DP17: Impact of the COVID-19 pandemic on melanoma staging in a Scottish health board

Craig Johnstone,¹ Sarah Drummond,² Kirsty Stafford,³ Fiona Macdonald³ and Lucy Melly¹

¹Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK; ²Department of Dermatology, Glasgow Royal Infirmary, Glasgow, UK; and ³Department of Dermatology, Royal Alexandra Hospital, Paisley, UK

The COVID-19 pandemic forced changes to the way healthcare is accessed and delivered. The authors aimed to identify if the COVID-19 pandemic led to increased waiting times for the assessment and management of patients with melanoma and whether there was a trend towards presentation of melanoma at a higher stage during the COVID-19 pandemic vs. a 2019 cohort. All primary melanomas excised in secondary care within our health board between February and August in both 2019 and 2021 were identified using the laboratory booking-in codes and SNOMED T and M codes. This identified 216 melanomas in the 7-month period in 2019 and 198 in the same period in 2021. The clinical records and pathology reports of these patients were reviewed. In 2019, 43·1% of melanomas were referred as an urgent suspicion of cancer referral vs. 55·6% in 2021. The mean waiting time for clinic review was 11 days (2019) and 10 days (2021). Nineteen per cent of melanomas in 2019 were referred as urgent vs. 17·4% in 2021. There was an increase in mean waiting time for urgent referrals from 30 days (2019) to 45 days (2021). Twenty-four per cent of melanomas were referred routinely in 2019 vs. 14% in 2021, and mean waiting time increased from 50 (2019) to 86 days (2021). Thirteen per cent of melanomas were diagnosed in patients already under dermatology follow-up in 2019 vs. 12·4% in 2021. Eight per cent of melanomas in 2019 were diagnosed as an incidental finding vs. 7% in 2021. The mean time from review to excision of melanoma in 2019 was 18 days vs. 13 days in 2021. Forty-eight per cent of melanomas were excised at the initial clinic appointment in 2019 and 49% in 2021. Better prognosis pT1a melanomas accounted for 40% (2019) and 43% (2021). The proportion of melanomas diagnosed at stage pT1b and above was comparable between 2019 and 2021. Microsatellites were reported in 2·5% (2019) and 2·8% (2021). The increase in lymphovascular invasion from 2·5% (2019) to 5·6% (2021) may not be significant owing to the small number of cases. This audit was undertaken following a review of melanomas diagnosed in September 2020, which demonstrated a reduction in the proportion of pT1a melanomas at diagnosis vs. 2019. We have demonstrated that this trend has not continued in 2021, with no overall change in melanoma staging at diagnosis in 2021 vs. 2019.