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2.
J Drugs Dermatol ; 20(12): 1343-1345, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1573164

ABSTRACT

Patients with polypoid (pedunculated) melanoma have the poorest 5-year survival rate compared with all other variants of nodular melanoma, presenting with increased thickness, incidence of metastasis, and rates of ulceration. There are few published reports regarding the pathogenesis and treatment of polypoid melanomas. We report the successful treatment of a rapidly developing red nodular polypoid melanoma with metastasis using surgery followed by anti-PD-1 antibody nivolumab in a SARS-CoV-2-positive patient who delayed seeking care due to the COVID-19 pandemic. J Drugs Dermatol. 2021;20(12):1343-1345. doi:10.36849/JDD.6071.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , Humans , Melanoma/diagnosis , Melanoma/drug therapy , Melanoma/epidemiology , Nivolumab , Pandemics , SARS-CoV-2 , Skin Neoplasms/diagnosis , Skin Neoplasms/drug therapy , Skin Neoplasms/epidemiology
3.
Ann Surg Oncol ; 29(3): 1629-1635, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1526674

ABSTRACT

BACKGROUND: Covid-19 significantly affected healthcare delivery over the past year, with a shift in focus away from nonurgent care. Emerging data are showing that screening for breast and colon cancer has dramatically decreased. It is unknown whether the same trend has affected patients with melanoma. METHODS: This is a retrospective cohort study of melanoma patients at two large-volume cancer centers. Patients were compared for 8 months before and after the lockdown. Outcomes focused on delay in treatment and possible resultant upstaging of melanoma. RESULTS: A total of 375 patients were treated pre-lockdown and 313 patients were treated post-lockdown (17% decrease). Fewer patients presented with in situ disease post-lockdown (15.3% vs. 17.9%), and a higher proportion presented with stage III-IV melanoma (11.2% vs. 9.9%). Comparing patients presenting 2 months before versus 2 months after the lockdown, there was an even more significant increase in Stage III-IV melanoma from 7.1% to 27.5% (p < 0.0001). Finally, in Stage IIIB-IIID patients, there was a decrease in patients receiving adjuvant therapy in the post lockdown period (20.0% vs. 15.2%). CONCLUSIONS: As a result of the recent pandemic, it appears there has been a shift away from melanoma in situ and toward more advanced disease, which may have significant downstream effects on prognosis and could be due to a delay in screening. Significantly patients have presented after the lockdown, and fewer patients are undergoing the recommended adjuvant therapies. Patient outreach efforts are essential to ensure that patients continue to receive preventative medical care and screening as the pandemic continues.


Subject(s)
COVID-19 , Melanoma , Communicable Disease Control , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/therapy , Retrospective Studies , SARS-CoV-2
6.
Melanoma Res ; 31(4): 389-392, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1434530

ABSTRACT

The Novel Coronavirus disease (COVID-19) first emerged in Wuhan province, China, in late November 2019 and changed public healthcare perception. It has caused a significant decline in attendance to outpatient clinics. However, other diseases have not stopped, including malignant melanoma. Survey of the number of visits to plastic surgery outpatient clinic during the first lockdown in Israel concerning malignant melanoma was compared to the same months in the previous years. We assessed the number of visits to the oncology department during 2020 compared to the number of visits and treatment protocols for malignant melanoma. During the first lockdown, the attendance at the plastic surgery outpatient clinic and ambulatory surgery decreased significantly (P = 0.002), both in excisions of suspected malignant melanoma and malignant melanoma follow-ups (P = 0.019 and P = 0.035, respectively). The last third of 2020 (from September to December) had shown a significant rise in new protocols commenced (P < 0.001). This rise in the final third of the year was not noted in 2018 or 2019. These data clearly show the rise in advanced and metastatic malignant melanoma cases due to refraining from medical follow-ups and treatments during the COVID-19 pandemic. Diseases other than COVID-19 have not vanished, and continue to treat those diseases. Ignoring malignant melanoma treatment because of COVID-19 and vice-versa will not benefit our patients.


Subject(s)
Appointments and Schedules , COVID-19/prevention & control , Melanoma/epidemiology , Patient Acceptance of Health Care , Skin Neoplasms/epidemiology , COVID-19/epidemiology , COVID-19/transmission , Humans , Israel/epidemiology , Melanoma/diagnosis , Melanoma/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Time Factors , Workload
7.
Am Soc Clin Oncol Educ Book ; 41: e295-e303, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1416833

ABSTRACT

A diagnosis of melanoma requires multidisciplinary specialized care across all stages of disease. Although many important advances have been made for the treatment of melanoma for local and advanced disease, barriers to optimal care remain for many patients who live in areas without ready access to the expertise of a specialized melanoma center. In this article, we review some of the recent advances in the treatment of melanoma and the persistent challenges around the world that prevent the delivery of the best standard of care to patients living in the community. With the therapeutic landscape continuing to evolve and newer more complex drug therapies soon to be approved, it is important to recognize the many challenges that patients face and attempt to identify tools and policies that will help to improve treatment outcomes for their melanoma.


