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Background For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline. Methods Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: ''pre-pandemic'' from May 2019 to May 2020 and ''pandemic,'' after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables were recorded and analyzed. Results A total of 112 patients were identified: 51 patients from the ''pre-pandemic'' and 61 from the ''pandemic'' time period. The pandemic cohort more frequently presented with lesions greater than 1 mm thickness compared to pre-pandemic (68.8% v 49%, p = 0.033) and were found to have significantly more advanced T stage (p = 0.02) and overall stage disease (p = 0.022). Additionally, trends show that for pandemic patients more time passed from patient-reported lesion appearance/change to diagnostic biopsy (5.7 ± 2.0 v 7.1 ± 1.5 months, p = 0.581), but less time from biopsy to operation (42.9 ± 2.4 v 52.9 ± 5.0 days, p = 0.06). Conclusions ''Pandemic'' patients presented with thicker melanoma lesions and more advanced-stage disease. These results may portend a dangerous trend toward later stage at presentation, for melanoma and other cancers with rapid growth patterns, that will emerge as the prolonged effects of the pandemic continue to impact patients' presentation for medical care.

Background: Overall survival is directly correlated to melanoma thickness and definitive surgical excision. Spindle cell melanoma is a rare subtype of malignant melanoma and particularly difficult to diagnose. Identification of histopathological features and referral to specialists are essential. Case presentation: We describe the case of an 86-year-old male who presented to his family medicine physician with complaints of a large 40 mm mass on his right posterior trunk which was clinically diagnosed as a lipoma. This mass was subsequently removed in his family physician’s office as an office procedure. Less than eight months post-excision, the tumor had erupted through the incision site. At time of surgical oncologist evaluation, the tumor was pedunculated and measured 92 mm at its greatest diameter. This tumor was subsequently biopsied to reveal spindle cell melanoma with thickness of at least 22 mm. Wide local excision was performed with complete removal of the tumor with negative margins. Conclusion: Our report supports the importance of early and correct diagnosis of cutaneous melanoma which can often be mistaken for other cutaneous lesions, both benign and malignant. In these situations, it is important to obtain a tissue biopsy and consult with specialists in pathology and surgical oncology/dermatology to ensure timely, appropriate treatment.

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