# Indirect Impact of Pandemic on the Diagnosis of New Primary Melanoma: A Retrospective, Multicenter Study

## TL;DR

This study shows that the pandemic indirectly affected melanoma diagnoses in Italy, with delayed treatment and thicker tumors detected even in the second year of the pandemic.

## Contribution

The study confirms the indirect impact of the pandemic on melanoma characteristics in the second year and highlights the importance of early diagnosis policies.

## Key findings

- Melanoma characteristics at diagnosis showed an indirect impact of the pandemic in the second year.
- Thicker tumors and later stages were observed during the pandemic period.
- Diagnostic delays were linked to changes in hospital priorities during the pandemic.

## Abstract

Background/Objectives: The indirect impact of the pandemic on the diagnosis and treatment of new primary melanoma has been carefully evaluated in recent years. The aim of the present study was to investigate if the indirect impact of the pandemic in Italy could be detectable also in the second year of the pandemic, as suggested by the characteristics of melanoma at diagnosis. Methods: Retrospective analysis of 1640 diagnoses of cutaneous melanoma in pre-pandemic period and 1292 diagnoses in the pandemic period from 10 centers (from 1 March 2019 to 28 February 2022). Results: Our findings confirmed an indirect impact of the pandemic on characteristics of incident melanoma, also in the second year of the pandemic in Italy (Breslow thickness p < 0.0001, tumor stage p = 0.002, ulceration p = 0.04, SNLB p = 0.03), without statistically significant differences between centers. A statistically significant reduction in the time interval from diagnosis to surgical treatment was observed, but only in centers that had to modify their case mix to address the needs of treating COVID-19 patients (p = 0.0002). Conclusions: Our study confirmed the indirect impact of the pandemic on melanoma characteristics at the diagnosis in the second year of the pandemic in Italy. We also found no differences in melanoma characteristics between hospitals with different organization. Diagnostic delays may be related to a delayed access of the patient to the entire diagnostic pathway, and therefore, especially in the case of a pandemic, policies to support early diagnosis are crucial.