The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre

McClean, Adam; Matteucci, Paolo; Totty, Joshua

doi:10.1016/j.bjps.2022.06.062

Cited by 4 publications

(9 citation statements)

References 4 publications

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“…Our results prove that there was a 40% reduction in cSCC diagnoses at our center, suggesting that patients' health-seeking behavior changed [24]. McClean et al also reported an overall reduction in SCC diagnoses of 28% in 2020 in their single-center study [25], confirming the phenomenon of reduced patient presentation due to the perceived risk of COVID-19 disease exposure.…”

Section: Discussionsupporting

confidence: 74%

“…The occurrence of metastasis associated with cSCC diagnoses is rare and the current study is underpowered for any observation of significant differences. However, a larger singlecenter, cross-sectional study (2019 vs. 2020) performed in the United Kingdom reported a significant increase in nodal and metastatic cSCC tumor stages following the initial wave of the COVID-19 pandemic [25]. This trend is concerning, as metastatic involvement in cSCC impacts both patient prognosis and the complexity of the patient pathway, requiring more aggressive, complex, and expensive therapies, which often lead to patient death (>70%) [35].…”

Section: Discussionmentioning

confidence: 99%

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Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches

Taccioli,

Blessent,

Paganelli

et al. 2024

Cancers

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Background: The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. Objective: To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018–2019) with the phase following the pandemic’s second wave (2021–2022). Methods: An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. Results: More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021–2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018–2019 and two in 2021–2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55–8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09–3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44–7.17, p = 0.004). Conclusions: Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches

Taccioli,

Blessent,

Paganelli

et al. 2024

Cancers

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“…Tejera-Vaquerizo et al also found that the number of patients in Spain treated for cSCC decreased by 44% during 2020 compared to the number of patients treated during 2019 (770 cases in 2019 and 429 cases in 2020) [40]. Similar results were obtained from the Netherlands, the USA, and the United Kingdom [28,[41][42][43]. Valenti et al proposed a causal relationship between the emergence of advanced skin tumors and the unavailability of dermoscopy, as well as regular follow-ups of previously diagnosed patients [35].…”

Section: Discussionmentioning

confidence: 61%

COVID-19 and Cutaneous Squamous Cell Carcinoma—Impact of the Pandemic on Unequal Access to Healthcare

Jović

Marinković²,

Suđecki³

et al. 2023

Healthcare

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Most skin tumors are not fatal, but if not treated in a timely manner, they can lead to significant morbidity. Due to the COVID-19 pandemic and in order to create more capacities for the treatment of COVID-19-positive patients as well as to contain the spread of the virus, the healthcare system was reorganized worldwide, leading to decreased access to preventive screening programs. The aim of this study was to evaluate the impact of the pandemic on healthcare accessibility to cutaneous squamous cell carcinoma patients in Serbia. This retrospective study was conducted at the Clinic for Burns, Plastic, and Reconstructive Surgery, University Clinical Center of Serbia in Belgrade. Patient demographics and pathohistological findings of tumors of patients living in and outside the capital in the period before, during, and after the pandemic were compared. The two groups did not show any differences regarding the largest tumor diameter prior and during the pandemic; however, this difference became extremely noticeable after the pandemic (15 mm vs. 27 mm; p < 0.001). While cSCCs are commonly slow-growing tumors, the impact of the COVID-19 pandemic is not negligible. This study found a population at a significant risk of cSCC metastasis, with additional evidence likely to emerge in the upcoming years.

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“…Existing literature suggests that melanoma overall staging and histological prognostic features have worsened since the beginning of the COVID-19 pandemic [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. For instance, a four-year Romanian study (2018–2022) that did not report the use of a prioritization system showed higher Breslow thickness and more stage-III patients during the pandemic [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fu et al, 2023, have also reported worse short-term survival for Ontario melanoma patients during the pandemic in 2020 [9]. Several international studies have also shown that patients have presented with higher-stage melanoma since the start of the pandemic [10][11][12][13][14]; however, there is a scarcity of studies assessing wait times to melanoma surgery during the COVID-19 pandemic. No studies to date have explored the impact of the COVID-19 pandemic on melanoma surgical management, wait times, and staging in Canada.…”

Section: Introductionmentioning

confidence: 99%

Prioritizing Melanoma Surgeries to Prevent Wait Time Delays and Upstaging of Melanoma during the COVID-19 Pandemic

Aw,

Lau,

Nessim

2023

Current Oncology

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Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018–29 February 2020 (pre-pandemic) and 1 March 2020–22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22–48] pre-pandemic and 35 [24–49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes.

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The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre

Cited by 4 publications

References 4 publications

Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches

Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches

COVID-19 and Cutaneous Squamous Cell Carcinoma—Impact of the Pandemic on Unequal Access to Healthcare

Prioritizing Melanoma Surgeries to Prevent Wait Time Delays and Upstaging of Melanoma during the COVID-19 Pandemic

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