DS26: The impact of COVID-19 on the rate of diagnosis of nonmelanoma skin cancer: a single-centre experience

Anna Wolinska, Gregg Murray, Stephanie Bowe, Sinead Collins and Cliona Feighery

Our Lady of Lourdes Hospital, Drogheda, Ireland

The COVID-19 pandemic has had a significant impact on the diagnosis of melanoma and nonmelanoma skin cancers (NMSCs). Previous studies have examined the impact of COVID-19 on the rates of skin cancer diagnoses throughout the first wave of the pandemic when nationwide lockdowns were imposed and nonemergency care suspended (Marson J, Maner B, Harding T et al. The magnitude of COVID-19’s effect on the timely management of melanoma and nonmelanoma skin cancers. J Am Acad Dermatol 2021; 84: 1100–3). This is the first study, to our knowledge, to compare the rates of diagnosis of NMSCs prior to the pandemic to rates of diagnosis following the easing of nationwide restrictions, the rollout of vaccination programmes, the re-establishment of access to primary care and the resumption of elective theatre lists. This was a retrospective, single-centre study. We examined the total number of patients who attended for skin biopsy or excision from January to December 2020 and 2021 and compared the rates of diagnoses of NMSCs throughout 2019. Patients were identified through departmental histology records. Exclusion criteria included those undergoing excision of a histology-proven lesion and those diagnosed with superficial basal cell carcinoma or squamous cell carcinoma in situ. The total number of patients attending for skin biopsy or excision decreased by 34% from 2019 to 2020 (576 vs. 368 patients) but recovered in 2021 (509 patients). Despite this, 25·1% (P = 0·047) fewer patients were diagnosed with NMSC in 2021 vs. 2019, which was a further decline from 15·9% (P = 0·275) in 2020. There was a 27·4% (P = 0·025) decrease in the total number of NMSC lesions diagnosed in 2021 vs. 2019, a further decline from a 12·2% (P = 0·413) decrease in 2020. Thirty-four per cent more patients were diagnosed with multiple NMSCs in 2019 than in 2021 (26 patients vs. 17 patients). Rates of diagnosis of squamous cell carcinoma vs. basal cell carcinoma were similar throughout all the years studied (range 24–27% vs. 72–75%) and there was no significant difference in age at diagnosis (range 72·4–74·5 years). Despite the resumption of services and easing of restrictions, alongside a nationwide vaccination rollout, there was a significant decrease of 25·1% fewer patients diagnosed with NMSC in 2021 compared with prepandemic figures in 2019. This may be explained by factors such as a significant ‘third wave’ at the beginning of 2021 coupled with a continued heightened reluctance by elderly patients to access tertiary care due to the ongoing risk of COVID-19. As the pandemic continues with a more protracted course than initially anticipated, future studies will be useful to assess whether this has had a lasting effect on the rates of diagnosis of NMSC and the subsequent implications on patient outcomes.