Skin cancer and COVID-19: was the diagnosis safeguarded by teledermatology? a study on 1229 cases.

Editor

During COVID‐19 pandemic, dermatology practices are shifting to teledermatology (TD). , The objective of our study is to assess the effect of the first vs second COVID‐19 waves on skin cancer (SC) requests via TD.

The study was conducted in a dermatology department, characterized by a store‐and‐forward TD between health care professionals (HCPs) and dermatologists. All TD requests during the first (March and April 2020) and second (October and November 2020) COVID‐19 waves in France were retrieved and compared with the corresponding period in 2019. Collected data included the provenance and diagnoses of patients. The provenance was divided into institutions [long‐term care facilities (LTCF) and hospitals] and non‐institutions (private physician clinics). Diagnoses of patients were divided into SC, inflammatory dermatoses, infectious dermatoses, cutaneous drug adverse reactions and ‘other’ diagnoses. The proportions of these diagnoses during both COVID waves in 2020 were compared with the corresponding months in 2019. For SC diagnoses, institution and non‐institutions requests during both waves were also compared with the same period in 2019.

First wave (March and April 2020 vs 2019): The total number of requests was 583 in 2019 vs. 629 in 2020. Skin diagnoses are represented in Fig. 1. In ‘other’ diagnoses, 32.1% of these diagnoses (55/171) were COVID‐19‐related cutaneous lesions, mostly chilblains (70.9%). Regarding SC, the comparison of institution requests and non‐institutions requests in 2020 vs 2019 is represented in Fig. 2.

Figure 1

Skin diagnoses in teledermatology requests during both COVID‐19 waves in 2020 vs 2019. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 2

Skin cancer cases among teledermatology (TD) total requests, institution requests and non‐institution requests during both COVID‐19 waves in 2020 vs 2019. [Colour figure can be viewed at wileyonlinelibrary.com]

Second wave (October and November 2020 vs 2019): (Figs 1 and 2).

The total number of requests was 547 in 2019 vs. 600 in 2020. In ‘other diagnoses’, 11.4% of these diagnoses (10/87) were COVID‐19‐related cutaneous lesions.

In total, during the first wave, there was significantly fewer concern in skin cancer and more concern in ‘other’ skin diagnoses, which included COVID‐19‐related cutaneous signs. Both institutions and non‐institution requests for SC significantly decreased. During the 2nd wave, there was no significant difference in any type of skin diagnosis.

During the first pandemic wave, LTCF physicians seemed more concerned about COVID‐19 than other health issues. This is because outbreaks of infection developed rapidly in LTCF and elderly are more vulnerable to infections and at a higher mortality risk. Since confinement was essential for COVID‐19 control and public health endorsed social distancing, less patients consulted their general physicians (GPs). Moreover, physicians cancelled consultations to avoid virus transmission.

During the first wave, there was a decrease in overall in‐person oncology referrals. Unexpectedly, even though access to TD expertise was possible, there was also a decrease in SC requests. The delay in SC diagnosis was manifested by an increase in Breslow thickness in primary melanomas seen after the first COVID‐19 lockdown.

Shortly after the first pandemic, all health care professionals were urged to shift their activity to telemedicine, which has become a cornerstone for continuity of care. , Consultations were less likely to be cancelled. Moreover, a balance was made between medical attention to COVID patients and regular attention to other patients. Contrary to the persistence of a general decline in skin cancer diagnoses during the second wave, , , SC diagnosis through TD showed no decrease compared to 2019.

Since TD has already shown efficacy in diagnosis and management of SC, , it is important for physicians to scale the use of TD in order to prevent unnecessary in‐person visits and help schedule specific appointments for vulnerable patients. Prompting doctors to use TD for SC diagnosis and SC pathway organization would prevent increased morbidity, mortality and health care costs.

Funding sources

None.

Conflicts of interest

None declared.

IRB status

approved, IRB number 00011558.