Delays in melanoma diagnoses due to the pandemic continue to take their toll, leading to more advanced and difficult-to-treat skin cancers. This is shown by a study conducted at the Melanoma Unit of the Dermopathic Institute of the Immaculate Conception (Idi) in Rome and published in the “Journal of the European Academy of Dermatology and Venereology”. Research has indeed shown that diagnosed melanomas in the early 2021 were discovered at a more advanced stage than those diagnosed before the pandemic, and they had a degree of infiltration (Breslow thickness) which went from an average of 0.88 mm in the pre-pandemic phase to an average of 1.96 mm in the immediate post-lockdown.
The new work shows that the days of the study period (January-June 2021) were 157 and the new cases of melanoma detected 294, with an average number of 1.9 new diagnoses per day (slightly lower than the 2.3 new diagnoses daily observed at the IDI in the pre-pandemic phase). The greater severity of melanomas seen in the immediate post-lockdown of 2020 was also repeated in the first months of 2021. This greater severity was evident both in terms of the average Breslow thickness (1.4 mm in 2021 versus 0, 88 mm of the pre-pandemic period), and for the clinical characteristics of these tumors, with a higher proportion of nodular melanomas (13.7% compared to 4.2%), ulcerated (10.4% vs 5.9%) or with a nodular growth component (10.0% versus 5.0%).
“The indirect consequences of the pandemic – he says Paolo Marchetti, scientific director of the IDI, full professor of Oncology at the La Sapienza University of Rome and President of the Foundation for Personalized Medicine – make themselves heard for patients who are diagnosed with more advanced melanoma. The thickness of the melanoma is decisive for establishing the course of treatment. When it is less than a millimeter, surgery is enough in most cases to achieve healing. When it exceeds the millimeter, it is instead necessary to evaluate any involvement of the lymph nodes (sentinel lymph node technique) and a different disease extension balance with second and third level examinations, because the risk of disease recurrence is higher. More advanced diagnoses result not only in greater suffering for patients and their families, but also in substantial costs for the national health system. The diagnostic delay accumulated in 2020 was not fully absorbed in 2021. Therefore, interventions by the institutions are necessary, also in terms of investments to hire more medical and nursing staff, with the aim of restoring and accelerating the diagnosis and treatment of melanoma “.
The percentage of less severe melanomas remained substantially stable in the various pandemic phases (25-28% of the total melanomas) and is very close to the values observed in the period 2018-2019. The diagnostic delay mainly concerned men aged 50 years or older. “A positive note that emerges from the study is the greater attention paid by women to the body and health in general – concludes Marchetti -. In fact, the diagnostic delay is lower in women than in men. Hence the importance of targeted awareness campaigns aimed at the male population. In conclusion, our findings suggest that we may still be paying the price for the reduction in prevention, later diagnoses and the reduced number of early diagnoses caused by the pandemic. “