Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
1/12
Published by Medical Jou nals Sweden, on behal o he Socie y o Publica ion o Ac a De ma o-Vene eologica. This is an Open Access a icle dis ibu ed
unde he e ms o he C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional License (h ps://c ea i ecommons.o g/licenses/by-nc/4.0/)
REVIEW ARTICLE
SIGNIFICANCE
The COVID-19 pandemic has dis up ed global heal hca e
since Decembe 2019, wi h unce ain long- e m e ec s on
skin cance . Ou s udy e iewing 27 esea ch pape s and
o e 373,000 skin cance cases ound ha om Janua y
o June 2020, melanoma su ge ies dec eased by 29.7%,
and ke a inocy e ca cinomas su ge ies by 50.8%. Tumou s
ope a ed on du ing he pandemic’s ea ly mon hs had in-
c eased hickness and s age. E en beyond his phase, me-
lanoma su ge ies emained down by 9.3%, and ke a ino-
cy e ca cinomas by 16.6%. The s udy sugges s ha he
pandemic likely led o delays in skin cance diagnosis and
ea men , po en ially a ec ing pa ien ou comes.
Since Decembe 2019, he COVID-19 pandemic has
p o oundly a ec ed heal hca e. The eal e ec s o he
COVID-19 pandemic on skin cance a e s ill unclea ,
mo e han 3 yea s la e . This s udy aims o summa ise
he pandemic’s impac on skin cance diagnosis and
ou come. A sys ema ic e iew and me a-analysis was
conduc ed, selec ing s udies compa ing skin cance
diag nosis and p ognosis pos -pandemic wi h p e-pan-
demic da a. A o al o 27 pape s we e e iewed inclu-
ding 102,263 melanomas and 271,483 ke a inocy e
ca cinomas. Du ing he ini ial pandemic mon hs (Janu-
a y–July 2020), melanoma su ge ies d opped by 29.7%
and ke a inocy e ca cinomas su ge ies by 50.8%. Ea ly
pandemic umou s exhibi ed g ea e hickness and
s age. In a long- e m pe iod beyond he ini ial mon hs,
melanoma su ge ies dec eased by 9.3%, ke a inocy e
ca cinomas by 16.6%. No signi ican di e ences we e
obse ed in he B eslow hickness o melanomas a e
he s a o he pandemic (mean di e ence 0.06, 95%
con idence in e al –0.46, 0.58). Melanomas ope a ed on
pos -pandemic onse had an inc eased isk o ulce a ion
(odds a io 1.35, 95% con idence in e al 1.22–1.50).
Ke a inocy e ca cinomas showed inc eased hickness
and wo sened s age pos -pandemic. How e e , s udies
included we e mos ly e ospec i e and c oss-sec ional,
epo ing di e se da a. This e iew indica es ha he
pandemic likely caused delays in skin cance diagnosis
and ea men , po en ially impac ing pa ien ou comes.
Key wo ds: melanoma; squamous cell ca cinoma; basal cell
ca cinoma; COVID-19.
Submi ed Sep 18, 2024. Accep ed a e e iew Feb 22, 2024
Published Ma 14, 2024. DOI: 10.2340/ac ad . 104.19460
Ac a De m Vene eol 2024; 104: ad 19460.
Co : An onio Ma ínez-López, A enida de Mad id 15, ES-18014, G a-
nada, Spain. E-mail: [email p o ec ed]
In Decembe 2019, se e e acu e espi a o y synd ome
co ona i us ype-2 (SARS-CoV-2) eme ged in Wuhan,
China. This i us has sp ead globally and has p oduced
o e 770 million COVID-19 cases and 6.9 million
dea hs wo ldwide (1). In he mos a ec ed coun ies,
go e nmen s imposed gene al con inemen s and
COVID-19 o ced li es yle changes (2). These measu es
also a ec ed heal hca e sys ems, necessi a ing adap a-
ions o main ain pa ien ca e, wi h a no iceable neglec
o o he diseases like skin cance (3). Mo eo e , pa ien s
s opped consul ing, p ima ily due o ea o in ec ion (4).
Skin cance s a e he mos equen umou s in humans,
wi h an inc easing incidence (5). Delays in diagnosis
mean wo se umou s ages, causing poo e su i al
a es and he need o mo e complex p ocedu es, such
as su gical laps o g a s and adju an he apies (6, 7).
The ue impac o he COVID-19 pandemic on skin
cance , o e 3 yea s a e i s onse , emains unclea .
Knowing hese da a could help o de elop s a egies o
main ain ea ly diagnosis in u u e con inemen s, po en i-
ally in ol ing ini ia i es like elede ma ology, imp o ed
iaging, o educa ional campaigns.
The aim o his s udy is o summa ise he COVID-19
pandemic’s impac on skin cance diagnosis and ou come.
METHODS
Design
A sys ema ic e iew and me a-analysis we e pe o med ollo-
wing he P e e ed Repo ing I ems o Sys ema ic Re iews and
Me a-Analyses checklis (8) (Table SII). The s udy p o ocol was
egis e ed on PROSPERO (www.c d.yo k.ac.uk/PROSPERO/
display_ eco d.asp?ID=CRD42022369656).
Da a sou ces and sea ch s a egy
Da a we e ob ained om he ollowing da abases: MEDLINE,
Embase, Scopus, Web o Science, and Coch ane Lib a y.
