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Mounica B, Pushker N, Kashyap S, Sen S, Agrawal S, Meel R, Bajaj MS, Bakhshi S. Clinicopathological presentations of eyelid malignancy in COVID era versus pre-COVID era. Indian J Ophthalmol 2024; 72:1442-1447. [PMID: 39331434 DOI: 10.4103/ijo.ijo_3332_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/28/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era. METHODS This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation. RESULTS In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities. CONCLUSION During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future.
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Affiliation(s)
- B Mounica
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Department of Ocular Pathology (Dr Rajendra Prasad Centre of Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Department of Ocular Pathology (Dr Rajendra Prasad Centre of Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplasty and Oncology Services (Dr. Rajendra Prasad Centre for Ophthalmic Sciences), All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology (Institute Rotary Cancer Hospital), All India Institute of Medical Sciences, New Delhi, India
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2
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Scharf C, Mongardini FM, Fisone F, Briatico G, Brancaccio G, Chirico F, Tolone S, Docimo L, Gambardella C, Lucido F, Parisi S, Moscarella E, Argenziano G, Iovino F. Impact of the COVID pandemic on melanoma thickness and ulceration: a meta-analysis. Int J Dermatol 2024. [PMID: 39095953 DOI: 10.1111/ijd.17401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
The global healthcare sector faced immense challenges due to the COVID-19 pandemic. Oncologists noted reduced cancer screening, which impacted melanoma diagnosis and treatment, leading to concerns about delayed care and poorer outcomes. This review analyzes how the pandemic influenced melanoma ulceration risk and Breslow thickness index through a meta-analysis of published studies. Following PRISMA guidelines, we conducted a systematic review of literature from January 2021 to December 2022 on cutaneous melanoma before and during the COVID-19 pandemic. Upon screening 1854 manuscripts, the review led to 13 studies meeting inclusion standards. The quality assessment followed MINORS and Newcastle-Ottawa Scale criteria. Regarding ulceration, post-COVID ulceration surpassed pre-COVID levels significantly, with a risk ratio of 1.31 and an estimated odds ratio of 1.41, indicating a 44% rise post-COVID. As for Breslow thickness, studies show a rising trend in the Breslow index post-COVID, but less significantly, with an effect size of 0.08 regarding the meta-analysis model (P = 0.02) with a pre-COVID mean Breslow of 1.56 mm and post-COVID of 1.84 mm. This meta-analysis concluded that post-COVID ulceration rates significantly surpassed pre-COVID levels. Considering that ulcerated melanomas usually undergo sentinel lymph node biopsy and are more likely to benefit from adjuvant therapies, this indicates important implications, as many patients might have missed the opportunity to start therapy appropriately, regardless of their Breslow thickness status.
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Affiliation(s)
- Camila Scharf
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Federico M Mongardini
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Fisone
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Briatico
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Fabrizio Chirico
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Lucido
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Parisi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Francesco Iovino
- Department of Translational Medicine Science, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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3
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Díaz-Calvillo P, Muñoz-Barba D, Ureña-Paniego C, Maul LV, Cerminara S, Kostner L, Martínez López A, Arias-Santiago S. Effects of COVID-19 Pandemic on the Diagnosis of Melanoma and Keratinocyte Carcinomas: a Systematic Review and Meta-analysis. Acta Derm Venereol 2024; 104:adv19460. [PMID: 38483083 PMCID: PMC10953710 DOI: 10.2340/actadv.v104.19460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Since December 2019, the COVID-19 pandemic has profoundly affected healthcare. The real effects of the COVID-19 pandemic on skin cancer are still unclear, more than 3 years later. This study aims to summarise the pandemic's impact on skin cancer diagnosis and outcome. A systematic review and meta-analysis was conducted, selecting studies comparing skin cancer diagnosis and prognosis post-pandemic with pre-pandemic data. A total of 27 papers were reviewed including 102,263 melanomas and 271,483 keratinocyte carcinomas. During the initial pandemic months (January-July 2020), melanoma surgeries dropped by 29.7% and keratinocyte carcinomas surgeries by 50.8%. Early pandemic tumours exhibited greater thickness and stage. In a long-term period beyond the initial months, melanoma surgeries decreased by 9.3%, keratinocyte carcinomas by 16.6%. No significant differences were observed in the Breslow thickness of melanomas after the start of the pandemic (mean difference 0.06, 95% confidence interval -0.46, 0.58). Melanomas operated on post-pandemic onset had an increased risk of ulceration (odds ratio 1.35, 95% confidence interval 1.22-1.50). Keratinocyte carcinomas showed increased thickness and worsened stage post-pandemic. However, studies included were mostly retrospective and cross-sectional, reporting diverse data. This review indicates that the pandemic likely caused delays in skin cancer diagnosis and treatment, potentially impacting patient outcomes.