Subject(s)
Melanoma , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/therapy , Treatment Outcome
9.
Acta Derm Venereol ; 101(8): adv00525, 2021 08 25.
Article in English | MEDLINE | ID: covidwho-1359145

ABSTRACT

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.


Subject(s)
COVID-19 , Carcinoma, Squamous Cell , Melanoma , Skin Neoplasms , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/surgery , Communicable Disease Control , Humans , Melanoma/epidemiology , Melanoma/surgery , Pandemics , SARS-CoV-2 , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Tumor Burden
13.
Medicina (Kaunas) ; 57(6)2021 May 27.
Article in English | MEDLINE | ID: covidwho-1256604

ABSTRACT

Background and Objectives: The COVID-19 pandemic has globally affected health systems and services. Non-melanoma skin cancers (NMSCs) are the most common malignancies around the world. This study aimed to analyze the differences in the benign and malignant histopathological diagnoses performed on radical excision skin tumors and skin biopsies in the dermatopathology ward in Mures Clinical County Hospital, Targu Mures, Romania, 1 year prior to and during the COVID-19 pandemic, to emphasize the changes in the diagnostic process as per the new regulations. Materials and Methods: A total of 1168 histopathological diagnoses were included in the study-302 from the COVID-19 period and 866 from the non-COVID-19 period-considering the number, type, and frequency of the histopathological diagnoses as variables to be analyzed. Results: In the COVID-19 period, out of the 55 NMSC and melanoma histopathological diagnoses, 50.9% (n = 28) were BCCs, 20% (n = 11) were SCCs, 10.9% (n = 6) were basosquamous cell carcinomas, and 18.18% (n = 10) were melanoma cases. Regarding the non-COVID-19 period, out of the 173 NMSC and melanoma histopathological diagnoses, 46.82% (n = 81) were BCCs, 22.54% (n = 39) were SCCs, 7.51% (n = 13) were basosquamous cell carcinomas, and 23.12% (n = 40) were melanoma cases. Conclusions: During the COVID-19 pandemic, a decrease in histopathological diagnoses at the dermatopathology ward in our hospital was observed, for both benign and malignant pathologies, especially for NMSCs and melanomas, compared to the same period 1 year prior to the pandemic.


Subject(s)
COVID-19 , Carcinoma, Squamous Cell , Melanoma , Skin Neoplasms , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Pandemics , Romania/epidemiology , SARS-CoV-2 , Skin Neoplasms/epidemiology
14.
J Plast Reconstr Aesthet Surg ; 74(10): 2776-2820, 2021 10.
Article in English | MEDLINE | ID: covidwho-1252517

ABSTRACT

INTRODUCTION: Axillary sentinel node biopsy for melanoma is routinely performed under general anaesthesia. Emerging evidence has shown general anaesthetics are associated with increased mortality in the context of the COVID-19 pandemic. In the interest of patient safety, we have designed a series of bespoke axillary regional blocks enabling surgeons to remove nodes up to and including level III without the need for a general anaesthetic. The aim of this study was to assess the feasibility of performing axillary sentinel node biopsy under such blocks. METHODS: Approval was granted by the Joint Study Review Committee on behalf of the Research and Ethics Department. Ten consecutive patients having axillary sentinel node biopsy for melanoma were included in this prospective study. Patients completed a Quality of Recovery-15 (QoR15) questionnaire preoperatively and 24 h postoperatively. DISCUSSION: One patient had a positive sentinel node, the remining were negative. A significant reduction in time spent in hospital post-operatively (p = 0.0008) was observed. QoR15 patient reported outcome measures demonstrated high levels of satisfaction evidenced by lack of statistical difference between pre and post-operative scores (p = 0.0118). 80% of patients were happy to have a regional block and 90% were happy to attend hospital during the pandemic. CONCLUSION: ASNB under regional block is safe, negates risks associated with performing GAs during the COVID-19 pandemic and facilitates quicker theatre turnover and discharge from hospital. Collaboration between anaesthetic and surgical teams has enabled this change in practice. There is a learning curve with both patient selection, education and development of technique.


