Disruptions from the COVID-19 pandemic have affected every area of health care. A new study published in the American Academy of Dermatology found that more melanomas in advanced stages and with aggressive features were diagnosed during the pandemic, suggesting COVID-19 shutdowns caused a delay in the diagnosis — and a delay in treating the dangerous skin cancer.
Sancy Leachman, M.D., Ph.D., chair of the OHSU Department of Dermatology and the director of the OHSU Knight Cancer Institute’s Melanoma Program, co-lead the study in collaboration with Harvard Medical School and Brigham and Women’s Hospital, and colleagues at 12 academic centers with dedicated melanoma clinics across the country. She says the study’s findings, coupled with declining rates of new melanoma diagnoses nationally, suggest that melanoma cases went undiagnosed during the COVID-19 pandemic and were identified only after the cancer had progressed to later stages.
“As someone who is dedicated to treating and preventing melanoma, the results of the study were sobering,” Leachman says. “It appears that some patients with melanoma couldn’t be seen as readily due to COVID-related restrictions, leading to worse, and potentially more life-threatening, cases of melanoma.”
The study observed increased rates of patient-identified melanomas and decreased rates of provider-identified melanomas during the COVID-19 pandemic, and the cancers were in more advanced stages at diagnosis — emphasizing the importance of screening high-risk individuals. Melanoma is the most dangerous type of skin cancer in part because it’s much more likely to spread to other parts of the body if not caught and treated early.
Leachman says it’s a problem that needs to be taken into consideration in future pandemics and balanced with the need for control of the virus.
“If you are a high-risk melanoma patient or you see something suspicious — even if it is during a pandemic — it is incredibly important for you to be seen by a provider, even if it is done virtually or by sending a photograph,” she says. “Death is not the outcome we want for anyone, whether it is from COVID or melanoma, so risks during a pandemic need to be balanced.”
Hospitals continue to experience heavy demand and backlog due to the pandemic. Because delays in care often exacerbate health conditions, patients are arriving at OHSU with more complex and acute health care needs because of delays in care during the pandemic.
OHSU leaders advise people to stay abreast of preventive health care, like skin cancer screenings; get regular check-ups; and don't ignore health concerns.
“Following the COVID-19 shutdowns, our team has seen more people in my clinic with more advanced melanomas, and that plays out in the data from this national study,” said Elizabeth Berry, M.D., associate professor of dermatology in the OHSU School of Medicine and a co-author on the study. “We are also seeing this trend in other types of skin cancer. Fortunately, people are now seeking care, but it will take us a while to catch up.”
Caleb Freeman, M.D., is a second-year resident in the department of dermatology who led the OHSU data collection for the study. He says the delays in diagnosis of melanoma due to COVID-19 reinforce the importance of routine self-skin exams.
“Of the cases of melanoma diagnosed in the first year of the pandemic, over 50% were first detected independently by the patient,” he says. “We encourage everyone to familiarize themselves with the skin findings of melanoma and to seek further evaluation by a health provider with any concerns. Any delay in diagnosis can be costly.”
To raise awareness about what people can do to check their skin, the dermatology team created a public health campaign called “Start Seeing Melanoma,” explaining what to look for, how to properly do skin exams, and what to do if you find something suspicious.
Funding for this study was provided by the Melanoma Research Foundation.