Impact of the COVID pandemic on melanoma thickness and ulceration: a meta-analysis
Corresponding Author
Camila Scharf
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Correspondence
Camila Scharf
University of Campania L. Vanvitelli
Naples
Italy
E-mail: [email protected]
Search for more papers by this authorFederico M. Mongardini
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorFrancesca Fisone
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorGiulia Briatico
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorGabriella Brancaccio
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorFabrizio Chirico
Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorSalvatore Tolone
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorLudovico Docimo
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorClaudio Gambardella
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorFrancesco Lucido
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorSimona Parisi
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorElvira Moscarella
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorGiuseppe Argenziano
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorFrancesco Iovino
Department of Translational Medicine Science, School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorCorresponding Author
Camila Scharf
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Correspondence
Camila Scharf
University of Campania L. Vanvitelli
Naples
Italy
E-mail: [email protected]
Search for more papers by this authorFederico M. Mongardini
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorFrancesca Fisone
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorGiulia Briatico
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorGabriella Brancaccio
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorFabrizio Chirico
Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorSalvatore Tolone
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorLudovico Docimo
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorClaudio Gambardella
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorFrancesco Lucido
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorSimona Parisi
Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorElvira Moscarella
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorGiuseppe Argenziano
Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
Search for more papers by this authorFrancesco Iovino
Department of Translational Medicine Science, School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
Search for more papers by this authorConflict of interest: None.
Funding source: None.
Abstract
The global healthcare sector faced immense challenges due to the COVID-19 pandemic. Oncologists noted reduced cancer screening, which impacted melanoma diagnosis and treatment, leading to concerns about delayed care and poorer outcomes. This review analyzes how the pandemic influenced melanoma ulceration risk and Breslow thickness index through a meta-analysis of published studies. Following PRISMA guidelines, we conducted a systematic review of literature from January 2021 to December 2022 on cutaneous melanoma before and during the COVID-19 pandemic. Upon screening 1854 manuscripts, the review led to 13 studies meeting inclusion standards. The quality assessment followed MINORS and Newcastle-Ottawa Scale criteria. Regarding ulceration, post-COVID ulceration surpassed pre-COVID levels significantly, with a risk ratio of 1.31 and an estimated odds ratio of 1.41, indicating a 44% rise post-COVID. As for Breslow thickness, studies show a rising trend in the Breslow index post-COVID, but less significantly, with an effect size of 0.08 regarding the meta-analysis model (P = 0.02) with a pre-COVID mean Breslow of 1.56 mm and post-COVID of 1.84 mm. This meta-analysis concluded that post-COVID ulceration rates significantly surpassed pre-COVID levels. Considering that ulcerated melanomas usually undergo sentinel lymph node biopsy and are more likely to benefit from adjuvant therapies, this indicates important implications, as many patients might have missed the opportunity to start therapy appropriately, regardless of their Breslow thickness status.
Supporting Information
| Filename | Description |
|---|---|
| ijd17401-sup-0001-Supplementary_table_1.pdfPDF document, 55.1 KB |
Table S1. Characteristics and Quality Assessment of manuscripts included in the study |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1London JW, Fazio-Eynullayeva E, Palchuk MB, Sankey P, McNair C. Effects of the COVID-19 pandemic on cancer-related patient encounters. JCO Clin Cancer Inform. 2020; 4: 657–665. https://doi.org/10.1200/CCI.20.00068
- 2Bianconi F, Crocetti E, Grisci C, Primieri C, Stracci F. What has changed in the epidemiology of skin melanoma in central Italy during the past 20 years? Melanoma Res. 2020; 30(4): 396–401. https://doi.org/10.1097/CMR.0000000000000551
- 3Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097.
- 4Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73: 712–716.
- 5Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
- 6Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959; 22(4): 719–748.
- 7Viechtbauer W. Bias and efficiency of meta-analytic variance estimators in the random-effects model. J Educ Behav Stat. 2005; 30(3): 261–293.
- 8Knapp G, Hartung J. Improved tests for a random effects meta-regression with a single covariate. Stat Med. 2003; 22(17): 2693–2710. https://doi.org/10.1002/sim.1482
- 9Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11): 1539–1558. https://doi.org/10.1002/sim.1186
- 10Baujat B, Mahé C, Pignon J-P, Hill C. A graphical method for exploring heterogeneity in meta-analyses: application to a meta-analysis of 65 trials. Stat Med. 2002; 21(18): 2641–2652.
