Primary Cutaneous Melanoma and Covid-19: A Hospital-Based Study

Background: The COVID-19 pandemic prompted drastic containment measures and a rearrangement of healthcare services, with reduction of melanoma diagnoses and related activities.1 It has been hypothesized that the lockdown may have led to a delay in diagnosis, resulting in an increase in melanoma upstaging cases and healthcare costs.2 Several series of melanoma management have been published in various Italian centers with variable results.3,4 Methods: We collected melanomas and melanocytic nevi diagnosed from January 2019 to December 2021 at Azienda Ospedaliero-Universitaria di Parma. Differences in the number of diagnoses, histopathological characteristics, diagnostictherapeutic pathway and staging were evaluated. Result(s): There were no significant differences between 2019 and 2020 in the number of melanomas, while there was a decrease in 2021 (540 vs 554 vs 407), determined by a reduction in melanomas in situ (395 vs 412 vs 238, p<0.001) rather than invasive melanomas. The Breslow thickness, excluding melanomas in situ, was not significantly increased in 2020 and 2021. A reduction of ulcerated melanoma was observed in 2020 (13.6% vs 5.3% vs 9.3%, p 0.04), contrary to the literature in the Covid-19 era (4). No significant differences were observed in the type and duration of diagnostic-therapeutic pathway and the staging. On the other hand, there was a reduction in the number of nevi between 2019 and 2020 (2608 vs 1452, p<0.001), with an increased percentage of dysplastic/atypical vs common nevi (6.6% vs 83.5% in 2019 and 21.3% vs 67.6% in 2020, p<0.001). Conclusion(s): Unlike other studies, we analyzed both melanomas and nevi for a longer period than lockdown. In particular we observed a marked decrease of nevi (especially common nevi), but no worsening of invasive melanomas, Breslow thickness, diagnostic-therapeutic pathway and staging. These data corroborate the results of a patient-based IMI survey (5), in which no worsening of melanoma management was observed during the COVID-19 pandemic in Italy.

Meta-analysis of diagnostic performance of serological tests for SARS-CoV-2 antibodies up to 25 April 2020 and public health implications

We reviewed the diagnostic accuracy of SARS-CoV-2 serological tests. Random-effects models yielded a summary sensitivity of 82% for IgM, and 85% for IgG and total antibodies. For specificity, the pooled estimate were 98% for IgM and 99% for IgG and total antibodies. In populations with 5% of seroconverted individuals, unless the assays have perfect (i.e. 100%) specificity, the positive predictive value would be 88%. Serological tests should be used for prevalence surveys only in hard-hit areas.