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

ABSTRACT

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.