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Affiliation(s)
- Pablo Díaz-Calvillo
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Daniel Muñoz-Barba
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Clara Ureña-Paniego
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Sara Cerminara
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Lisa Kostner
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland.
| | - Antonio Martínez López
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Salvador Arias-Santiago
- Department of Dermatology, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Department of Dermatology, University of Granada, Granada, Spain
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4
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Apostu AP, Vesa ȘC, Frățilă S, Iancu G, Bejinariu N, Muntean M, Șenilă SC, Baba OA, Secășan CP, Ungureanu L. The effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma 2 years after the pandemic in two Romanian counties. Front Med (Lausanne) 2024; 11:1328488. [PMID: 38323030 PMCID: PMC10844525 DOI: 10.3389/fmed.2024.1328488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background The COVID-19 pandemic disrupted the healthcare system and negatively affected the diagnosis and management of melanoma worldwide. The purpose of this study is to investigate the long-term effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma. Materials and methods This retrospective cohort study included histopathologically confirmed melanoma cases from March 2019 to February 2023 in Cluj and Bihor counties. Data from the post-COVID-19 period (March 2021 to February 2023) were compared to the pre-COVID-19 period (March 2019 to February 2020) and the COVID-19 period (March 2020 to February 2021). Patient characteristics, monthly diagnostics, histological subtypes, and key histological features were analyzed using statistical tests. Results The number of melanoma cases diagnosed annually decreased by 31.37 and 23.75% in the first and second post-pandemic years, respectively, compared to pre-pandemic numbers. Diagnostic rates also decreased by 14.9 and 5.4% in the first and second post-pandemic years, respectively, compared to the pandemic period. Prognostic factors worsened in the post-pandemic period, with higher Breslow index and mitotic rate, and increased ulceration and thick melanomas compared to the pre-pandemic period. Conclusion The COVID-19 pandemic had a long-lasting impact on the diagnosis of melanoma in Romania, resulting in advanced stages and unfavorable prognostic factors. Larger global studies are needed to comprehensively understand the pandemic's long-term effects on the diagnosis of melanoma.
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Affiliation(s)
- Adina Patricia Apostu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases, Cluj Napoca, Romania
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Frățilă
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
- Clinical Emergency County Hospital, Oradea, Romania
| | - Gabriela Iancu
- Department of Dermatology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, Sibiu, Romania
- Clinic of Dermatology, County Emergency Hospital Sibiu, Sibiu, Romania
| | - Nona Bejinariu
- Santomar Oncodiagnostic Laboratory, Cluj-Napoca, Romania
| | - Maximilian Muntean
- Department of Plastic and Reconstructive Surgery, “Prof Dr. I. Chiricuță” Institute of Oncology, Cluj-Napoca, Romania
| | - Simona C. Șenilă
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, Cluj-Napoca, Romania
| | | | | | - Loredana Ungureanu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, Cluj-Napoca, Romania
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5
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Pauvels LSP, Fiegenbaum AB, Bakos RM. Skin cancer characteristics during the first year of the COVID-19 pandemic at a tertiary hospital in Latin America. Int J Dermatol 2023; 62:1378-1383. [PMID: 37737439 DOI: 10.1111/ijd.16848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The influence of the novel human coronavirus disease (COVID-19) pandemic on skin cancer characteristics in Latin America is still poorly elucidated. METHODS This was a cross-sectional study which included patients diagnosed with skin cancer (basal cell carcinoma [BCC], cutaneous squamous cell carcinoma [cSCC], and primary cutaneous melanoma [cMM]) during the first year of the COVID-19 pandemic (from March 1, 2020, to February 28, 2021) and the preceding year at our institution. The total number of skin cancer diagnoses and surgeries, as well as their topography, clinicopathological staging at diagnosis, and treatment delay were compared between the two periods. RESULTS There was a 31.8% reduction in skin cancer diagnoses during the first year of the COVID-19 pandemic at our institution. There was an increase in the proportion of low-risk cancers according to the NCCN guidelines for BCCs (40.8-49%, P < 0.001) and cSCCs (41.7-49.6%, P = 0.03), but there was no difference in the distribution of other staging systems for the three types of cancer. We also found a significant reduction in surgeries for BCCs (-57.6%, P < 0.001) and cSCCs (-44.7%, P < 0.001) but not for cMM. CONCLUSIONS The first year of the COVID-19 pandemic was associated with reduced numbers of skin cancer diagnoses and surgeries at our institution. This study provides an assessment of skin cancer characteristics during the first year of the pandemic in the Latin American population.
