The impact of the COVID-19 pandemic on management of cutaneous malignancies in Australia

Abstract

Introduction: The Australian healthcare system, including its management of cutaneous malignancies, has faced unprecedented challenges due to the COVID-19 pandemic. This study aimed to quantify the impact of the first wave of the pandemic on the diagnosis and management of cutaneous malignancies in Australia. Methods: Monthly service data was extracted from the Australian Medicare Benefits Schedule database for all cutaneous biopsies, non-melanotic skin cancer (NMSC) excisions and melanoma excisions performed between January 2017 and December 2019. Holt-Winters exponential smoothing forecasting models were developed for total biopsies, NMSC excisions and melanoma excisions. These models were used to predict monthly data between January 2020 and June 2020 with a 95 per cent confidence interval (p < 0.05). Absolute and percentage residual differences (RDs) between actual and predicted excisions for this time period were calculated. Results: There were statistically significant reductions in total NMSC excisions in March 2020 (RD: −6,943, −13.0%), April 2020 (RD: −8,954, −12.2%), May 2020 (RD: −17,667, −20.9%) and June 2020 (RD: −5,152, −6.9%). There were statistically significant reductions in melanoma excisions in April 2020 (RD: –695, –11.1%), May 2020 (RD: −1,982, –28.7%) and June 2020 (RD: –973, –16.0%). Conclusions: There was a significant reduction in skin cancer excisions in Australia during the COVID-19 pandemic. This observed reduction in skin cancer surgery has significant public health implications, highlighting the need for improved surveillance, diagnosis and treatment capacity of cutaneous malignancies during the recovery phase of the pandemic.

Slice by slice: An Australian state‐by‐state analysis of Mohs micrographic surgery over 5 years

“…There may also have been a patient reluctance to seek medical attention for their skin cancers due to fears of burdening the healthcare system or being exposed to COVID-19. 14 These considerations are reflected in our model's findings for both VIC and NT. Overall, our model demonstrated a statistically significant lesser number of cases performed in VIC across 2020 and 2021, compared to predicted case numbers.…”

“…States with a higher coronavirus burden, specifically VIC and NSW, faced greater restrictions, including multiple lockdowns, remote learning and workplace closures 12 . However, despite skin cancer surgery generally being given high priority and thus being able to continue despite these restrictions, there was a reported decrease in patient presentations for skin cancer in NSW and VIC 13,14 . Certainly, residents of Melbourne and Sydney experienced high‐level restrictions during multiple lockdowns between March 2020 and October 2021, 12 with a plausible impact on access to MMS.…”

“…Certainly, residents of Melbourne and Sydney experienced high‐level restrictions during multiple lockdowns between March 2020 and October 2021, 12 with a plausible impact on access to MMS. There may also have been a patient reluctance to seek medical attention for their skin cancers due to fears of burdening the healthcare system or being exposed to COVID‐19 14 …”

“…The self‐reported number of cases and sessions performed by Mohs surgeons in different states may also reflect different waves of the pandemic. As noted above, restrictions were enforced at different times in each state, and patients themselves were variably affected due to travel restrictions and pandemic‐related health concerns 12–14 . The states with fewer restrictions showed greater and more consistent increases in MMS claims, self‐reported surgeon cases and sessions.…”

“…12 However, despite skin cancer surgery generally being given high priority and thus being able to continue despite these restrictions, there was a reported decrease in patient presentations for skin cancer in NSW and VIC. 13,14 Certainly, residents of Melbourne and Sydney experienced high-level restrictions during multiple lockdowns between March 2020 and October 2021, 12 with a plausible impact on access to MMS. There may also have been a patient reluctance to seek medical attention for their skin cancers due to fears of burdening the healthcare system or being exposed to COVID-19.…”