Impact of the COVID-19 pandemic on melanoma: A retrospective study from the French clinical database of melanoma patients (RIC-Mel).

BACKGROUND

COVID-19 pandemic had a variable impact on the severity of melanomas.

OBJECTIVE

To assess the role of the COVID-19 pandemic in France on the severity of melanomas at initial diagnosis.

METHODS

New melanoma cases recorded in the French RIC-Mel database were included in a retrospective study spanning three timeframes: pre-COVID (01/01/2018 to 03/16/2020), lockdown (03/17/2020 to 10/05/2020), and the COVID pandemic period (hereafter referred to as "COVID") (11/05/2020 to 30/09/2022). Patient and melanoma characteristics at diagnosis, along with time intervals to lymph node procedures and initiation of systemic treatments, were extracted. Statistical comparisons were conducted between the pre-COVID and COVID periods.

RESULTS

A total of 3650 patients in the pre-COVID period were included: 121 during lockdown, and 2878 during the COVID period. Melanomas diagnosed during the COVID period were thicker (median 1.5 mm; interquartile range [IQR]: 0.7-3.6) compared to those in the pre-COVID period (median 1.2 mm; IQR: 0.5-3.0; p < 0.0001) and more frequently ulcerated (25.4 % vs. 20.6 %; p < 0.0001). The average number of melanomas diagnosed per day decreased from 4.53 (pre-COVID) to 3.30 (COVID), primarily due to reductions in Tis (-32.4 %) and T1 stage diagnoses (-32.5 %). Adjusted odds ratios (adj OR), accounting for age at diagnosis, sex, personal history of melanoma, and treatment center, indicated increased frequency of advanced tumor stages during the COVID period: T2 (adj OR = 1.23; 95 % confidence interval [CI]: 1.0519-1.459; p = 0.0130), T3 (adj OR = 1.204; 95 % CI: 1.027-1.425; p = 0.0310), and T4 (adj OR = 1.467; 95 % CI: 1.237-1.731; p < 0.001). Stage III cases rose from 6.3 % to 11.9 % (adj OR = 2.05; 95 % CI: 1.67-2.51; p < 0.001). Sentinel lymph node biopsy (SLNB) rates almost doubled (40.3 % vs. 23.4 %; p < 0.001), with a higher positivity rate (adj OR = 1.26; 95 % CI: 1.02-1.56; p = 0.035). Interval times between diagnosis and SLNB, as well as initiation of systemic therapy, remained similar across study periods.

CONCLUSION

In France, the COVID-19 pandemic was associated with a higher proportion of severe melanoma cases, partially attributed to a reduction in the diagnosis of thin melanomas.