We used he ollowing sea ch e ms: (melanoma OR squamous
cell ca cinoma OR basal cell ca cinoma) AND COVID-19, using
he il e s: “Humans” and “Adul s”.
E ec s o COVID-19 Pandemic on he Diagnosis o Melanoma and
Ke a inocy e Ca cinomas: a Sys ema ic Re iew and Me a-analysis
Pablo DÍAZ-CALVILLO
1,2
, Daniel MUÑOZ-BARBA
1,2
, Cla a UREÑA-PANIEGO
1,2
, La a Valeska MAUL
3
, Sa a CERMINARA
3
, Lisa
KOSTNER
3
, An onio MARTÍNEZ LÓPEZ
1,2,*
and Sal ado ARIAS-SANTIAGO
1,2,4
1
Depa men o De ma ology, Vi gen de las Nie es Uni e si y Hospi al,
2
Ins i u o de In es igación Biosani a ia ibs.GRANADA, G anada,
Spain,
3
Depa men o De ma ology, Uni e si y Hospi al o Basel, Basel, Swi ze land,
4
Depa men o De ma ology, Uni e si y o G anada,
G anada, Spain
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”2/12
Ac a De m Vene eol 2024
Fo ull sea ch s a egy o each da abase, see Appendix S1.
As ou sea ch s a egy used index, some pe inen a icles migh
no be included due o he indexing delay. To mi iga e his, we
supplemen ed he sea ches wi h manual sc eening. In addi ion, a
supplemen a y sea ch was ca ied ou o lessen he possibili y o
publica ion bias by manually sea ching he e e ence lis s o he
a icles ha we e selec ed o he e iew.
Inclusion and exclusion c i e ia
Inclusion: o iginal a icle o clinical ial, coho s udy, case-con ol
s udy, o c oss-sec ional s udy, assessing changes in skin cance
diagnosis and p ognosis a e he pandemic and compa ing wi h
he p e-pandemic pe iod, published in pee - e iewed jou nals and
w i en in English o Spanish.
Exclusion: e iews, guidelines, p o ocols, le e s, con e ence ab-
s ac s, unpublished s udies, case epo s, and case se ies.
The selec ion o a icles was ca ied ou by PDC, DMB, and
CUP. Disc epancies we e esol ed by consensus among all au ho s.
Documen a y quali y
To assess isk o bias, we used he Na ional Ins i u es o Heal h
quali y assessmen ool (9). This con ains 14 ques ions and, o
each a icle, 1 poin was assigned o each p esen i em (i no
applicable, no sco ed), ca ego ised as good (> 9 c i e ia), ai
(5–9), o poo (< 5) (Table SI).
Da a ex ac ion
Duplica e eco ds we e e ined using EndNo e X9 (Cla i a e Ana-
ly ics, London, UK). The a icles we e classi ied acco ding o he
a iables: i s au ho , yea o publica ion, coun y, design, quali y
o he s udy, numbe o pa icipan s, skin cance ype s udied, and
he pe iods ocused on o ou comes. We hen s a i ied he da a
acco ding o skin cance ype. Fo melanoma s udies, we collec-
ed: p e-pandemic s udy pe iod, pandemic s udy pe iod, numbe
o days in each pe iod, numbe o umou s, age, sex, B eslow
hickness, mi o ic index, T- alue ( om he TNM), and s aging
acco ding o he Ame ican Join Commi ee on Cance , eigh h
edi ion (10). In a icles s udying ke a inocy e ca cinomas (KC)
we collec ed: p e-pandemic s udy pe iod, pandemic s udy pe iod,
numbe o days in each pe iod, ype o umou s udied, numbe
o umou s, age, sex, in asion dep h, and T- alue (10). Da a o
in e es ha we e no included in he a icles we e calcula ed based
on he da a epo ed in each pape .
S udies we e s a i ied acco ding o whe he hey assessed he
sho - e m e ec s o he pandemic ( ocusing on he mon hs o i s
con inemen s: Ma ch–July 2020) o he long- e m ones (beyond
he mon hs o i s con inemen s o assessing he pe iod o con ine-
men in addi ion o la e pe iods). F om he s udies ha compa ed
a ious pe iods be o e he pandemic, we ob ained he a e age o
he di e en a iables. The s udies we e o de ed acco ding o he
numbe o days s udied.
S a is ical analysis
Me a-analyses we e pe o med i 3 o mo e a icles had a ailable
da a. Thus, he long- e m e ec o he COVID-19 pandemic on
B eslow hickness and ulce a ion we e es ima ed. In s udies in-
ol ing se e al pandemic pe iods, he da a we e combined in o
a single pe iod. We used weigh ed da a om he s udies, which
we e hen p esen ed in o es plo s along wi h hei 95% con idence
in e als. The he e ogenei y among he s udies was e alua ed
using he Coch ane Q s a is ic and I2 measu e. We obse ed high
he e ogenei y o B eslow hickness and used a andom e ec s
model o calcula e he ou come. In con as , we de ec ed low he e-
ogenei y o ulce a ion and used a ixed e ec s model o calcula e
he odds a io. To assess publica ion bias we used unnel plo s
(Figs S1–S2). Sensi i i y analyses we e pe o med by excluding
s udies wi h a high isk o bias o assess signi ican ly changes in
he he e ogenei y. The da a analysis was conduc ed using Re iew
Manage e sion 5.4 (Coch ane Collabo a ion, 2020).
RESULTS
We iden i ied 1,032 pape s ac oss da abases (Fig. 1).
