The Effect of the COVID-19 Lockdown on Melanoma Diagnosis in Italy

Abstract The COVID-19 pandemic has led to lockdowns for much of the world. In Italy, all health procedures not directly related to COVID-19 were reduced/suspended, thus limiting patient access to hospitals. Any delay in cancer treatment presents the additional risk of tumors progressing from being curable to becoming incurable. Specifically, melanoma survival rate strictly depends on tumor thickness which, in turn, is a function of time. To estimate the impact on melanoma progression of the reduction in the dermatologic services during the COVID-19 lockdown, a retrospective observational cohort study was conducted, designed to compare the clinical/histologic characteristics of the primary melanomas removed in the first two months after the end of the lockdown (May-July 2020) in twelve Italian centers characterized by different COVID-19 case frequencies. The control group was represented by the melanomas removed in the same period of the previous three years. Overall, 1,124 melanomas were considered: 237 as part of the study group and 887 from the control group (average 295), with a 20% reduction. Breslow thickness – as well as high-risk histotypes and melanomas with vertical growth – increased for all melanomas. Ulcerated and high mitotic index melanomas increased, particularly in northern Italy. In Italy, the lockdown led to a significant worsening of melanoma severity, determining a staging jump, with a consequent worsening of the outcomes.