To the Editor: We read with interest the article by Shannon et al1 regarding the impact of the COVID-19 pandemic on the presentation status of newly diagnosed malignant melanomas (MMs). We noted a recent Italian study,2 which demonstrated a similar finding of increased tumor depth. We conducted this study to assess and compare melanoma diagnosis before and during the COVID-19 pandemic at our tertiary referral center. Our aim was to assess whether the rates, clinical characteristics, and thicknesses of MMs differed between 2019 and 2020 and then between the 2 halves of 2020.
In 2020, Ireland was under lockdown for more than 6 months, from March to July and then again from August to November.
This retrospective review examined all patients discussed at the melanoma multidisciplinary team (MDT) meeting at a single tertiary referral center from 2019 and 2020. We compared the number of MMs diagnosed, along with characteristics from all periods. We also compared the period from January to June 2020 with that from July to December 2020 to assess whether multiple outbreaks and subsequent lockdowns affected MM diagnosis.
In 2019, 78 patients were diagnosed with MM and 54 with melanoma in situ (Table I ). The average Breslow thickness was 2.13 mm. In 2020, 84 patients were diagnosed with MM and 44 with melanoma in situ. The average Breslow thickness was 2.79 mm. From January to June 2020, 40 patients were diagnosed with MM, with an average Breslow thickness of 2.13 mm. From July to December 2020, 44 patients were diagnosed with MM, with an average Breslow thickness of 3.23 mm.
Table I.
Patient and tumor characteristics of all melanomas discussed at MDT
| Patient and tumor characteristics | 2019 |
2020 |
|---|---|---|
| n = 78 | n = 84 | |
| Age (median), y | 68.5 | 75.5 |
| <50 | 16 (20.5%) | 18 (21.4%) |
| 50-59 | 7 (9%) | 18 (21.4%) |
| 60-69 | 19 (24.35%) | 16 (19%) |
| 70-79 | 19 (24.35%) | 14 (16.67%) |
| >80 | 17 (21.8%) | 18 (21.4%) |
| Sex | ||
| Male | 34 (44%) | 39 (46.4%) |
| Female | 44 (56%) | 45 (53.4%) |
| Breslow thickness | ||
| Median (average) | 1.15 (2.13) | 1.9 (2.79) |
| PT staging group | ||
| 1/2 | 53 (68%) | 52 (61.9%) |
| 3/4 | 25 (32%) | 32 (38.1%) |
| Clarke level | ||
| II | 30 (38.4%) | 20 (23.8%) |
| III | 11 (14.1%) | 19 (22.6%) |
| IV | 29 (37.1%) | 37 (44%) |
| V | 4 (5.1%) | 5 (5.95%) |
| Unknown | 4 (5.1%) | 3 (3.6%) |
| Mitotic count | ||
| None | 28 (35.9%) | 26 (31%) |
| <1 | 20 (25.6%) | 16 (19%) |
| >1 | 25 (38.5%) | 39 (46%) |
| Unknown | 5 (6.4%) | 3 (3.6%) |
| Ulceration | 20 (25.6%) | 18 (21.4%) |
| Place of diagnosis | ||
| Dermatology | 53 (68%) | 53 (63%) |
| Surgery | 20 (26%) | 21 (25%) |
| GP | 5 (6%) | 10 (12%) |
GP, General practitioner; MDT, multidisciplinary team; PT, primary tumor.
We compared the Breslow thickness measured in the period from January to June 2020 inclusive with that measured in the period from July to December 2020. We found that the median Breslow thickness was greater in the second half of the year (2.45 mm) than in the first half of the year (1.15 mm) (Fig 1 ). A statistically significant difference was noted between median figures (2.45 mm − 1.15 mm = 1.3 mm) upon applying the 1-tailed Mann-Whitney U test (P = .0304).
Fig 1.
Box-plot of Breslow thickness for half-year.
Our data support the theory that the COVID-19 pandemic may have led to a delay in the diagnosis of MM, supporting research published by Shannon et al.1 Our data showed a progression in the Breslow thickness over the 2 halves of 2020. This strengthens the theory that repeated lockdowns and the closure of health care services might have resulted in delayed presentations. As the COVID-19 pandemic continues, we must ensure that time-sensitive diagnoses are referred and seen promptly.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: None.
IRB approval status: Not applicable.
References
- 1.Shannon A.B., Sharon C.E., Straker R.J., III, et al. The impact of the COVID-19 pandemic on the presentation status of newly diagnosed melanoma: a single institution experience. J Am Acad Dermatol. 2021;84(4):1096–1098. doi: 10.1016/j.jaad.2020.12.034. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ricci F., Fania L., Paradisi A., et al. Delayed melanoma diagnosis in the COVID-19 era: increased Breslow thickness in primary melanomas seen after the COVID-19 lockdown. J Eur Acad Dermatol Venereol. 2020;34(12):e778–e779. doi: 10.1111/jdv.16874. [DOI] [PMC free article] [PubMed] [Google Scholar]