A e emo ing duplica e en ies, 740 pape s emained.
Following sc eening, 658 we e excluded: 328 we e un-
ela ed o skin cance , 91 lacked a p e-pandemic con ol
g oup, 231 we e no o iginal a icles om clinical ial,
coho , case-con ol, o c oss-sec ional s udies, 6 we e
no in English o Spanish, and 2 we e inaccessible.
Ano he 55 we e excluded because hey did no in-
es iga e changes in diagnosis o p ognosis a e he
pandemic. Ul ima ely, 27 pape s we e included (Table I;
11–37).
Conce ning s udy design, 16 c oss-sec ional s udies,
10 coho s udies, and 1 case-con ol s udy we e in-
cluded. Using he Na ional Ins i u es o Heal h quali y
assessmen ool, 5 s udies had “poo ” quali y and 22
“ ai ” quali y. The majo i y o s udies (n = 23) we e
conduc ed in Eu ope, wi h I aly con ibu ing he mos
(n = 7). Fou s udies we e om No h Ame ica and 1
was om Aus alia. In o al, 373,746 umou s we e
included: 102,263 melanomas and 271,483 KC. Fi een
s udies ocused on melanoma, 4 on KC, and 8 included
bo h ypes. Conce ning ou comes, 8 s udies ocused on
sho - e m ou comes, 16 on long- e m ou comes, and 3
on bo h. Six s udies included mo e han 2 s udy pe iods
(20, 23, 27, 29, 31). Fou s udies had di e en du a ions
o he p e-pandemic and pandemic g oups (15, 17, 18,
20). The pandemic ime o s udy a ied om 28 days
(34) o 731 days (12), and he p e-pandemic pe iod om
28 days (34) o 1,141 days (15).
Reco ds iden i ied om:
MEDLINE (n = 63)
Embase (n = 419)
Scopus (n = 332)
Web o Science (n = 211)
Coch ane Lib a y (n = 7)
Duplica e eco ds emo ed
(n = 292)
Reco ds sc eened (n = 740)
Repo s excluded (n = 658)
No ela ed o skin cance (n = 328)
No p e-pandemic con ol g oup (n = 91)
No o iginal a icles o clinical ial,
coho s udy, case-con ol s udy o
c oss-sec ional (n
= 231)
O he language (n = 6)
No access (n = 2)
S udies selec ed (n = 82)
Repo s excluded (n = 55)
No ela ed o diagnosis educ ion o
p ognosis a e COVID-19 (n = 55)
S udies included in e iew
(n = 27)
Iden i ica ion
Sc eening
Included
Fig. 1. Flow diag am o s udies included in he e iew.
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
3/12 P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”
Ac a De m Vene eol 2024
Sho - e m e ec s o COVID-19 on melanoma
Ten s udies assessed he sho - e m e ec s o he pande-
mic on melanoma (Table II; 17, 20, 25, 26, 29–31, 34,
36), encompassing 17,962 melanomas. Conside ing he
7 pape s ha s udied he same numbe o days be o e
and a e he pandemic (25, 26, 29–31, 34, 36), 4,411
melanomas we e ea ed be o e and 3,100 a e he pan-
demic, a educ ion o 29.7%.
All 3 s udies assessing B eslow hickness epo ed an
inc ease a e he pandemic (17, 20, 34). Two s udies
e alua ed ulce a ion, e ealing an inc ease in he pe cen-
age o ulce a ed melanomas a e he pandemic (34, 36).
Sange s e al. (20) and Teje a-Vaque izo e al. (36) as-
sessed he e ec s on TNM. In bo h s udies T1 melanomas
dec eased, while T2, T3, and T4 melanomas inc eased. In
si u melanomas we e only assessed by Teje a-Vaque izo
e al. (36), obse ing a educ ion a e he pandemic.
Long- e m e ec s o COVID-19 pandemic on melanoma
The long- e m e ec s o COVID-19 pandemic on mela-
noma we e s udied in 18 pape s (Table III; 11–20, 24,
26–28, 32, 34, 35, 37), in ol ing 95,974 melanomas.
Among s udies ha include he same numbe o days in
pe iods s udied be o e and a e he pandemic (11–14,
16, 17, 19, 24, 26–28, 30, 32, 34, 35, 37), 40,305 pa ien s
unde wen su ge y be o e he pandemic and 36,541 a e -
wa ds, a dec ease o 9.3%. The numbe o in e en ions
declined in all o hese s udies, excep o 3 o hem (14,
35, 37). In he s udy wi h he longes ime pe iod s udied
(12), he d op was om 163 o 138, while he s udy
wi h he sho es ime pe iod s udied (35) had a highe
numbe o melanomas ope a ed on a e he pandemic,
om 22 o 25.
Nine s udies e alua ed he e ec s o he pandemic on
B eslow hickness (11, 12, 14, 15, 19, 20, 24, 27, 34, 35).
In mos , B eslow hickness wo sened, no ably in Ma í-
nez-López e al. (19) (1.08 o 2.65) and Je emic e al. (15)
(1.80 o 3.00). Se e is e al. (35), Hu ley e al. (14), and
in he i s pos -con inemen pe iod o Sange s e al. (20),
epo ed lowe B eslow hickness a e he pandemic. A
me a-analysis o 6 s udies ound no signi ican di e en-
ces be ween p e-pandemic and pandemic pe iods, wi h a
mean di e ence o 0.06 (95% CI, –0.46, 0.58) (Fig. 2).
