Camila Scharf1, Gabriella Brancaccio2, Alessandro Di Stefani3, Maria Concetta Fargnoli4, Harald Kittler5, Athanassios Kyrgidis6, Aimilios Lallas7, Caterina Longo8, Josep Malvehy9, Elvira Moscarella2, Ketty Peris3, Simonetta Piana10, Susana Puig9, Luc Thomas11, Giuseppe Argenziano2. 1. Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy. Electronic address: kmischarf@gmail.com. 2. Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy. 3. Dermatologia, Università Cattolica e Fondazione Policlinico A. Gemelli-IRCCS, Rome, Italy. 4. Dermatologia, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy. 5. Department of Dermatology, Medical University of Vienna, Austria. 6. Department of Oral & Maxillofacial Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "George Papanikolaou," Greece. 7. First Department of Dermatology, Medical School, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece. 8. Department of Dermatology, University of Modena and Reggio Emilia, Italy; Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Italy. 9. Melanoma Unit, Dermatology Department, Hospital Clinic, University of Barcelona, Spain. 10. Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy. 11. Centre Hospitalier Lyon Sud, France; Lyons France, Lyon 1 University, France; Lyons France and Lyons Cancer research center UMR INSERM U1052 - CNRS5286 - UCBL1, France.
To the Editor: After the COVID-19 pandemic, a drop was observed in all cancer screening visits, including those for melanoma because even with the growth of telemedicine, remote melanoma screenings are challenging. The purpose of this study was to evaluate how the COVID-19 pandemic restrictions affected melanoma diagnosis. In this multicenter, retrospective, cross-sectional study, we reviewed histopathologic reports performed 1 year before and 1 year after the beginning of lockdowns in 6 European referral centers and compared the number of and histologic features of melanomas diagnosed in each period. The data collected included patients’ sex and age, melanoma anatomical location, date of diagnosis, invasion thickness, presence of ulceration, sentinel lymph node status, and stage according to the American Joint Committee on Cancer 8th TNM. Differences between groups were tested using nonparametric tests; χ2 test for categorical variables and Wald-Wolfowitz test for continuous variables. All tests were 2-sided, and statistical significance was set at P < .05.In the prelockdown period, 2311 melanomas were diagnosed, of which 1425 (61.7%) were invasive with a mean invasion thickness of 1.7 mm (95% CI, 1.58-1.85; P < .001). In the postlockdown period, 1722 melanomas were diagnosed, of which 1065 (60.1%) were invasive, with a mean invasion thickness of 2.0 mm (95% CI, 1.86-2.21; P < .001). In the postlockdown period, the total number of melanomas that were diagnosed decreased by 25.5% and the mean invasion thickness increased by 0.3 mm (P < .001). In addition, there was a significant decrease in in situ and stage I melanomas (−3.8%; 95% CI: −6.4% to −1.1%; P = .004) and a significant increase in stage II melanomas (+2.5%; 95% CI, 4.1%-4.6%; P = .016). A significant decrease was observed in the number of diagnoses performed monthly (Fig 1
) during the first few months of lockdown, which is similar to the finding reported in the studies published by Gisondi et al and Javor et al in Italy. An even higher reduction in the number of diagnoses performed monthly was observed in the studies by Koch et al and Lallas et al, in which the decrease in melanoma diagnosis was 31.2% and 36.4%, respectively.
Fig 1
Melanoma diagnosis per month in the prelockdown and postlockdown cohorts.
Melanoma diagnosis per month in the prelockdown and postlockdown cohorts.When analyzing the median invasion thickness in the prelockdown period, trends where highly stable—around 0.7 mm. However, in the postlockdown period, this number increased in the first months as soon as the restrictions were relieved, meaning that melanomas diagnosed in that period were of a higher thickness (Fig 2
). In situ melanomas, concomitantly, were less diagnosed in that period because those lesions are usually observed during routine visits and dermatoscopic controls, which were considerably diminished in that time.
Fig 2
Median invasion thickness of melanomas diagnosed per month in the prelockdown and postlockdown cohorts.
Median invasion thickness of melanomas diagnosed per month in the prelockdown and postlockdown cohorts.The main limitations of this study are that cause-effect relationships are difficult to assess from retrospective observational data and that the impact of confounding variables is unknown. We also did not include follow-up data regarding disease progression and prognosis, and because only 5 Europeans countries were included, it may not reflect the actual trends of different European countries.In conclusion, in our study, which was performed for a longer period than the time period of previous reports, the total number of new melanomas seen in the postlockdown period was 25.5% lower than that seen in the prelockdown period, with a slight but significant increase in the mean invasion thickness and the number of stage II melanomas.
Fig 1
Fig 2