Subject(s)
Anesthesia, Conduction/methods , COVID-19/epidemiology , Lymph Nodes/surgery , Melanoma/secondary , Sentinel Lymph Node Biopsy/methods , Skin Neoplasms/pathology , Axilla , Comorbidity , Global Health , Humans , Lymph Node Excision/methods , Lymphatic Metastasis , Melanoma/diagnosis , Melanoma/epidemiology , Pandemics , Skin Neoplasms/epidemiology
15.
Clin Dermatol ; 39(5): 911-919, 2021.
Article in English | MEDLINE | ID: covidwho-1244719

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has led to lockdowns for much of the world. In Italy, all health procedures not directly related to COVID-19 were reduced or suspended, thus limiting patient access to hospitals. Any delay in cancer treatment presents the additional risk of tumors progressing from being curable to incurable. Specifically, melanoma survival rate strictly depends on tumor thickness, which, in turn, is a function of time. To estimate the impact on melanoma progression caused by the reduction in dermatologic services during the COVID-19 lockdown, a retrospective observational cohort study was conducted. This study was designed to compare the clinical and histologic characteristics of the primary melanomas removed in the first 2 months after the end of the lockdown (May-July 2020) in 12 Italian centers characterized by different COVID-19 case frequencies. The control group was represented by the melanomas removed during the same period in the previous 3 years. Overall, 1,124 melanomas were considered: 237 as part of the study group and 887 from the control group (average, 295), with a 20% reduction. Breslow thickness, as well as high-risk histotypes and melanomas with vertical growth, increased for all melanomas. Ulcerated and high mitotic index melanomas increased, particularly in northern Italy. In Italy, the lockdown led to a significant worsening of melanoma severity, causing a staging jump, with a consequent worsening of outcomes.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , Communicable Disease Control , Humans , Italy/epidemiology , Melanoma/diagnosis , Melanoma/epidemiology , Retrospective Studies , SARS-CoV-2 , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology
18.
Front Public Health ; 9: 630620, 2021.
Article in English | MEDLINE | ID: covidwho-1128012

ABSTRACT

The outbreak of coronavirus disease-2019 (COVID-19) ineluctably caused social distancing and unemployment, which may bring additional health risks for patients with cancer. To investigate the association of the pandemic-related impacts with the health-related quality of life (HRQoL) among patients with melanoma during the COVID-19 pandemic, we conducted a cross-sectional study among Chinese patients with melanoma. A self-administered online questionnaire was distributed to melanoma patients through social media. Demographic and clinical data, and pandemic-related impacts (unemployment and income loss) were collected. HRQoL was determined by the Functional Assessment of Cancer Therapy-General (FACT-G) and its disease-specific module (the melanoma subscale, MS). A total of 135 patients with melanoma completed the study. The mean age of the patients was 55.8 ± 14.2 years, 48.1% (65/135) were male, and 17.04% (34/135) were unemployed since the epidemic. Unemployment of the patients and their family members and income loss were significantly associated with a lower FACT-G score, while the MS score was associated with the unemployment of the patients' family members. Our findings suggested that unemployment is associated with impaired HRQoL in melanoma patients during the COVID-19 epidemic.


Subject(s)
/psychology , COVID-19/economics , COVID-19/psychology , Melanoma/economics , Melanoma/psychology , Quality of Life/psychology , Unemployment/psychology , Adult , Aged , COVID-19/epidemiology , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Melanoma/epidemiology , Middle Aged , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Unemployment/statistics & numerical data
20.
Dermatol Ther ; 34(3): e14908, 2021 05.
Article in English | MEDLINE | ID: covidwho-1096758

ABSTRACT

Due to the COVID-19 crisis, many scheduled medical and surgical activities have been suspended. This interruption to the healthcare system can negatively affect the diagnosis and management of melanoma. Neglecting melanoma throughout the outbreak may be associated with increased rates of mortality, morbidity, and healthcare expenses. We performed a retrospective review of all dermatological and surgical activity performed in our Melanoma Skin Unit between 23 February 2020 and 21 May 2020 and compared these data with those from the same period in 2019. During the lockdown period, we observed a decrease in dermatologic follow-up (DFU) (-30.2%) and in surgical follow-up (SFU) (-37%), and no modification of melanoma diagnosis (-3%). Finally, surgical excisions (SE) (+ 31.7%) increased, but sentinel lymph node biopsy (SLNB) (-29%) and lymph node dissections(LND) (-64%) decreased compared to the same period in 2019. Our experience supports the continuation of surgical and diagnostic procedures in patients with melanoma during the COVID-19 pandemic. Surgical and follow-up procedures for the diagnosis and treatment of melanoma should not be postponed considering that the pandemic is lasting for an extended period.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , Communicable Disease Control , Humans , Italy/epidemiology , Lymph Node Excision , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/surgery , Pandemics , Retrospective Studies , SARS-CoV-2 , Sentinel Lymph Node Biopsy , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery
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