267 Impact of COVID-19 healthcare disruption on delays in melanoma treatment in rural and urban Iowa

Previous studies have shown delays in skin cancer diagnosis and treatment due to disrupted care as a result of the COVID-19 pandemic. Diagnoses of melanoma in rural areas are associated with higher all-cause mortality when compared to metropolitan areas. Patients with melanoma treated after three months of diagnosis experience higher mortality than patients treated after one month. This study aimed to determine how COVID-19 shutdowns affected time to treatment of melanoma and patient outcomes between patients who lived in rural vs. urban areas. Patients with a pathologic diagnosis of melanoma at a large academic tertiary referral center were identified from 1/1/2019 to 12/31/2020 (n=408). Data from pathologic reports and demographic information regarding rurality (address and zip code) were collected from medical records. Documented telephone encounters were utilized to determine delays due to COVID-19. Average Breslow depth increased from 1.16 mm to 1.50 mm and proportion of clinical lymphadenopathy increased from 1.12% to 6.76% from 2019 to 2020. Conversely, average time to treatment from diagnosis decreased from 2019 to 2020 (29.55 vs. 23.76 days). These findings suggest that the COVID-19 pandemic resulted in a higher proportion of later stage tumors at presentation, but with no significant treatment delay once melanoma diagnosis was established. These results characterize the impacts of pandemic shutdowns on medical care and can aid health systems in designing optimal strategies to better serve patients from rural backgrounds.