Sensi i i y analyses demons a ed ha excluding s udies
wi h a high isk o bias educed he e ogenei y, sugges ing
ha s udy quali y may in luence obse ed he e ogenei y.
Howe e , excluding s udies wi h small sample sizes did
no signi ican ly impac he e ogenei y.
Rega ding ulce a ion, 8 s udies assessed i (11, 12, 14,
15, 17, 19, 24, 34). All showed an inc ease in ulce a ed
melanomas, pa icula ly in Ma ínez-López e al. (19)
(11.7 o 22.6) and Je emic e al. (15) (33.7 o 44.2), bu
wi h he excep ion o Kos ne e al. (17) (21.2 o 20.6).
Me a-analysis e ealed a highe isk o ulce a ion in
pandemic melanomas, wi h an odds a io o 1.35 (95%
CI 1.22–1.50) (Fig. 3). Sensi i i y analyses did no show
signi ican a ec a ion o he he e ogenei y.
Six s udies e alua ed T- alue (12, 13, 18, 20, 24, 35).
The pe cen age o in si u and T1 melanomas dec eased
a e he pandemic, excep o in si u melanomas in Je e-
Table I. S udy cha ac e is ics
S udy
numbe Fi s au ho Yea o
publica ion Coun y S udy design Quali y Pa icipan s Tumou s udied Ou comes ocused
1T oesch (11) 2023 Swi ze land, Ge many,
Aus ia, I aly C oss-sec ional Fai 7865 Melanoma Long e m
2Aabed (12) 2022 Romania Coho Fai 301 Melanoma Long e m
3Da is (13) 2022 Uni ed S a es Coho Fai 688 Melanoma Long e m
4Hu ley (14) 2022 I eland C oss-sec ional Fai 589 Melanoma Long e m
5Je emic (15) 2022 Se bia C oss-sec ional Fai 393 Melanoma Long e m
6Kleeman (16) 2022 Ge many C oss-sec ional Fai 242,985 Melanoma, KC Long e m
7Kos ne (17) 2022 Swi ze land Coho Fai NR Melanoma Sho e m
8Lamm (18) 2022 Uni ed S a es C oss-sec ional Fai 112 Melanoma Long e m
9Ma ínez-López (19) 2022 Spain Coho Fai 130 Melanoma Long e m
10 Sange s (20) 2022 Ne he lands Coho Fai 89,266 Melanoma, KC Sho e m, long e m
11 Shahid (21) 2022 Uni ed Kingdom C oss-sec ional Fai 174 KC Long e m
12 Sil ia (22) 2022 I aly C oss-sec ional Fai 214 KC Long e m
13 Slo man (23) 2022 Ne he lands C oss-sec ional Fai 49,040 KC Sho e m
14 Ungu eanu (24) 2022 Romania Coho Fai 616 Melanoma Long e m
15 Anichini (25) 2021 I aly C oss-sec ional Poo 5,542 Melanoma Sho e m
16 Asai (26) 2021 Canada Coho Fai 6,185 Melanoma, KC Sho e m, long e m
17 Be y (27) 2021 Aus alia C oss-sec ional Poo NR Melanoma Long e m
18 Cocuz (28) 2021 Romania C oss-sec ional Fai 246 Melanoma, KC Long e m
19 Fe a a (29) 2021 I aly C oss-sec ional Poo 4,158 Melanoma, KC Sho e m
20 Filoni (30) 2021 I aly Coho Poo 130 Melanoma Sho e m
21 Gualdi (31) 2021 I aly Coho Fai 532 Melanoma Sho e m
22 Gu en (32) 2021 Tu key C oss-sec ional Fai 25 Melanoma Long e m
23 Hamel (33) 2021 Uni ed S a es C oss-sec ional Poo 594 KC Sho e m
24 Hoellwe h (34) 2021 Aus ia C oss-sec ional Fai 1,365 Melanoma Sho e m, long e m
25 Se e is (35) 2021 G eece C oss-sec ional Fai 131 Melanoma, KC Long e m
26 Teje a-Vaque izo (36) 2021 Spain Coho Fai 1,758 Melanoma, KC Sho e m
27 Valen i (37) 2021 I aly Case-con ol Fai 1,146 Melanoma, KC Long e m
KC: ke a inocy e ca cinoma.