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Affiliation(s)
- Lucas S P Pauvels
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Arthur B Fiegenbaum
- Department of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato M Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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6
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Aw K, Lau R, Nessim C. Prioritizing Melanoma Surgeries to Prevent Wait Time Delays and Upstaging of Melanoma during the COVID-19 Pandemic. Curr Oncol 2023; 30:8328-8337. [PMID: 37754519 PMCID: PMC10528302 DOI: 10.3390/curroncol30090604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018-29 February 2020 (pre-pandemic) and 1 March 2020-22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22-48] pre-pandemic and 35 [24-49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes.
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Affiliation(s)
- Katherine Aw
- Faculty of Medicine, University of Ottawa, 541 Smyth Road, Ottawa, ON K1H 8M5, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Rebecca Lau
- Faculty of Medicine, University of Ottawa, 541 Smyth Road, Ottawa, ON K1H 8M5, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Carolyn Nessim
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Department of General Surgery, Division of Surgical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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7
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Troesch A, Magdalena H, Forchhammer S, Del Regno L, Lodde G, Turko P, Cheng PF, Levesque ML, Hadaschik E, Livingstone E, Peris K, Flatz L, Peter K, Dummer R, Dimitriou F. The impact of the COVID-19 pandemic on the diagnosis of cutaneous melanomas: A retrospective cohort study from five European skin cancer reference centres. J Eur Acad Dermatol Venereol 2023; 37:922-931. [PMID: 36785973 DOI: 10.1111/jdv.18953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The COVID-19 lockdown had a dramatic impact on primary care access and resulted in postponed skin cancer screenings. This raises concerns for a diagnostic delay on primary cutaneous melanomas, which can subsequently increase morbidity and mortality. OBJECTIVES The aim of the study was to investigate the impact of the COVID-19-related restrictions on the melanoma diagnosis in five European skin cancer reference centres in Switzerland, Germany, Austria and Italy. METHODS A total of 7865 cutaneous melanoma cases were collected between 01 September 2018 and 31 August 2021. The time period was stratified into pre-COVID (pre-lockdown) and post-COVID (lockdown and post-lockdown) according to the established restrictions in each country. The data collection included demographic, clinical and histopathological data from histologically confirmed cutaneous melanomas. Personal and family history of melanoma, and presence of immunosuppression were used to assess the diagnosis delay in high-risk individuals. RESULTS There was an overall increase of the Breslow tumour thickness (mean 1.25 mm vs. 1.02 mm) during the post-COVID period, as well as an increase in the proportion of T3-T4 melanomas, rates of ulceration and the number of mitotic rates ≥2 (all, p < 0.001). Patients with immunosuppression and personal history of melanoma showed a decrease in the mean log10-transformed Breslow during lockdown and post-COVID. In the multivariate analysis, age at melanoma diagnosis (p < 0.01) and personal history of melanoma (p < 0.01) showed significant differences in the mean Breslow thickness. CONCLUSIONS The study confirms the diagnostic delay in cutaneous melanomas due to the COVID-19 lockdown. High-risk individuals, such as patients with personal history of melanoma and elderly individuals, were more hesitant to restart their regular skin cancer screenings post-COVID. Further studies with longer follow-up are required to evaluate the consequences of this diagnostic delay in long-term outcomes.
