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A recent systematic review analyzed how the COVID-19 pandemic disrupted melanoma diagnosis and treatment.1 Researchers found an increase in disease incidence, severity, and diagnostic delays when comparing results pre- and post-pandemic. This is one of the first systematic reviews to explore the impact of COVID-19 on melanoma treatment practices.
Background
During the unprecedented time of the COVID-19 global pandemic, lockdowns and curfews were implemented, limiting the scheduling of routine appointments like cancer screenings, skin checks, and follow-ups. Melanoma diagnoses dropped by up to 67% in April 2020.2 Other cancers, such as breast and colorectal, saw up to a 90% decline in screenings.3 Although cancer and melanoma rates appeared to decrease during this time, it’s likely due to the delayed diagnosis rather than an actual reduction in cases.
Methods & Materials
A literature search of the PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted in September 2024. Investigators compared study findings from pre-pandemic and pandemic periods. Pre-COVID-19 was considered to be between the years 2015 and 2019 while COVID-19/post-COVID-19 included years between 2019 and 2024.
The analysis included clinical trials, observational studies, reviews, and case studies. Of the 503 studies initially screened, 55 were eligible and included in the final review. One was a modeling study while the rest were observational studies. These were conducted in Europe (particularly the United Kingdom), Canada, the United States, Australia, Israel, and South America (particularly in Brazil). In both pre- and post-pandemic periods, the majority of patients were between the ages of 58 and 69, with a slight male predominance.
Authors extracted patient population characteristics along with incidence rates, Breslow thickness, ulceration, stage at diagnosis, mortality, treatment changes, and adaptations. The Newcastle–Ottawa Scale and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist were used to assess the risk of bias.
Results & Critical Findings
Diagnosed melanoma cases decreased during the pandemic, with referrals and biopsies falling dramatically in 53 of the studies. Monthly referrals in Australia declined by 48% with Canada saw a 27% drop in biopsy rates. Initial visits to a dermatologist decreased by up to 37% in Italy. Italy also observed a 29% decrease in sentinel lymph node biopsies.
With this, Breslow thickness and ulceration rates increased, indicating delayed presentations and more advanced, aggressive disease. In some cases, mean Breslow thickness increased from 1.1 mm in the pre-COVID-19 era to 1.8 mm during the pandemic. Ulceration rates nearly doubled in some findings as well (~ 11.7% to 22.6%).
Additionally, less surgical excisions were performed, with a decrease of up to 20%. This could be due to limited surgical resources, reduced hospital capacities, and hesitancy among patients. Many countries saw an increase in presentations with inoperable tumors. These findings are consistent with what was researched in other cancer types, specifically breast, colorectal, prostate, and cervical cancers.
Future Planning for Global Emergencies
With this proven increase in severe melanoma during the pandemic period, it is imperative for health providers to be more prepared and strengthen future pandemic responses. The study authors outlined several methods to help mitigate diagnosis delays and prevent stage migration in melanoma and other cancers.
Clinics should create clear policies and frameworks for cancer care, especially for high-risk patients. This could include clear communication and follow-up methods with patients as well as ensuring there is an adequate number of staff members for procedures, if needed.
The authors also introduced the early implementation of innovative diagnostic methods like teledermatology and artificial intelligence. Although telemedicine is not a substitute, it can be beneficial during public emergencies as an initial check. Additionally, more public education on self-conducted skin checks or other prevention practices can promote earlier intervention in case another global emergency like the COVID-19 pandemic occurs.
References
1.Soni, A., Purcell, E., Lim, B., Marcaccini, G., Seth, I. and Rozen, W.M. (2025), The Silent Spread: A Systematic Review of Delayed Melanoma Diagnosis and Disease Progression During the COVID-19 Pandemic. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70154
2. McBain RK, Cantor JH, Jena AB, Pera MF, Bravata DM, Whaley CM. Decline and Rebound in Routine Cancer Screening Rates During the COVID-19 Pandemic. J Gen Intern Med. 2021;36(6):1829-1831. doi:10.1007/s11606-021-06660-5
3. Schadendorf D, van Akkooi ACJ, Berking C, et al. Melanoma. Lancet. 2018;392(10151):971-984. doi:10.1016/S0140-6736(18)31559-9