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”4/12
Ac a De m Vene eol 2024
Table II. Sho - e m e ec s o COVID-19 pandemic on melanoma
Fi s au ho Hoellwe h (34) Asai (26) Fe a a (29) Sange s (20)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 16/03/2018–
13/04/2018 16/03/2019–
13/04/2019 16/03/2020–
13/04/2020 11/03/2019–
21/04/2019 09/03/2020–
19/04/2020 11/03/2019–
19/05/2019 +
12/03/2018–
20/05/2018
09/03/2020–
17/05/2020 01/01/2019–
11/03/2020 12/03/2020–
31/05/2020
Numbe o days in he s udy pe iod 28 28 28 41 41 69 69 436 80
Numbe o melanomas 32 43 18 323 96 181 92 9,377 1037
Age, yea s, mean (SD) 60a63a62a64.54 (15.91) 65.44 (15.12) NR NR 62.8 (15.0) 61.5 (16.0)
Sex, % males/% emales 56.3/43.7 41.9/58.1 55.6/44.4 52.9/46.1 59.4/40.6 NR NR 50.2/49.8 47.7/52.3
B eslow index, mm, mean (SD) 0.69* 0.58* 0.76* NR NR NR NR 1.5 (0.02) 1.66 (0.067)
Ulce a ion, % 0.00 6.98 18.00 NR NR NR NR NR NR
Mi o ic index, mean (SD) NR NR NR NR NR NR NR NR NR
Tis, % NR NR NR NR NR NR NR NR NR
T1, % NR NR NR NR NR NR NR 58.6 52.3
T2, % NR NR NR NR NR NR NR 17.8 18.9
T3, % NR NR NR NR NR NR NR 11.0 13.2
T4, % NR NR NR NR NR NR NR 7.3 9.1
S age 0, % NR NR NR NR NR NR NR NR NR
S age I, % NR NR NR NR NR NR NR NR NR
S age II, % NR NR NR NR NR NR NR NR NR
S age III, % NR NR NR NR NR NR NR NR NR
S age IV, % NR NR NR NR NR NR NR NR NR
Fi s au ho Filoni (31) Anichini (25) Teje a-Vaque izo (36) Gualdi (31) Kos ne (17)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 23/02/2019–
21/05/2019 23/02/2020–
21/05/2020 01/02/2019–
30/04/2019 01/02/2020–
30/04/2020 14/03/2019–
13/06/2019 14/03/2020–
13/06/2020 01/05/2017–
31/07/2017 +
01/05/2018–
31/07/2018 +
01/05/2019–
31/07/2019
01/05/2020–
31/07/2020 01/02/2019–
15/03/2020 16/03/2020–
22/06/2020
Numbe o days in he
s udy pe iod 87 88 89 90 91 91 93 93 409 98
Numbe o melanomas 66 64 3,156 2,386 352 207 295 237 NR NR
Age, yea s, mean (SD) NR NR NR NR 64.0 (16.4) 62.9 (16.7) NR NR NR NR
Sex, % males/% emales NR NR NR NR 44.3/55.7 57.5/42.5 NR NR NR NR
B eslow index, mm, mean
(SD) NR NR NR NR NR NR NR NR 1.2 (0.6–2.6) 1.4 (0.7–3.0)
Ulce a ion, % NR NR NR NR 13.9 20 NR NR NR NR
Mi o ic index, mean (SD) NR NR NR NR NR NR NR NR NR NR
Tis, % NR NR NR NR 34.9 29.0 NR NR NR NR
T1, % NR NR NR NR 31 26.6 NR NR NR NR
T2, % NR NR NR NR 12.2 14.5 NR NR NR NR
T3, % NR NR NR NR 11.6 11.6 NR NR NR NR
T4, % NR NR NR NR 10.2 18.4 NR NR NR NR
S age 0, % NR NR NR NR 34.9 20.9 NR NR NR NR
S age I, % NR NR NR NR 39.7 36.7 NR NR NR NR
S age II, % NR NR NR NR 18.2 24.6 NR NR NR NR
S age III, % NR NR NR NR 5.7 8.2 NR NR NR NR
S age IV, % NR NR NR NR 1.7 1.4 NR NR NR NR
SD: s anda d de ia ion; NR: no epo ed; amedian ( ange).
mic e al. (15), and T1 in Se e is e al. (35), Gu en e al.
(32), and he ou h pe iod o Sange s e al. (20) (which
co esponds o he second pe iod o con inemen in he
Ne he lands). T2, T3, and T4 umou s inc eased in all
cases, excep o Sange s e al. (20). Rega ding umou
s aging, he pe cen age o ad anced umou s (s age III
and IV) inc eased. In Hu ley e al. (14), he pe cen age
o me as a ic melanomas dec eased a e he pandemic
and in Sange s e al. (20) he da a a ied acco ding o
he pe iod s udied a e he pandemic.
Sho - e m e ec s o COVID-19 pandemic on
ke a inocy e ca cinomas
A o al o 96,313 umou s we e analysed in 6 s udies
(Table IV; 20, 23, 26, 29, 33, 36). Six s udies ocused
on squamous cell ca cinoma (SCC), 2 ocus on SCC and
basal cell ca cinoma (BCC) and 2 s udies do no speci y
he umou ype. Among s udies conside ing he same
numbe o days be o e and a e he pandemic (23, 26,
29, 33, 36), 39,407 umou s unde wen su ge y be o e
and 19,389 a e wa ds, indica ing a 50.8% educ ion.
The in asion dep h was only assessed in SCC in
Sange s e al. (20). Sange s e al. (20) and Teje a-
Vaque izo e al. (36) conside ed he T- alue, obse ing
a dec ease in he pe cen age o T1 umou s and an
inc ease in he pe cen age o T2, T3, and T4 umou s
a e he pandemic.
