20 | How Covid-19 pandemic influenced the diagnosis of new primary melanoma: a retrospective, multicenter study by the Italian Society of Oncological Surgery

Giuseppe Sciacca*^1|2, Luca Nespoli¹, Virginia Caliendo², Dario Piazzalunga³, Piero Rossi⁴, Marco Clementi⁵, Corrado Caracò⁶, Salvatore Asero⁷, Matteo Mascherini⁸, Franco De Cian⁸, Francesco Russano⁹, Paolo Del Fiore⁹, Sara Coppola¹⁰, Elisabetta Pennacchioli¹⁰, Pietro Gallina¹¹, Marzia Franzò¹², Marco Rastrelli^9|12 | ¹General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Fondazione IRCCS San Gerardo dei Tintori, Monza; ²Department of Surgery, Dermatologic Surgery Section, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Turin; ³Unit of Surgery, Papa Giovanni XXIII Hospital, Bergamo; ⁴Dipartimento Di Scienze Chirurgiche, Università di Roma Tor Vergata, Policlinico Tor Vergata, Rome; ⁵General Surgical Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila; ⁶Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori "Fondazione Pascale" IRCCS, Napoli; ⁷Soft Tissue U.O. Surgical Oncology-Soft Tissue Tumors, Dipartimento di Oncologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi di Catania; ⁸Department of Surgical Sciences and Integrated Diagnostic DISC, University of Genoa; ⁹Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova; ¹⁰Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, IRCCS, Milano; ¹¹Directorate General, Veneto Institute of Oncology IOV-IRCCS, Padua; ¹²Department of Surgery, Oncology and Gastroenterology, DISCOG, University of Padua, AOPD Azienda Ospedale Università Padova, Padova, Italy.

Background: Melanoma is a severe and potentially fatal skin cancer, which is particularly sensitive to delays in diagnosis and treatment (Figure 1). It has been widely demonstrated that the diagnostic delays during COVID-19 pandemic determined higher incidence of advanced disease at presentation. Despite the fact that oncological surgery remained operative in Italy, the pandemic peak and lockdown led to reductions in the number of patient visits and diagnostic testing. This study aimed to investigate if the indirect impact of pandemic in Italy could be identified also in the second year of pandemic, analyzing the characteristics of primary melanoma at the diagnosis.

Methods: It has been conducted a retrospective observational multicenter study involving 10 SICO Italian Melanoma centres. The pre-pandemic period (1^st March 2019 - 28^th February 2020, 1640 diagnoses) was compared to the Pandemic period (1^st March 2021 – 28^th February 2022, 1292 diagnoses). Melanoma Centre Units were classified into «Covid-free centres» (without Covid-19 dedicated beds) or «Covid centres» (with COVID-19 dedicated beds). Clinically relevant tumor characteristics at the diagnosis were considered: Breslow thickness, tumor stage, intratumoral and peritumoral-infiltrating lymphocytes (TILs), mitosis, and ulceration.

Results: This study found that there was a statistically significant reduction in the mean interval from diagnosis to surgery between pre-pandemic and pandemic period only in COVID-19 centres (p=0.002). This is explained by the fact that they needed to change their case mix treating only oncological patients or emergencies, in order to face the demands of COVID-19 pandemic. Our results showed an indirect effect of the pandemic in Italy during the second year on melanoma features at the diagnosis (Breslow thickness p< 0.0001, tumor stage p = 0.002, ulceration p = 0.04, SNLB p = 0.03) (Table 1).

Conclusions: It was confirmed an indirect impact of pandemic on tumor characteristics at the diagnosis during the second year of outbreak equally in both Covid and Covid-free centres. Politics to preserve access to dermatological visits are necessary and must be preserved in both Covid free and Covid Centers in case of pandemics, also using strategies such as teledermatology to do preliminary skin examinations when the number of specialist visits is restricted.

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Table 1.
Summary of the outcome measures in the pre-pandemic period (from March 2019 to February 2020) and the pandemic period (from March 2021 to February 2022) stratified by COVID-19-free centers and COVID-19 centers.

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Figure 1. 
Histology of skin Melanoma: hematoxylin and eosin staining.