DS07: Missing melanomas in England during the COVID-19 pandemic: 2488 fewer melanoma diagnoses in 2020 than in 2019

Lena Ibrahim,¹ Zoe Venables,¹ Daniella Sousa Massri² and Nick Levell¹

¹Norfolk and Norwich University Hospitals NHS Foundation Trust and ²University of East Anglia, Norwich, UK

Malignant melanoma (MM) can have a high mortality if diagnosed late. Three waves of COVID-19 infection in 2020–21 led to periods of reduced healthcare provision in England. Although most cancer services were maintained, factors such as patient anxiety, staff and facility redeployment, and staff sickness delayed cancer diagnoses. We aimed to investigate the effect of the COVID-19 pandemic on MM diagnoses and stage at presentation in England. Analysis was undertaken between January 2019 and September 2021 using data from the Rapid Cancer Registration Dataset, developed by The National Disease Registration Service (https://www.cancerdata.nhs.uk/covid-19/rcrd). We report the crude incidence with 95% confidence intervals (CIs). Incidence rate ratios (IRRs) and P-values were derived using the Poisson exact method. The greatest impact on MM diagnoses occurred during the first wave. In April 2020, total diagnoses reduced to 70%: stage I to 72%, stage II to 74%, stage III and IV to 83% and unknown stage to 60% of baseline values in April 2019. After the second wave in December 2020, total and stage I MM were 93% and 91% of December 2019 values, respectively. After the third wave, total and stage I MM in February 2021 represented 91% and 96% of numbers in February 2019, respectively. In total, 13 786 cases of MM were diagnosed in 2019 vs. 11 298 in 2020. This was a shortfall of 2488 diagnoses, the majority being stage I (n = 1 475) and ‘unknown’ stage (n = 880). The crude incidence rate for diagnosed MM reduced between 2019 and 2020 from 24·49 (95% CI 24·09–24·9) to 19·98 per 100 000 person-years [PYs; 95% CI 19·61–20·35 (IRR 0·82, 95% CI 0·80–0·84; P < 0·001)]. Similarly, stage I MM diagnoses reduced from 11·66 (95% CI 11·38–11·95) to 9·00 PY [95% CI 8·80–9·25 (IRR 0·77, 95% CI 0·74–0·80; P < 0·001)] and ‘unknown’ stage diagnoses from 7·00 (95% CI 6·77–7·21) to 5·40 PY [95% CI 5·21–5·60 (IRR 0·77, 95% CI 0·74–0·81; P < 0·001)]. No statistically significant difference was found in stage II or stage III and IV MM. Owing to the nature of the rapid data collection and lack of registry quality assurance, results must be interpreted cautiously. COVID-19 significantly impacted MM diagnoses in England, with the greatest effect observed in stage I cases. Despite a later increase in MM incidence, there remains concern that there may still be many undiagnosed cases with unknown consequences.