Long- e m e ec s o COVID-19 pandemic on
ke a inocy e ca cinomas
A o al o 247,263 umou s we e analysed in 7 s udies
(Table V; 16, 20–22, 28, 35, 37). Fi e s udies ocused
on SCC, 1 ocused on SCC and BCC and 3 do no
speci y he umou ype. Among s udies conside ing
an equal numbe o days be o e and a e he pandemic
(16, 21–23, 28, 35, 37), 99,570 umou s unde wen su -
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
5/12 P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”
Ac a De m Vene eol 2024
Table III. Long- e m e ec s o COVID-19 on melanoma
Fi s au ho Se e is (35) Be y (27) Lamm (18) Hu ley (14)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 20/05/2019–
20/09/2019 20/05/2020–
20/09/2020 01/04/2017–
31/08/2017,
01/04/2018–
31/08/2018,
01/04/2019–
31/08/2019
01/04/2020–
31/08/2020 01/05/2019–
30/04/2020 01/05/2020–
30/09/2021 01/03/2019–
31/12/2019 01/03/2020–
31/12/2020
Numbe o days in he
s udy pe iod 123 123 153 153 366 153 306 306
Numbe o melanomas 22 25 NR NR, 48% less han
p e-pandemic pe iod 51 61 277 312
Age, yea s, mean (SD) 66.23 (13.97) 63.64 (18.19) NR NR 61.3 (2.09) 63.0 (1.98) 68.5 (25–96)a63.1 (24–91)a
Sex, % males/ %
emales 81.8/18.2 44.0/56.0 NR NR 62.7/37.3 52.5/47.5 49.5/50.5 46.8/53.2
B eslow index, mm,
mean (SD) 6.88 (2.10)b1.31 (0.59)c2.06 2.70 NR NR 3.11 (3.65) 2.60 (3.16)
Ulce a ion, % NR NR NR NR NR NR 22.7 29.9
Mi o ic index, mean
(SD) NR NR NR NR NR NR 1.60 (3.95) 2.29 (4.98)
Tis, % 37.5d1.1e18.3 7.5 9.8 4.9 NR NR
T1, % 12.5 d 55.6eNR NR 43.1 26.2 NR NR
T2, % 0.0 d 22.2eNR NR 29.4 34.4 NR NR
T3, % 0.0 d 11.1eNR NR 9.8 19.7 NR NR
T4, % 50.0 d 0.0eNR NR 7.8 14.8 NR NR
S age 0, % NR NR NR NR 9.8 3.2 NR NR
S age I, % NR NR NR NR 41.2 27.9 NR NR
S age II, % NR NR NR NR 15.7 8.2 NR NR
S age III, % NR NR NR NR 211.5 NR NR
S age IV, % NR NR NR NR 3.8 0.0 5.78 3.21
Fi s au ho Cocuz (28) Kleeman (16) Je emic (15) Kos ne (18)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 01/04/2019–
29/02/2020 01/04/2020–
28/02/2021 18/03/2019–
17/03/2020 18/03/2020–
17/03/2021 01/01/2017–
14/03/2020 15/03/2020–
31/03/2022 01/02/2019–
16/03/2020 17/03/2020–
30/04/2021
Numbe o days in he
s udy pe iod 335 334 366 365 1169 381 410 410
Numbe o melanomas 40 10 31,910 29,822 339 54 655 585
Age, yea s, mean (SD) NR NR NR NR 64.5 (15.8) 65.7 (15.3) 63.9 (15.3) 64.2 (15.2)
Sex, % males/ %
emales NR NR NR NR 55.8/44.2 55.6/44.4 60.6/39.4 58.8/41.2
B eslow index, mm,
mean (SD) 2.06 2.70 NR NR 1.80 (0.65–4.30)a3.00 (1.50–5.30)a2.23 (3.14) 2.23 (3.26)
Ulce a ion, % NR NR NR NR 33.7 44.2 21.2 20.6
Mi o ic index, mean
(SD) NR NR NR NR 2 (0–5)a5 (1–12)aNR NR
Tis, % NR NR 9.80 7.94 NR NR NR NR
T1, % NR NR NR NR NR NR NR NR
T2, % NR NR NR NR NR NR NR NR
T3, % NR NR NR NR NR NR NR NR
T4, % NR NR NR NR NR NR NR NR
S age 0, % NR NR NR NR 16.8 20.4 NR NR
S age I, % NR NR NR NR 30.4 14.8 54.7 58.2
S age II, % NR NR NR NR 15.0 11.1 22.0 18.8
S age III, % NR NR NR NR 15.0 24.1 17.4 20.4
S age IV, % NR NR NR NR 22.7 29.6 5.8 2.6
Fi s au ho Sange s (20) Valen i (37) Da is (13) Asai (26)
S udy pe iod P e-pandemic Pandemic (pos - i s
lockdown) P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 01/01/2019–
11/03/2020 01/06/2020–
13/10/2020 18/05/2019–
18/11/2019 18/05/2020–
18/11/2020 01/08/2019–
31/03/2020 01/05/2020–
31/12/2020 7/01/2019–
29/09/2019 6/01/2020–
27/09/2020
Numbe o days in he
s udy pe iod 436 135 184 184 244 245 265 265
Numbe o melanomas 9,377 3,532 224 237 375 313 1,399 804
Age, yea s, mean (SD) 62.8 (15.0) 63.1 (15.0) 64.3 65.4 65.7 67 NR NR
Sex, % males/ %
emales 50.2/49.8 48.9/51.1 NR NR NR NR NR NR
B eslow index, mm,
mean (SD) 1.50 (0.02) 1.48 (0.03) NR NR NR NR NR NR
Ulce a ion, % NR NR NR NR NR NR NR NR
Mi o ic index, mean (SD) NR NR NR NR NR NR NR NR
Tis, % NR NR NR NR 17.9 15.3 NR NR
T1, % 58.6 58.1 NR NR 55.8 42. 8 NR NR
T2, % 17.8 18.0 NR NR 16.5 16.3 NR NR
T3, % 11.0 11.4 NR NR 7.2 9. 6 NR NR
T4, % 7.3 5.9 NR NR 0.3 1.6 NR NR
S age 0, % NR NR NR NR NR NR NR NR
S age I, % NR NR NR NR NR NR NR NR
S age II, % NR NR NR NR NR NR NR NR
S age III, % NR NR NR NR NR NR NR NR
S age IV, % NR NR NR NR NR NR NR NR

Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”6/12
Ac a De m Vene eol 2024
ge y be o e and 83,036 a e he pandemic, indica ing
a 16.6% educ ion.