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Affiliation(s)
- Alexander Troesch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hoellwerth Magdalena
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Laura Del Regno
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrick Turko
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mitchell L Levesque
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ketty Peris
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Lukas Flatz
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Koelblinger Peter
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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8
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Toma AO, Prodan M, Reddyreddy AR, Seclaman E, Crainiceanu Z, Bloanca V, Bratosin F, Dumitru C, Pilut CN, Alambaram S, Vasamsetti NG, Decean L, Pricop M. The Epidemiology of Malignant Melanoma during the First Two Years of the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:305. [PMID: 36612627 PMCID: PMC9819675 DOI: 10.3390/ijerph20010305] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
It is hypothesized that the COVID-19 pandemic had a major impact on the epidemiology of malignant melanoma owing to diminished screening, diagnostic, and treatment capacities, resulting in a more advanced stage at initial presentation. The goal of this study is to undertake a systematic analysis of all epidemiological and clinical data on the trends and patient outcomes with malignant melanoma during the ongoing pandemic. Records were identified from PubMed, Cochrane, and Web of Science, selecting a total of 39 articles, narrative reviews, and editorial letters, following the PRISMA guidelines. The vast majority of the studies were published in Europe (28/39), and North America (7/39). A total of 99,860 patients were analyzed during 2020 and 2021 of the COVID-19 pandemic, and it was observed that malignant melanoma TNM staging increased significantly compared to the pre-pandemic period. Before the pandemic, 25.88% of patients had TNM stage II or above, compared to 36.25% during 2020-2021. During the COVID-19 pandemic, the malignant melanoma Breslow depth index grew from 1.59 mm before 2020 to 1.86 mm in 2020 and 2021. Patients decreased by 19.58% in 2020 and 2021 compared to pre-pandemic numbers. The patient-loss ratio indicated lower screening activity and patient addressability to dermatology and plastic surgery departments with skin cancer concerns during the COVID-19 pandemic. This systematic study shows that the identification and management of malignant melanoma during the COVID-19 pandemic faced major challenges which should alert medical systems to the high number of patients with advanced disease stages who may need emergency treatment and become incurable.
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Affiliation(s)
- Ana-Olivia Toma
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mihaela Prodan
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Akash Reddy Reddyreddy
- School of General Medicine, Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | - Edward Seclaman
- Department of Biochemistry and Pharmacology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Center for Complex Networks Science, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Zorin Crainiceanu
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Vlad Bloanca
- Department of Plastic Surgery, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ciprian Nicolae Pilut
- Kaloji Narayana Rao University of Health Sciences, Nizampura, Warangal, Telangana 506007, India
| | - Satish Alambaram
- School of General Medicine, Bhaskar Medical College, Amdapur Road 156-162, Hyderabad 500075, India
| | | | - Luminita Decean
- Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Strada Gheorghe Marinescu 38, 540139 Targu Mures, Romania
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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9
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Jeremić J, Suđecki B, Radenović K, Mihaljević J, Radosavljević I, Jovanović M, Milić N, Pavlović V, Brašanac D, Jović M. Impact of the COVID-19 Pandemic on Melanoma Diagnosis: Increased Breslow Thickness in Primary Melanomas-A Single Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16806. [PMID: 36554683 PMCID: PMC9779520 DOI: 10.3390/ijerph192416806] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Early melanoma diagnosis plays a key role in ensuring best prognosis with good survival rates. The ongoing global COVID-19 pandemic has greatly impacted global and national healthcare systems, thus making it a real challenge. The aim of this study was to evaluate the impact of the pandemic on diagnostic delay in melanoma patients in Serbia. In this retrospective study, we included patients treated at the university hospital in Serbia's capitol over a period of five years and three months. We compared the prepandemic (01/JAN/17-14/MAR/20) and pandemic periods (15/MAR/20-31/MAR/22) by evaluating patient demographic data, melanoma subtype, Breslow thickness, Clark level, ulceration status, mitotic index rate and pT staging. We observed a significant reduction in the number of diagnosed patients (86.3 vs. 13.7%; p = 0.036), with melanomas having an increased median Breslow thickness (1.80 vs. 3.00; p = 0.010), a higher percentage of Clark IV-V level lesions (44.0% vs. 63.0%; p = 0.009), an increase in median mitotic index rate (2 vs. 5; p < 0.001) and a trend of increase in lesions thicker than 2 mm (37.8% vs. 53.7%; p = 0.026). We believe that this study can be a useful scenario guide for future similar events, highlighting the importance of preventive measures and timely diagnosis for the best patient outcomes.