- 11Aabed H, Bloanca V, Crainiceanu Z, Bratosin F, Citu C, Diaconu MM, et al. The impact of SARS-CoV-2 pandemic on patients with malignant melanoma at a romanian academic center: a four-year retrospective analysis. Int J Environ Res Public Health. 2022; 19(14):8499. https://doi.org/10.3390/ijerph19148499
- 12Lamm R, Lyons W, So W, Willis AI. Advanced-stage melanoma at presentation following the peak of the pandemic: a COVID-19 cancer canary in a coal mine. World J Surg. 2022; 46(8): 1820–1825. https://doi.org/10.1007/s00268-022-06623-9
- 13Gil-Pallares P, Figueroa-Silva O, Gil-Pallares ME, Vázquez-Bueno JÁ, Piñeyro-Molina F, Monteagudo B, et al. Did COVID-19 lockdown delay actually worsen melanoma prognosis? An Bras Dermatol. 2023; 98(2): 176–180. https://doi.org/10.1016/j.abd.2022.08.004
- 14Cariti C, Merli M, Avallone G, Rubatto M, Marra E, Fava P, et al. Melanoma management during the COVID-19 pandemic emergency: a literature review and single-center experience. Cancers (Basel). 2021; 13(23):6071. https://doi.org/10.3390/cancers13236071
- 15Hedges LV. Distribution theory for Glass's estimator of effect size and related estimators. J Educ Stat. 1981; 6(2): 107–128.
10.3102/10769986006002107 Google Scholar
- 16Martinez-Lopez A, Diaz-Calvillo P, Cuenca-Barrales C, Montero-Vilchez T, Sanchez-Diaz M, Buendia-Eisman A, et al. Impact of the COVID-19 pandemic on the diagnosis and prognosis of melanoma. J Clin Med. 2022; 11(14): 4181. https://doi.org/10.3390/jcm11144181
- 17Viechtbauer W, Cheung M. Outlier and influence diagnostics for meta-analysis. Res Synth Methods. 2010; 1(2): 112–125.
- 18Spurny-Dworak J, Steiner A, Breier F, Stella A, Feldmann R. Effects of the COVID-19 pandemic on the diagnosis of malignant melanoma: a retrospective study. Eur J Dermatol. 2022; 32(5): 615–617. https://doi.org/10.1684/ejd.2022.4340
- 19Scharf C, Brancaccio G, Di Stefani A, Fargnoli MC, Kittler H, Kyrgidis A, et al. The association between COVID-19 lockdowns and melanoma diagnosis and thickness: a multicenter retrospective study from Europe. J Am Acad Dermatol. 2022; 87(3): 648–649. https://doi.org/10.1016/j.jaad.2022.05.018 Erratum in: J Am Acad Dermatol. 2022 Dec;87(6):1467.
- 20Kostner L, Cerminara SE, Pamplona GSP, Maul JT, Dummer R, Ramelyte E, et al. Effects of COVID-19 lockdown on melanoma diagnosis in Switzerland: increased tumor thickness in elderly females and shift towards stage IV melanoma during lockdown. Cancer. 2022; 14(10):2360. https://doi.org/10.3390/cancers14102360
- 21Jeremić J, Suđecki B, Radenović K, Mihaljević J, Radosavljević I, Jovanović M, et al. Impact of the COVID-19 pandemic on melanoma diagnosis: increased breslow thickness in primary melanomas-a single center experience. Int J Environ Res Public Health. 2022; 19(24):16806. https://doi.org/10.3390/ijerph192416806
- 22Hoellwerth M, Kaiser A, Emberger M, Brandlmaier M, Laimer M, Egger A, et al. COVID-19-induced reduction in primary melanoma diagnoses: experience from a dermatopathology referral center. J Clin Med. 2021; 10(18):4059. https://doi.org/10.3390/jcm10184059
- 23Tejera-Vaquerizo A, Paradela S, Toll A, Santos-Juanes J, Jaka A, López A, et al. Effects of COVID-19 lockdown on tumour burden of melanoma and cutaneous squamous cell carcinoma. Acta Derm Venereol. 2021; 101(8):adv00525. https://doi.org/10.2340/00015555-3890
- 24Gedeah C, Damsin T, Absil G, Somja J, Collins P, Rorive A, et al. The impact of COVID-19 on the new diagnoses of melanoma. Eur J Dermatol. 2021; 31(4): 565–567. https://doi.org/10.1684/ejd.2021.4086
- 25Gualdi G, Porreca A, Amoruso GF, Atzori L, Calzavara-Pinton P, De Tursi M, et al. The effect of the COVID-19 lockdown on melanoma diagnosis in Italy. Clin Dermatol. 2021; 39(5): 911–919. https://doi.org/10.1016/j.clindermatol.2021.05.015
- 26 Multicenter Selective Lymphadenectomy Trials Study Group, Crystal JS, Thompson JF, Hyngstrom J, Caracò C, Zager JS, et al. Therapeutic value of sentinel lymph node biopsy in patients with melanoma: a randomized clinical trial. JAMA Surg. 2022; 157(9): 835–842. https://doi.org/10.1001/jamasurg.2022.2055 Erratum in: JAMA Surg. 2022 Sep 1;157(9):859. 10.1001/jamasurg.2022.4558.
- 27Sadurní MB, Meves A. Breslow thickness 2.0: why gene expression profiling is a step toward better patient selection for sentinel lymph node biopsies. Mod Pathol. 2022; 35(11): 1509–1514. https://doi.org/10.1038/s41379-022-01101-y
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