The Epidemiology of Malignant Melanoma during the First Two Years of the COVID-19 Pandemic: A Systematic Review

Abstract

It is hypothesized that the COVID-19 pandemic had a major impact on the epidemiology of malignant melanoma owing to diminished screening, diagnostic, and treatment capacities, resulting in a more advanced stage at initial presentation. The goal of this study is to undertake a systematic analysis of all epidemiological and clinical data on the trends and patient outcomes with malignant melanoma during the ongoing pandemic. Records were identified from PubMed, Cochrane, and Web of Science, selecting a total of 39 articles, narrative reviews, and editorial letters, following the PRISMA guidelines. The vast majority of the studies were published in Europe (28/39), and North America (7/39). A total of 99,860 patients were analyzed during 2020 and 2021 of the COVID-19 pandemic, and it was observed that malignant melanoma TNM staging increased significantly compared to the pre-pandemic period. Before the pandemic, 25.88% of patients had TNM stage II or above, compared to 36.25% during 2020–2021. During the COVID-19 pandemic, the malignant melanoma Breslow depth index grew from 1.59 mm before 2020 to 1.86 mm in 2020 and 2021. Patients decreased by 19.58% in 2020 and 2021 compared to pre-pandemic numbers. The patient–loss ratio indicated lower screening activity and patient addressability to dermatology and plastic surgery departments with skin cancer concerns during the COVID-19 pandemic. This systematic study shows that the identification and management of malignant melanoma during the COVID-19 pandemic faced major challenges which should alert medical systems to the high number of patients with advanced disease stages who may need emergency treatment and become incurable.

The effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma 2 years after the pandemic in two Romanian counties

“…A systematic review carried out by Toma AO et al analyzing the epidemiology of melanoma 2 years after the COVID-19 pandemic found that the percentage of thick melanomas was higher during 2020–2021 then before the pandemic (36.25% vs 25.88%). They also found a decrease in the proportion of in situ melanoma diagnoses, reported by most of the studies included in the review ( 36 ).…”

Effects of COVID-19 Pandemic on the Diagnosis of Melanoma and Keratinocyte Carcinomas: a Systematic Review and Meta-analysis

“…Time of tumour progression is a well-known factor associated with worse prognostic outcomes ( 41 ). A delay in melanoma diagnosis is associated with reduced survival rates and an increased demand for more intricate and less cost-effective procedures, including selective sentinel lymph node biopsy, positron emission tomography, or systemic treatment ( 12 , 19 , 42 ). Similarly, KC with an extended evolution time may need more complex surgical techniques with higher complication rates, such as flaps or skin grafts, or even other treatments like adjuvant radiotherapy or systemic therapies, although the impact on survival may not be as pronounced ( 7 ).…”

Pathophysiology, Histopathology, and Differential Diagnostics of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma—An Update from the Pathologist’s Point of View

“…The study was based on an update of the Even though the treatment of NMSCs is currently based on surgical and oncological treatments and seems easily accessible by many patients, the COVID-19 pandemic had a very important role in the dermatological diagnostics, histopathological diagnostics, and treatment for these patients. This has resulted in more advanced stages, with less prevention, and a decrease in the quality of life of these patients, and is directly related to their satisfaction and outcome [66,67].…”