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Affiliation(s)
- Jelena Jeremić
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Suđecki
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Kristina Radenović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Mihaljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Radosavljević
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nataša Milić
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Vedrana Pavlović
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dimitrije Brašanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute of Pathology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Department of Plastic Surgery, Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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10
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Seretis K, Bounas N, Gaitanis G, Bassukas I. A Meta-Analysis on the Impact of the COVID-19 Pandemic on Cutaneous Melanoma Diagnosis in Europe. Cancers (Basel) 2022; 14:6085. [PMID: 36551570 PMCID: PMC9776971 DOI: 10.3390/cancers14246085] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has been the epicenter of healthcare attention globally for the past two years, and large-scale adaptations in healthcare provision have been required. This study aimed to investigate the impact of the pandemic and the resulting lockdowns on cutaneous melanoma diagnosis and tumor burdens in Europe. A relevant literature search in electronic databases was conducted from inception to September 2022. The inclusion criteria were: controlled studies published in a peer-reviewed journal evaluating cutaneous melanoma in Europe and reporting data on melanoma characteristics from diagnoses. The quality of studies was evaluated using the Cochrane ROBINS-I tool for assessing bias in non-randomized studies. Meta-analysis was conducted utilizing a random effects model to synthesize the data. A total of 25 studies involving 32,231 patients were included in the data analysis models. Statistically significant increases in mean Breslow thickness (0.29 mm (0.03-0.55 mm)), ulceration rates (OR = 1.66 (1.29-2.13)), and resultant tumor staging were observed in the PostCovid group, with subgroup analysis revealing that lockdown-derived data were responsible for this trend. This meta-analysis reported on the impact of COVID-19 restrictions on melanoma diagnosis in Europe, emphasizing the higher tumor burden and disease progression state provoked by healthcare adaptations in the pandemic period.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Nikolaos Bounas
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Ioannis Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
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11
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Martinez-Lopez A, Diaz-Calvillo P, Cuenca-Barrales C, Montero-Vilchez T, Sanchez-Diaz M, Buendia-Eisman A, Arias-Santiago S. Impact of the COVID-19 Pandemic on the Diagnosis and Prognosis of Melanoma. J Clin Med 2022; 11:4181. [PMID: 35887944 PMCID: PMC9321960 DOI: 10.3390/jcm11144181] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Early detection of melanoma is one of the main diagnostic goals of dermatologists worldwide, due to the increasing incidence of the disease in our environment. However, the irruption of the SARS-CoV-2 pandemic has posed a challenge to global healthcare, forcing systems to focus their resources on the fight against COVID-19. Methods: Retrospective cohort study. The exposed cohort were patients diagnosed with melanoma in the year after the general confinement in Spain (15 March 2020) and the unexposed cohort were patients with melanoma diagnosed in the previous year. Results: 130 patients were included. No differences were observed between demographic characteristics in both cohorts. The mean Breslow of melanoma before the onset of the pandemic was 1.08, increasing to 2.65 in the year after the onset of the pandemic (p < 0.001). On the other hand, the percentage of melanomas in situ decreased from 38.96% to 16.98% in the year after the declaration of the state of alarm in Spain. Conclusions: The SARS-CoV-2 outbreak has led to a reduction in the early diagnosis of melanoma, with an increase in invasive melanomas with poor prognosis histological factors. This could lead to an increase in melanoma-related mortality in the coming years in our environment.
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Affiliation(s)
- Antonio Martinez-Lopez
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
- TECe19-Investigational and Traslational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain;
| | - Pablo Diaz-Calvillo
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
| | - Carlos Cuenca-Barrales
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
- TECe19-Investigational and Traslational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain;
| | - Trinidad Montero-Vilchez
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
| | - Manuel Sanchez-Diaz
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
| | - Agustin Buendia-Eisman
- TECe19-Investigational and Traslational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain;
- Department of Dermatology, University of Granada, 18011 Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (P.D.-C.); (C.C.-B.); (T.M.-V.); (M.S.-D.); (S.A.-S.)
