Effects of COVID-19 Lockdown on Melanoma Diagnosis in Switzerland: Increased Tumor Thickness in Elderly Females and Shift towards Stage IV Melanoma during Lockdown

Abstract

At the early stages of the COVID-19 outbreak in 2020, Switzerland was among the countries with the highest number of SARS-CoV2-infections per capita in the world. Lockdowns had a remarkable impact on primary care access and resulted in postponed cancer screenings. The aim of this study was to investigate the effects of the COVID-19 lockdown on the diagnosis of melanomas and stage of melanomas at diagnosis. In this retrospective, exploratory cohort study, 1240 patients with a new diagnosis of melanoma were analyzed at five tertiary care hospitals in German-speaking Switzerland over a period of two years and three months. We compared the pre-lockdown (01/FEB/19–15/MAR/20, n = 655) with the lockdown (16/MAR/20–22/JUN/20, n = 148) and post-lockdown period (23/JUN/20–30/APR/21, n = 437) by evaluating patients’ demographics and prognostic features using Breslow thickness, ulceration, subtype, and stages. We observed a short-term, two-week rise in melanoma diagnoses after the major lift of social lockdown restrictions. The difference of mean Breslow thicknesses was significantly greater in older females during the lockdown compared to the pre-lockdown (1.9 ± 1.3 mm, p = 0.03) and post-lockdown period (1.9 ± 1.3 mm, p = 0.048). Thickness increase was driven by nodular melanomas (2.9 ± 1.3 mm, p = 0.0021; resp. 2.6 ± 1.3 mm, p = 0.008). A proportional rise of advanced melanomas was observed during lockdown (p = 0.047). The findings provide clinically relevant insights into lockdown-related gender- and age-dependent effects on melanoma diagnosis. Our data highlight a stable course in new melanomas with a lower-than-expected increase in the post-lockdown period. The lockdown period led to a greater thickness in elderly women driven by nodular melanomas and a proportional shift towards stage IV melanoma. We intend to raise awareness for individual cancer care in future pandemic management strategies.

Impact of the COVID-19 epidemic on cancer burden and cancer care in Slovenia: a follow-up study

“…Delays in diagnosis can lead to a higher proportion of cancers being detected at higher stages, which could result in worse outcomes (worse prognosis, poorer quality of life and, in some cases, earlier death) as shown in an Italian study of lung cancer patients 43 or the Swiss study on malignant melanoma. 6 Our results show, that at least at the IOL, the stage distribution of patients first seen for diagnostics or treatment has not significantly changed in comparison to the pre-epidemic period 2015−2019. However, there were significantly fewer patients first seen at the IOL in 2020 and 2021 at almost all ages except the oldest group (80+), but most pronounced for ages 50−64 years, and in 2020 fewer were seen for cancer progression or relapse.…”

“…[1][2][3][4][5] Although healthcare services for serious conditions, such as cancer, were mostly exempt from restriction measures, nevertheless, they were affected by the COVID-19 pandemic. [6][7][8][9][10][11][12][13][14][15][16] As previously reported for Slovenia 17 , a middle European country with a universal health care system, in the first wave of COVID-19 containment measures (from March 2020 until May 2020) there was a decrease of over 30% in the number of new cancer diagnoses, 30% in referrals to cancer care (33% for first appointments, 46% for follow-up appointments and 85% for genetic testing and counselling), 20% in the number of outpatients appointments at the Institute of Oncology Ljubljana (IOL) and 40% in the number of diagnostic imaging performed, despite the fact that provision of oncology services was included among exemptions to healthcare-related restriction measures and was thus not directly scaled-down.…”

A Meta-Analysis on the Impact of the COVID-19 Pandemic on Cutaneous Melanoma Diagnosis in Europe

“…The study selection process is summarized in Figure 1 . From a total of 466 records, 25 studies were incorporated in our data analysis models [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Impact of the COVID-19 Pandemic on Melanoma Diagnosis: Increased Breslow Thickness in Primary Melanomas—A Single Center Experience

“…Contrary to these results, some authors, such as Kostner et al, have described an unchanged or even increased number of visits during and post-lockdown. This can be influenced by state regulations, restriction levels as well as the healthcare resource capacities of different regions [ 35 ]. Schauer et al reported an increase in early-stage melanoma diagnoses during the lockdown period, which can be explained by the fact that screening programs were still available despite the government restrictions [ 58 ].…”

“…Since the beginning of the pandemic, several studies have reported a significant reduction in melanoma patient diagnoses [ 27 , 28 , 29 ]. In addition, it was reported that newly discovered melanomas were thicker during the pandemic period in comparison to the prepandemic era [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Moreover, a study by Lallas et al reported a significantly higher-than-expected percentage of newly diagnosed melanomas in stages IIc, III, and IV after the 2020 lockdown when compared to previous years [ 38 ].…”