BOSTON — Too many melanoma cases went undiagnosed during the earlier stages of the COVID-19 pandemic and subsequently presented at later stages, according to a letter published in the Journal of the American Academy of Dermatology.1
Research led by Boston University School of Medicine and Brigham and Women’s Hospital, both in Boston, and including participation from the VA Palo Alto, CA, Health Care System collected retrospective cohort data at 12 academic centers nationwide with dedicated melanoma clinics.
The study team categorized melanoma cases as pre-COVID-19 (March 1, 2019-February 29, 2020) or COVID-19 (March 1, 2020-Feb. 28, 2021) based on biopsy dates. Sites enrolled the first 17 cases per month (204 cases per era), although occasionally fewer cases were collected due to patient volume.
Ultimately, the COVID-19 and pre-COVID-19 eras included 1834 and 2062 melanoma cases, respectively. Results indicated that, in the COVID-19 era, relative increases in patient-detected melanomas (54.0% vs. 47.8%; P < 0.001), nodular subtype (12.7% vs. 9.8%;P = 0.005), mean thickness (1.77 vs. 1.49 mm; P < 0.001), positive ulceration (20.0% vs. 15.4%;P <0.001) and mean mitotic rate (3.03 vs. 2.56 mitoses/mm2; P < 0.001) were identified compared to the pre-COVID-19 era.
Researchers reported that relative frequency of Stage I (67.6% vs. 72.7%;P = 0.001) melanoma was lower in the COVID-19 era but was higher for Stage II (18.3% vs. 14.8%; P = 0.006) and Stage IV (6.1% vs. 4.6%; P =0.045) melanomas.
They advised that a relatively lower proportion of Stage I melanomas were diagnosed during the COVID-19 pandemic for all months except for January 2020 vs. 2021. No difference between time from biopsy to wide local excision during the two eras was found.
After multivariable analysis, the following were found to be increased during the COVID-19 era:
- Odds of thickness >2.0-4.0 mm (adjusted odds ratio [aOR], 1.41; 95% CI, 1.07-1.86; P = 0.006),
- Odds of thickness >4.0 mm (aOR, 1.50; 95% CI, 1.10-2.04; P = 0.003),
- Ulceration (aOR, 1.40; 95% CI, 1.13-1.73; P <0.001),
- Mitoses >1/mm2 (aOR, 1.41; 95% CI, 1.17-1.71; P <0.001),
- Nodular sutype (aOR, 1.42; 95% CI, 1.06-1.89; P= 0.009), and
- Stage II melanoma (aOR, 1.37; 95% CI, 1.10-1.72, P = 0.002).
“In this nationwide multi-institutional study, we observed increased proportions of more advanced melanomas with aggressive features, similar to smaller cohort studies abroad and in the United States,” the researchers wrote. “Our findings, coupled with declining rates of new melanoma cases nationally, suggest that melanoma cases went undiagnosed during the COVID-19 pandemic and subsequently presented at later stages.”
They added, “As the proportion of internal diagnoses vs. referrals and time from biopsy to wide local excision remained stable in our study, it is unlikely that patients simply sought care elsewhere during the pandemic or that procedural delays caused the observed findings.”
- Trepanowski N, Chang MS, Zhou G, Ahmad M, et. al. Delays in melanoma presentation during the COVID-19 pandemic: A nationwide, multi-institutional cohort study. J Am Acad Dermatol. 2022 Jun 20:S0190-9622(22)01023-4. doi: 10.1016/j.jaad.2022.06.031. Epub ahead of print. PMID: 35738513; PMCID: PMC9212700.