- TECe19-Investigational and Traslational Dermatology Research Group, Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain;
- Department of Dermatology, University of Granada, 18011 Granada, Spain
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12
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Weltler P, Rappersberger K, Filzmoser P, Vujic I. The impact of the COVID-19 pandemic on melanoma diagnoses. JEADV CLINICAL PRACTICE 2022; 1:122-125. [PMID: 37829553 PMCID: PMC9088572 DOI: 10.1002/jvc2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 10/14/2023]
Abstract
Introduction We investigated whether governmental measures and lockdowns during the COVID-19 pandemic had an impact on the number and histopathologic stages of melanoma. Methods The number and thickness (Breslow) of all diagnosed melanomas per day, month, or period at the 'Institute for Pathology in the Centre' in 2019 and 2020 were compared. For 2020, we defined four time periods: Period 1: 1 January-15 March; Period 2: 16 March-15 May (Lockdown 1); Period 3: 16 May-2 November; Period 4: 3 November-7 December (Lockdown 2). Results We found similar melanoma numbers in 2019 (577) and 2020 (608). The mean number of diagnoses per day during Lockdown 1 (Period 2) was significantly lower (0.87 melanomas/day; p = 0.005) when compared to the respective time periods in 2019 and to the other three periods in 2020 (Period 1: 1.65 melanomas/day, Period 3: 1.77 melanomas/day, and Period 4: 2.49 melanomas/day). Tumour thickness in July 2020 (1.9 mm) was significantly higher (p = 0.02) than in July 2019 (1.1 mm). Discussion The significant lower number of histopathologic diagnoses of melanoma during 'Lockdown 1' may be explained by postponed or missed patient consultations. This assumption is supported by the demonstration of a higher tumour thickness in July and August 2020, compared to 2019.
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Affiliation(s)
- Patrick Weltler
- Faculty of MedicineSigmund Freud Private UniversityViennaAustria
| | - Klemens Rappersberger
- Faculty of MedicineSigmund Freud Private UniversityViennaAustria
- Department of DermatologyKlinik LandstraßeViennaAustria
- Institute of Pathology “In the Centre,”St. PoeltenAustria
| | - Peter Filzmoser
- Institute of Statistics and Mathematical Methods in EconomicsUniversity of TechnologyViennaAustria
| | - Igor Vujic
- Faculty of MedicineSigmund Freud Private UniversityViennaAustria
- Department of DermatologyKlinik LandstraßeViennaAustria
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13
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Caini S, Brusasco M, Niero G, De Giorgi V, Lombardo M, Massone C, Medri M, Palmieri G, Pizzichetta M, Quaglino P, Satta R, Feliciani C, Gandini S, Stanganelli I. Health Care and Safety of Patients with Melanoma during the COVID‐19 Pandemic in Italy. J Eur Acad Dermatol Venereol 2022; 36:e510-e512. [PMID: 35278222 PMCID: PMC9115002 DOI: 10.1111/jdv.18056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit Institute for Cancer Research, Prevention and Clinical Network (ISPRO) Florence Italy
| | - M. Brusasco
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
| | - G. Niero
- Italian Association of Melanoma Patients (AIMaMe) Rome Italy
| | - V. De Giorgi
- Department of Dermatology University of Florence Florence Italy
| | - M. Lombardo
- Department of Dermatology Ospedale di Circolo e Fondazione Macchi Varese Italy
| | - C. Massone
- Dermatology Unit Galliera Hospital Genoa Italy
| | - M. Medri
- Skin Cancer Unit Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Meldola FC Italy
| | - G. Palmieri
- Immuno‐Oncology & Cancer Biotherapies University of Sassari ‐ Unit of Cancer Genetics, Institute for Genetic and Biomedical Research – National Research Council (IRGB‐CNR) Sassari Italy
| | - M.A. Pizzichetta
- Dermatologic Clinic University of Trieste Trieste Italy
- Department of Medical Oncology Centro di Riferimento Oncologico di Aviano (CRO), (IRCCS) Aviano Italy
| | - P. Quaglino
- Dermatologic Clinic Department of Medical Sciences University of Turin Medical School Turin Italy
| | - R. Satta
- Department of Surgical Microsurgical and Medical Sciences Unit of Dermatology University of Sassari Sassari Italy
| | - C. Feliciani
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
| | - S. Gandini
- Division of Epidemiology and Biostatistics European Institute of Oncology Milan Italy
| | - I. Stanganelli
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
- Italian Association of Melanoma Patients (AIMaMe) Rome Italy
- Department of Dermatology University of Florence Florence Italy
