GIRFT01: The long-term costs of COVID-19 for patients with skin cancer: a retrospective single-centre review of multidisciplinary team skin cancer cases and outcomes from 2019 to 2021

Esra Musbahi, Mariha Ashraf, Erin Kamp and Claudia DeGiovanni

University Hospitals Sussex NHS Foundation Trust, Brighton, UK

The COVID-19 pandemic has affected skin cancer services in the UK and worldwide, with a reported decrease in referrals and diagnoses in 2020. Early detection and treatment are critical for improved patient outcomes. To determine if there was a difference in skin cancer diagnosis and management, we conducted a retrospective, single-centre cohort study of all patients discussed in skin cancer multidisciplinary team (MDT) meetings in the same period (May–July) in 2019, 2020 and 2021. This included melanoma, squamous cell carcinomas (SCC), complex basal cell carcinomas and rarer skin cancers. The patient cohort was identified via the MDT discussion database and electronic patient records. Overall, there was drastic decrease of 62% in the number of 2-week wait referrals in 2020 vs. the same period in 2019, increasing beyond prepandemic levels in 2021. A total of 643 patients were diagnosed with skin cancer: 221 in 2019, 155 in 2020 and 267 in 2021. Mean age at diagnosis (75 years) was similar for all 3 years. Patients with multiple lesions nearly halved in 2020 (7.1%) vs. 2019 (13.6%), increasing again in 2021 (10.9%). There was a 49.5% reduction in the total number of melanomas diagnosed in 2020 (n = 58) vs. 2019 (n = 67), increasing back to prepandemic levels in 2021 (n = 59). Fewer patients were referred for sentinel lymph node biopsy in 2020. An increase in thin melanomas (pT1a/pT1b) in 2020 vs. 2019 was seen, but there was a sustained reduction in the diagnosis of thicker melanomas (pT3a/pT3b and pT4a/pT4b). In 2019 and 2020, an equal number of SCCs were diagnosed (n = 132), but increased in 2021 (n = 170), with a significant increase in the diagnosis of poorly differentiated SCC in 2021. Recommendation for referral for all skin cancers to the plastic surgery department decreased in 2020 [n = 14 (–40%)] but increased dramatically in 2021 [n = 41 (+98%)]. Curettage rates increased in 2020 (36.8%) vs. both 2019 and 2021. There was a year-on-year increase for patients referred for radiotherapy. Overall, the data showed a reduction in skin cancer referrals and diagnosis during the COVID-19 pandemic. However, during the same time period in 2021, skin cancer diagnosis and treatment numbers exceeded prepandemic levels. The data also showed a decrease in poorly differentiated SCC in 2020, increasing in 2021 by 53.8% vs. 2019. There were also more referrals to plastic surgery, highlighting an increase in skin cancers requiring more complex surgical intervention in 2021 vs. 2019. Our findings add to the body of data that can be used to predict service needs and required funding to treat and manage this increased burden of skin cancer diagnosis, especially in view of the requirement for more complex and expensive treatments.