Shahid e al. (21) epo ed an inc ease in median in a-
sion dep h a e he pandemic. Con e sely, in Sange s e
al. (20), all pos -pandemic alues ac oss di e en pe iods
we e lowe compa ed wi h he median in asion dep h in
p e-pandemic SCC. Kleemann e al. (16) no ed a dec ease
in he pe cen age o in si u KC, om 3.8% o 3.4%. No
o he s udy assessed changes in in si u umou s. T- alue
was e alua ed in 3 s udies, wi h Shahid e al. (21) and
Se e is e al. (35) epo ing a dec ease in T1 SCC and
an inc ease in T2, T3, o T4 umou s a e he pandemic.
Howe e , in Sange s e al. (20) alues we e e y simila
p e-pandemic and in di e en pandemic pe iods. Valen i
Fig. 2. Fo es plo o
B eslow hickness
di e ences in pape s
s udying long- e m
changes in melanoma.
Table III. Con inued.
Fi s au ho Gu en (32) Ma ínez-López (19) Ungu eanu (24)
S udy pe iod P epandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 01/03/2019–
31/12/2019 01/03/2020–
31/12/2020 15/03/2019–
14/03/2020 15/03/2020–
14/03/2021 01/03/2019–
29/02/2020 01/03/2020–
28/02/2021
Numbe o days in he
s udy pe iod 306 306 366 365 366 365
Numbe o melanomas 15 10 77 53 341 275
Age, yea s, mean (SD) NR NR 63.31 (1.88) 65.02 (2.27) 59 63
Sex, % males/ %
emales NR NR 44.2/55.8 43.4/56.6 48.1/51.9 50.2/49.8
B eslow index, mm,
mean (SD) NR NR 1.08 (0.28) 2.65 (0.34) 1.37 (0.5–3.5)a2.20 (0.70–
5.11)a
Ulce a ion, % NR NR 11.7 22.6 32.8 40.7
Mi o ic index, mean
(SD) NR NR 1.40 (0.56) 3.58 (0.69) 3 (1–7)a4 (1–10)a
Tis, % NR NR NR NR 17.3 14.2
T1, % NR NR NR NR 32.8 25.9
T2, % NR NR NR NR 13.5 12.8
T3, % NR NR NR NR 17.6 15.2
T4, % NR NR NR NR 18.4 30.2
S age 0, % NR NR 39.0 17.0 NR NR
S age I, % 6.7 10.0 37.7 37.7 NR NR
S age II, % 26.7 10.0 11.7 22.6 NR NR
S age III, % 33.3 40.0 10.4 20.8 NR NR
S age IV, % 33.3 40.0 1.3 1.9 NR NR
Fi s au ho Hoellwe h (35) T oesch (11) Aabed (12)
S udy pe iod P e-pandemic P e-pandemic Pandemic Pandemic (second
lockdown) Pandemic
(pos -second
lockdown)
P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 2018 2019 2020 14/10/2020–
27/04/2021 28/04/2021–
22/07/2021 01/09/2018–
16/03/2020
17/03/2020
–31/08/2021 01/01/2018–
31/12/2019 01/01/2020–
31/12/2022
Numbe o days in he
s udy pe iod 365 365 366 225 146 563 549 730 731
Numbe o melanomas 428 505 432 4,049 2,439 4,340 3,525 163 138
Age, yea s, mean (SD) 61 60 63 64.2 (15.0) 63.5 (15.0) 62.3 (16.2) 63.4 (15.6) 58.1 (16.3) 58.8 (15.9)
Sex, % males/ %
emales 53.3/46.7 51.5/48.5 54.0/46.0 50.6/49.4 46.4/53.6 53.0/47.0 53.0/47.0 53.4/46.6 50.7/49.3
B eslow index, mm,
mean (SD) 0.65 0.6 0.7 1.51 (0.04) 1.59 (0.05) 1.02 (1.91) 1.25 (2.51) 1.1 (0.4) 1.8 (0.5)
Ulce a ion, % 4.91 4.36 8.33 NR NR 10.0 13.0 17.2 24.6
Mi o ic index, mean (SD) NR NR NR NR NR NR NR NR NR
Tis, % NR NR NR NR NR NR NR 3.7 2.2
T1, % NR NR NR 59.0 58.2 NR NR 19.0 9.4
T2, % NR NR NR 16.0 18.7 NR NR 30.1 20.3
T3, % NR NR NR 10.3 9.2 NR NR 44.2 56.5
T4, % NR NR NR 7.6 8.0 NR NR 3.1 11.6
S age 0, % NR NR NR NR NR 38.0 35.0 3.7 2.2
S age I, % NR NR NR NR NR 34.0 33.0 12.3 6.5
S age II, % NR NR NR NR NR 13.0 13.0 25.8 11.6
S age III, % NR NR NR NR NR 8.0 10.0 55.2 68.1
S age IV, % NR NR NR NR NR 6.0 8.0 3.1 11.6
SD: s anda d de ia ion; NR: no epo ed; amedian ( ange); b5 pa ien s analysed; c8 pa ien s analysed; d8 pa ien s analysed; e9 pa ien s analysed; di e en da es o he end o he
p e-pandemic pe iod, and he e o e he s a o he pandemic pe iod, depending on he i s con i med case in each coun y included in he s udy.
