Sentinel Lymph Node Biopsy in Melanoma Patients a Year after Introduction of COVID-19 Epidemic Restrictions: A Comparison with Pre-COVID Period in the National Referral Melanoma Centre

ABSTRACT

Aim/Introduction: Since its introduction in March 2020, the COVID-19 epidemic restrictions altered cancer care including melanoma. Shortly thereafter, we adjusted the clinical management of melanoma patients according to epidemicspecific recommendations provided by the multidisciplinary team for melanoma from the National Referral Melanoma Centre (NRMC), designed according to the National Comprehensive Cancer Network (NCCN). Our study aims to determine whether histopathologic features and sentinel lymph node biopsy (SLNB) in melanoma patients have been changed a year after the introduction of COVID-19 epidemic guidelines. Material(s) and Method(s) We retrospectively reviewed data of melanoma patients of stages IA to IIC (AJCC Staging System 8thedition) who underwent SLNB at our NRMC. We compared melanoma patients who had undergone SLNB during the 6-month (March-Aug) pre-COVID-19 period in 2019 with patients operated on during the corresponding period in the COVID-19 era in 2021. Selected patients underwent FDG PETCT before SLNB. After peritumoral injection of 99mTc-nanocolloid, dynamic and static planar imaging and in certain cases followed by SPECT/CT was performed. Result(s) Seventy-eight melanoma patients had undergone SLNB during the specified period in 2021 (Covid-19 group), and 61 patients during the same period in 2019 (pre-COVID-19 group). Among COVID-19 group, the most frequent melanoma location was trunk (57.7% vs. 44.3%), followed by arms (15.4% vs. 14.8%), legs (15.4% vs. 18.0%) and head and neck (11.5% vs. 23%), although the groups did not differ significantly (p=0.256). The pre-COVID-19 and COVID-19 group did not differ with regard to mean age (59.00 vs. 60.68 years, p = 0.525), gender (47.5% vs. 51.3% men, p=0.733), mean tumor thickness (2.63 vs.2.69 mm, p = 0.903), mean mitotic count (5.53 vs. 4.63/mm2 = 0.368) or presence of ulceration (31% vs. 32%, p=1.00). The mean time from primary melanoma excision to SLNB performance was slightly longer in COVID-19 group (54.67 vs.49.98 days, p=0.303). Patients in COVID-19 group more frequently underwent PET-CT before SLNB (17.9 % vs. 14.8%, p=0.653) and less frequently performed SPECT-CT (21.8% vs.29.5%, p=0.329), however without significant difference. The number of patients having tumor-positive SLNs (17.1% vs. 25.4%, p=0.287) and those with residual melanoma (5.1% vs. 4.9%, p=1.000) did not differ between the COVID-19 and pre-COVID-19 group, respectively. Conclusion(s) Besides slight differences in location of primary melanoma, interval to SLNB performance, and SPECT-CT use, we demonstrated that SLNB management and histopathologic features in our melanoma patients followed the pre-pandemic period a year after starting COVID-19 epidemic restrictions.