Effects of COVID-19 Lockdown on Tumour Burden of Melanoma and Cutaneous Squamous Cell Carcinoma

Abstract

There is little evidence regarding the impact of COVID-19 lockdown on skin tumour burden. The COVID-19 lockdown resulted in a reduction in surgery for melanoma and cutaneous squamous cell carcinoma and an increase in the proportion of tumours with a worse prognosis. The increase was due to patient-dependent factors; in particular, fear of SARS-CoV-2 infection. Therefore, health education programmes targeting the general population are needed to ensure the prompt treatment of patients with skin cancer. The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown inSpain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.

Impact of the COVID-19 Pandemic on Melanoma Diagnosis in Romania—Data from Two University Centers

“…Interestingly, melanoma thickness and the percentage of thick melanomas observed in our study both before and during the pandemic were higher than the ones reported by studies conducted in other countries [ 8 , 9 , 14 ]. Higher rates of advanced tumors and a lower survival were already reported in Central and Eastern Europe in previous studies [ 25 ]. Differences in the general educational status, reduced government expenditure on education and a lack of specific health education, resulting in a lower awareness among the general population and physicians, may at least partly explain the later diagnosis of advanced stages in our study.…”

Heterogeneity of reports about the impact of the COVID ‐19 pandemic on melanoma diagnosis

“…Reductions of new melanoma and/or cSCC diagnoses have also been observed in Spain 5 and Chile 6 . A large Canadian study showed a reduction of most cases of cancer during the COVID‐19 pandemic especially for melanoma and cervical, endocrinological and prostate cancers 7 .…”

Limited impact of COVID ‐19‐related diagnostic delay on cutaneous melanoma and squamous cell carcinoma tumour characteristics: a nationwide pathology registry analysis

“…Although reporting of skin cancer has fortunately increased again, the rebound is thought to be incomplete, but most data still require additional adjustment for changed population age distributions. [3][4][5][6][7][8][9] These nationwide reductions in skin cancer incidence offer a unique possibility to study the impact of diagnostic delay on skin cancer characteristics. Researchers have hypothesized that the delay of skin cancer diagnoses may have resulted in cases of skin cancer progressing to unfavourable cancer stages.…”