Response to ‘Reduction in skin cancer diagnosis, and overall cancer referrals, during the COVID‐19 pandemic’

Abstract

Linked Article: Earnshaw et al. Br J Dermatol 2020; 183:792–794.

Dear Editor, We noted with interest the recent letter by Earnshaw and colleagues documenting decreased skin cancer referrals to their dermatology department¹ and report a similar phenomenon seen in Ireland on a national level. An analysis of skin cancer referrals from the National Cancer Control Programme (NCCP) Ireland from January to June in 2019 and 2020 showed that between the months of January and June 2019, there were 2994 pigmented lesion electronic referrals from primary care. During the same months in 2020, there were 2507 pigmented lesion electronic referrals, a reduction of 487 referrals. Monthly recordings demonstrate a decrease in referrals since the introduction of the lockdown in March, April and May. During the month of March there was a 47% reduction in referrals from 470 to 252 in 2019 and 2020, respectively. During the month of April, there was a 58% reduction in referrals from 502 to 210 in 2019 and 2020, respectively, and a 30% reduction in referrals during the month of May (see Figure 1).

Figure 1.

(a) National Cancer Control Programme (NCCP) pigmented lesion referrals in Ireland. National pigmented lesion referrals recorded from NCCP Ireland during 2019 and 2020 for the months of January to June. The data demonstrates a 47%, 58% and 30% reduction in referrals for the months March, April and May, respectively. (b) Internet search trends for skin cancer. Mean internet search activity for the search term ‘skin cancer’ in Ireland in 2019 and 2020 for the months January to June.

Earnshaw et al. correctly identify that the cause of this reduction is likely to be multifactorial. In Ireland, data from Google Trends (https://trends.google.com/trends) demonstrated a decrease in internet search activity for both skin cancer and melanoma during COVID‐19, with a dip in online search activity during the months of March, April and May. Google Trends is a search volume reporting tool which provides results for search terms that receive a significant amount of online traffic. Data from Google Trends does not represent absolute search volume, but rather assigns a reference value of 100% to the peak search activity of that term, and all other data over different time periods is presented relative to that peak (relative search volume). The mean search activity per month is recorded and is plotted in Figure 1(b).

Following the easing of restrictions on 18 May, the data show search volumes began to return to the levels of the previous year during the month of June for skin cancer search interest (see Figure 1b). However, melanoma search interest remained lower than the previous year and did not return to similar levels until June. This could suggest that a reduction in online health and information‐seeking behaviour for skin cancer and melanoma is a result of patients’ interests shifting towards that of COVID‐19, and thus be a possible factor that has contributed to the reduced skin cancer referrals observed.

Author Contribution

Gregg Murray: Data curation (lead); Writing‐original draft (lead). Darren Roche: Formal analysis (equal). Amy Ridge: Formal analysis (equal); Writing‐original draft (equal). Caitriona Hackett: Supervision (equal); Writing‐review & editing (equal). Anne‐Marie Tobin: Supervision (lead); Writing‐original draft (equal).