- Department of Dermatology Ospedale di Circolo e Fondazione Macchi Varese Italy
- Dermatology Unit Galliera Hospital Genoa Italy
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14
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Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052699. [PMID: 35270391 PMCID: PMC8910370 DOI: 10.3390/ijerph19052699] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022]
Abstract
Background: After the outbreak of the corona virus disease-19 (COVID-19) pandemic, teledermatology was implemented in the Hungarian public healthcare system for the first time. Our objective was to assess aggregated diagnostic agreements and to determine the effectiveness of an asynchronous teledermatology system for skin cancer screening. Methods: This retrospective single-center study included cases submitted for teledermatology consultation during the first wave of the COVID-19 pandemic. Follow-up of the patients was performed to collect the results of any subsequent personal examination. Results: 749 patients with 779 lesions were involved. 15 malignant melanomas (9.9%), 78 basal cell carcinomas (51.3%), 21 squamous cell carcinomas (13.8%), 7 other malignancies (4.6%) and 31 actinic keratoses (20.4%) were confirmed. 87 malignancies were diagnosed in the high-urgency group (42.2%), 49 malignancies in the moderate-urgency group (21.6%) and 16 malignancies in the low-urgency group (4.6%) (p < 0.0001). Agreement of malignancies was substantial for primary (86.3%; κ = 0.647) and aggregated diagnoses (85.3%; κ = 0.644). Agreement of total lesions was also substantial for primary (81.2%; κ = 0.769) and aggregated diagnoses (87.9%; κ = 0.754). Conclusions: Our findings showed that asynchronous teledermatology using a mobile phone application served as an accurate skin cancer screening system during the first wave of the COVID-19 pandemic.
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15
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Wang X, Li M, Shi Q, Ji H, Kong S, Zhu L, Zhang HM. Fear of Progression, Anxiety, and Depression in Patients With Advanced Melanoma in the COVID-19 and Post-COVID-19 Era. Front Psychiatry 2022; 13:880978. [PMID: 35558429 PMCID: PMC9086779 DOI: 10.3389/fpsyt.2022.880978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) pandemic causes great disruption to cancer care services, which might bring about psychological problems and further lower both physical and mental life quality in cancer patients. Until now, very few studies focused on the psychological distress of patients with advanced melanoma before or during the epidemic. This study aimed to elucidate the fear of progression (FoP), anxiety, depression, and related independent predictors in patients with advanced melanoma during the COVID-19 outbreak. METHODS Two hundred and seventy-three patients with unresectable stage III or metastatic melanoma were recruited from February 2020 to November 2021, and completed the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), State Trait Anxiety Inventory (STAI-6), and Patient Health Questionnaire (PHQ-9). RESULTS One hundred and seventy-four (64.7%) patients experienced heighted FoP (FoP-Q-SF: 39.9 ± 11.0), 198 (72.5%) patients reported elevated anxiety (STAI-6: 13.1 ± 3.0), and 62 (22.7%) patients had increased depression (PHQ-9: 6.4 ± 6.1). In multivariate analysis, illness duration (OR = 0.987 for FoP; OR = 0.984 for depression), cancer stage (OR = 14.394 for anxiety) and disease progression (OR = 1.960 for FoP; OR = 23.235 for anxiety; OR = 1.930 for depression) were independent predictors for FoP, anxiety or depression. Additionally, the high levels of FoP, anxiety and depression were significantly positive correlated with each other (r = 0.466 for FoP and anxiety; r = 0.382 for FoP and depression; r = 0.309 for anxiety and depression). CONCLUSION Our study indicates that FoP, anxiety and depression are persisting among patients with advanced melanoma in the COVID-19 and post-COVID-19 era. Effective psycho-oncological interventions are needed for melanoma patients with psychological distress during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Xiaowen Wang
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Min Li
- Department of Neurosurgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Qiong Shi
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongchen Ji
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shengnan Kong
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Hong-Mei Zhang
- Department of Clinical Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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