructure — dedicated laboratories, long-running cohorts, accumulated expertise, the capacity to train successive generations of researchers.

QIMR Berghofer has provided that infrastructure for eight decades. Marking its 80th anniversary in 2025, the institute has made a significant contribution to the world-renowned reputation of Queensland-based research and continues to make a real impact on the future of health. The melanoma programme sits at the centre of that contribution — not as the only thing QIMR Berghofer does, but as the clearest expression of the relationship between this institution and the place it serves. Queensland generated the problem; Queensland built the institution to address it; the institution’s work has benefited populations far beyond Queensland’s borders.

As civic and scientific infrastructure increasingly requires stable digital identities — identities that persist across platforms, across funding cycles, across decades — the onchain namespace qimr.queensland anchors that institutional permanence to the state’s own identity layer. It is a fitting address for science that has always been inseparable from the geography of the place where it is conducted: the relentless Queensland sun, the fair-skinned communities that settled beneath it, and the researchers at Herston who have spent forty years trying to understand, and ultimately undo, the harm that results.