Melanoma defies ‘lockdown’: ongoing detection during Covid‐19 in central London

The COVID‐19 pandemic has presented significant challenges for dermatology services, particularly the diagnosis and management of malignant melanoma (MM).¹ Early detection and definitive surgical treatment are key to improving MM prognosis, and in England there is a suspected skin cancer referral pathway that facilitates specialist Dermatology assessment within 2 weeks (2‐week wait; 2WW).² We describe the impact of COVID‐19 on MM detection, based on data from a dermatology department in central London.

Our primary objective was to compare detection rates of MM before and during the UK Government‐mandated lockdown on 23 March 2020. This included MM diagnosed at the University College London Hospitals (UCLH) Dermatology Department, during the periods 27 January 2020–22 March 2020 and 23 March 2020–18 May 2020 (inclusive). Cases were identified from the hospital laboratory database and included a new histological diagnosis of melanoma in situ (Mis), lentigo maligna, invasive melanoma or metastatic melanoma.

In total, 17 newly diagnosed, histologically confirmed cases of MM were identified, comprised of 8 cases before and 9 cases during lockdown. Most of the cases represented early or thin MM, including Mis (n = 7, 44%) and stage 1 MM (n = 7, 41%). MM detection rates were higher during ‘lockdown’: 5.73% vs. 1.70% of the total cases reviewed in the 2WW skin cancer clinic for each specified time period (n = 481 before lockdown n = 157 during lockdown).

These findings highlight the importance of continued dermatology cancer services during the UK COVID‐19 lockdown, as nine MM may not have been detected otherwise. The high proportion of early melanomas diagnosed exemplifies the efficacy of this rapid‐access skin cancer service. Not only was there ongoing MM detection but there was in fact a three‐fold higher percentage detection rate demonstrated throughout the UK COVID‐19 lockdown. There are a number of factors that may be implicated in this higher MM detection to referral ratio, including patient self‐selection in a setting of heightened anxiety and restricted health care services. Ongoing monitoring after lockdown will be performed to explore whether there is a statistically significant difference between both referral and detection rates. This information may guide complex decision‐making and demonstrates the necessity of MM skin cancer services, even in times of national emergency and gross disruption of normal medical services.