DS26: COVID-19 and reduced detection of malignant melanoma in secondary dermatology services
C. Davies, S. Ogden, J. Newsham, A. Foulkes and A. Weidmann
Salford Royal Foundation Trust, Salford, UK
COVID-19 and the resulting national lockdown led to significant changes within secondary care dermatology services. We investigated the impact of the COVID-19 pandemic on the detection of malignant melanoma (MM) in our area. We undertook a retrospective review of patients diagnosed with MM [International Classification of Diseases (ICD) code 43] between the beginning of January 2016 and the end of January 2021 using the local skin cancer multidisciplinary team database covering our local Clinical Commissioning Group (CCG; population 291 500). The characteristics of these patients prior to the COVID-19 pandemic (51 months before April 2020) were compared with those during the COVID-19 pandemic (10 months from April 2020). Before the pandemic, 429 cases of MM were identified (annual age-standardized incidence 37·9/100 000). During COVID-19 (DCOVID), 60 cases of MM were identified (annual age-standardized incidence 27·5/100 000). Prior to COVID-19 (PCOVID), 55% of patients with MM were male and 45% were female (mean age 62·3 years). DCOVID 47% of patients with MM were male and 53% were female (mean age 68·0). The histological characteristics of the lesions were similar in both groups. The majority were superficial spreading invasive MM (PCOVID 70%; DCOVID 62%), with similar levels of nodular MM (PCOVID 11%; DCOVID 8%). Median staging level was pT1a (PCOVID 49%; DCOVID 47%) and mean Breslow thickness was also similar (PCOVID 1·30 mm; DCOVID 1·42 mm). Twenty-eight per cent of lesions in both groups were diagnosed as an incidental finding on full-skin examination rather than as the primary reason for referral. We found a marked reduction (29%) in the incidence of MM diagnosed in our local area coinciding with the outbreak of COVID-19 between April 2020 and January 2021. The rate of incidental MM diagnosis (28%) remained consistent across both cohorts and we are not aware of any non-COVID-19 factors locally that could account for the sudden reduction in cases. Factors associated with service provision change during the COVID-19 pandemic may explain these data, including diminished capacity and the use of remote consultation. Anxiety regarding hospital attendance and diminished access to general practitioners represent potential barriers to presentation for patients with skin lesions. As yet, the severity of MM at diagnosis does not appear to have been significantly affected, but the long-term implications remain to be seen, as patients with more advanced disease may become apparent with time. Patients with other forms of skin cancer may be similarly affected and considerable resources will be required to address the residual demand going forward.