The impact of the COVID-19 pandemic on new diagnoses of melanoma: a response to additional multi-institution and international reports

To the Editor: The COVID-19 pandemic caused significant delays in medical care internationally, resulting specifically in altered access to oncologic care, particularly among those patients diagnosed with melanoma.1Shannon A.B. Sharon C.E. Straker 3rd, R.J. et al.The impact of the COVID-19 pandemic on the presentation status of newly diagnosed melanoma: a single institution experience.J Am Acad Dermatol. 2021; 84: 1096-1098Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar We previously published in Shannon et al,1Shannon A.B. Sharon C.E. Straker 3rd, R.J. et al.The impact of the COVID-19 pandemic on the presentation status of newly diagnosed melanoma: a single institution experience.J Am Acad Dermatol. 2021; 84: 1096-1098Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar our institutional experience with the impact of the pandemic lockdown on presentation status of newly diagnosed cutaneous malignant melanoma. In our study, we demonstrated that surgical patients who presented during the COVID-19 era had an increased median tumor depth and proportion of pT3 and pT4 lesions (>50%). This increase in thicker lesions referred to our surgical oncology clinic suggested that there existed a delay in diagnosis due to restrictions imposed during the COVID-19 lockdown. Since this publication, there have been several other investigations into the impact of the COVID-19 pandemic lockdown on the presentation status of newly diagnosed cutaneous melanomas. Single-center and multiinstitutional studies have largely corroborated the finding that there was an increase in the mean Breslow thickness of melanomas diagnosed following COVID-19 pandemic lockdown restrictions.2McFeely O. Hollywood A. Stanciu M. O'Connell M. Paul L. Comment on “The impact of the COVID-19 pandemic on the presentation status of newly diagnosed melanoma: a single institution experience”.J Am Acad Dermatol. 2021; 85: e419-e420Abstract Full Text Full Text PDF Scopus (5) Google Scholar,3Scharf C. Brancaccio G. Di Stefani A. et al.The association between COVID-19 lockdowns and melanoma diagnosis and thickness: a multicenter retrospective study from Europe.J Am Acad Dermatol. 2022; 87: 648-649Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Additionally, Scarf et al3Scharf C. Brancaccio G. Di Stefani A. et al.The association between COVID-19 lockdowns and melanoma diagnosis and thickness: a multicenter retrospective study from Europe.J Am Acad Dermatol. 2022; 87: 648-649Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar noted that the overall number of melanomas seen by providers had decreased by 25% following lockdown precautions. These findings further support the idea that there appeared to be a delay in diagnosis of melanoma cases during the COVID-19 pandemic lockdown that subsequently resulted in more advanced presentation status of patient disease. More recently, Trepanowski et al4Trepanowski N. Chang M.S. Zhou G. et al.Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study.J Am Acad Dermatol. 2022; 87: 1217-1219Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar examined this question within a multi-institutional European study and demonstrated that the frequency of stage II and IV cutaneous melanoma presentations was significantly higher in the COVID-19 pandemic lockdown, despite there being no difference from the time of diagnosis to wide local excision. In addition to noting a significant increase in thicker Breslow depth lesions, this study noted more concerning features to be prevalent during the pandemic era.4Trepanowski N. Chang M.S. Zhou G. et al.Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study.J Am Acad Dermatol. 2022; 87: 1217-1219Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar In response to Trepanowski et al, Drumm et al5Drumm C. Griffin C. Van Baarsel S. et al.Response to Trepanowski et al.’s “Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study”.J Am Acad Dermatol. 2023; (forthcoming)Abstract Full Text PDF Google Scholar found a similar significant increase in median Breslow thickness as well as in the frequency of ulcerated lesions when comparing a pre- and intra-COVID-19 pandemic lockdown in a single institutional study in Ireland. These findings in conjunction with our previous findings in Shannon et al as well as the growing literature of institutions across Europe suggest that cutaneous malignant melanoma diagnoses have been significantly impacted by the lockdown restrictions resulting from COVID-19. Drumm et al's5Drumm C. Griffin C. Van Baarsel S. et al.Response to Trepanowski et al.’s “Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study”.J Am Acad Dermatol. 2023; (forthcoming)Abstract Full Text PDF Google Scholar findings that there was no significant change in melanoma presentation in 2021 as compared to 2020 raises a larger issue wherein the pandemic may have resulted in a more sustained negative impact on access to oncologic care. We agree with the comments of the previous authors that more longitudinal studies are necessary to assess if this negative impact is persistent long-term. The COVID-19 pandemic lockdown restrictions may be largely lifted globally, but the oncologic community continues to note the lasting impact of the pandemic on cancer diagnosis and care. Attention to this impact and increased vigilance to skin cancer surveillance is necessary for earlier diagnosis and for optimizing long-term outcomes of patients with melanoma. None disclosed. Response to Trepanowski et al’s “Delays in melanoma presentation during the COVID-19 pandemic: a nationwide multi-institutional cohort study”Journal of the American Academy of DermatologyPreviewThe COVID-19 pandemic has impacted skin cancer care globally, resulting in delayed diagnoses and potentially causing progression to more advanced tumor stages.1 We read with great interest the article by Trepanowski et al2 evaluating the impact of the pandemic on melanoma presentation. The authors reported a significant proportion of melanomas with aggressive features at diagnosis during the COVID-19 pandemic.2 We wish to add our experience of the effect of the pandemic on melanoma presentation, and additionally, to assess the ongoing impact in the postpandemic era. Full-Text PDF