Investigating the progression of melanoma and squamous cell carcinomas before and after the COVID-19 lockdown

ABSTRACT

Background: Delays due to COVID-19 impacted dermatology. Two Italian studies found significant decreases in melanoma diagnosis (MM) during the lockdowns, while a predicted growth model of cutaneous squamous cell carcinoma (cSCC) found delaying excision results in significant tumor upstaging. Objective: We hypothesized that the COVID-19 lockdown increased tumor severity and postoperative morbidity of MM and cSCC. Methods: This was a retrospective analysis of all newly diagnosed MM and cSCC treated with Mohs surgery during 2019 (pre-lockdown) and 2020 (post-lockdown) period. We collected data on the number of cases, tumor characteristics, extent of surgery, and time to treatment. Results: Our analysis (n = 554) found no significant difference in the number of cases of cSCC or MM between the 2 years (P =.675), the preoperative size of cSCCs or MMs (P =.68, P =.786), cSCC cases with flap or graft repairs (P =.076), or cSCC cases with aggressive histologic features (P =.243). There were significantly fewer days from biopsy to surgery in 2020 for MM (27.6 days compared with 23.8 days;P =.041) and cSCC (41.5 days compared with 33 days;P =.037);however, there were significantly more multistage Mohs surgeries for cSCC in 2020 (39 versus 69;P =.005). Conclusion: The COVID-19 lockdown resulted in a significantly increased number of multistage Mohs surgeries for the treatment of cSCC. For both cSCC and MM, the lockdown did not impact the number of cancers treated, the size of the tumors, the complexity of the repairs, or the presence of aggressive histology, while it did positively impact time to treatment.