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
7/12 P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”
Ac a De m Vene eol 2024
e al. (37) was he only one o assess he high- isk s a us
o SCC, obse ing an inc ease om 1.1% o 5.0% a e
he pandemic.
DISCUSSION
In he sho e m, skin umou diagnoses no ably de-
c eased, especially du ing widesp ead lockdowns (38).
KC showed mo e signi ican educ ions han melanomas,
likely because heal hca e cen es p io i ised melanoma
ea men (39).
Hospi al sa u a ion du ing peak pandemic pe iods,
p ima ily ocused on COVID-19 ca e, di e ed esou ces
om condi ions like skin cance (3). Con e sely, pa ien s’
ea o consul a ion was p oposed as a de e minan in
delayed skin cance diagnosis. In Teje a-Vaque izo e
al. (36), ocusing on he mon hs o gene al con inemen
in Spain, ea o SARS-CoV-2 in ec ion was epo ed
as a p edic o o SCC diame e in mul i a ia e analysis.
Two su eys on changes in melanoma ea men du ing
he pandemic obse ed a low pe cen age o al e a ions,
mos ly by pa ien choice. Fea o SARS-CoV-2 and
men al heal h p oblems, pa icula ly anxie y disease,
we e epo ed as he main causes (4).
O he non-cu aneous umou s expe ienced a educ ion
in pos -pandemic diagnoses, wi h e en b eas , colo ec-
al, and p os a e cance sc eening p og ammes being
a ec ed. This has been linked o poo e p ognos ic da a
a diagnosis (40).
Following con inemen s, a ious s udies epo ed an
inc ease in skin umou diagnoses compa ed wi h p e-
ious yea s (23, 34). Pa ien s who did no consul du ing
con inemen delayed hei consul a ion un il a e he
con inemen . Howe e , in he long e m, we ha e obse -
ed a dec ease in he numbe o skin umou s diagnosed.
A mo e signi ican educ ion was seen in KC (16.6%),
compa ed wi h melanomas (9.3%).
Du ing he i s pandemic mon hs, we obse ed poo e
in asion dep h and s aging da a. Following ecommen-
da ions o p io i ise su ge ies o umou s wi h poo e
p ognosis, hose wi h be e p ognosis we e possibly
delayed un il hospi al sa u a ion allowed o in e en-
ions. Consequen ly, he e was a ela i e inc ease in
umou s wi h highe in asion dep h and wo se s age. As
epo ed by Teje a-Vaque izo e al. (36), al hough he
same numbe o SCC la ge han 4 cm we e ope a ed on
du ing he 3 mon hs o con inemen in Spain as in he
3 mon hs be o e, hese umou s accoun ed o a highe
p opo ion o he o al numbe o umou s ope a ed on
du ing con inemen .
In he long e m, we con inue o obse e wo se p og-
nos ic da a. Tumou s wi h delayed diagnoses du ing
con inemen and hose wi h ea men delayed in a ou
o umou s wi h a wo se p ognosis had a longe e olu ion
ime. S udies epo ed a median delay o 21 days om
p esen a ion o diagnosis o melanoma and 57 days o
SCC (12, 21).
Time o umou p og ession is a well-known ac o as-
socia ed wi h wo se p ognos ic ou comes (41). A delay in
melanoma diagnosis is associa ed wi h educed su i al
a es and an inc eased demand o mo e in ica e and less
cos -e ec i e p ocedu es, including selec i e sen inel
lymph node biopsy, posi on emission omog aphy, o
sys emic ea men (12, 19, 42). Simila ly, KC wi h an
ex ended e olu ion ime may need mo e complex su gical
echniques wi h highe complica ion a es, such as laps
o skin g a s, o e en o he ea men s like adju an
adio he apy o sys emic he apies, al hough he impac
on su i al may no be as p onounced (7).
In pape s s udying bo h he sho - and long- e m e -
ec s o he pandemic, Hoellwe h e al. (34) ound a 50%
educ ion in melanoma su ge ies du ing he pandemic in
an Aus ian hospi al and, in he long e m, highe B es-
low hickness and mo e ulce a ed melanomas. Sange s
e al. (20), con e sely, no ed mo e agg essi e melano-
mas and SCC du ing he ini ial Du ch con inemen , bu
no signi ican long- e m pandemic impac , sugges ing
ha slowe -g owing umou s’ diagnoses we e delayed,
bu no as -g owing ones. Two na ionwide lockdowns
we e implemen ed in he Ne he lands in 2020 and 2021
and ou ine ca e was downscaled. Fu he mo e, ou
me a-analysis showed no signi ican B eslow hickness
wo sening pos -pandemic, unlike ulce a ion, possibly
due o da a he e ogenei y ac oss selec ed pape s. As
Ma ínez-López e al. (19) obse ed, ulce a ion co ela es
wi h highe B eslow hickness (43).
Fig. 3. Fo es plo
o ulce a ion in
pape s s udying
long- e m changes
in melanoma.
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”8/12
Ac a De m Vene eol 2024
Rega ding coun ies’ s a egies, lockdowns and es ic-
ions led o a signi ican educ ion in medical ac i i ies,
including skin cance sc eenings (44). S udies om
Canada and I aly epo ed 70% and 50% educ ion in me-
lanoma diagnoses du ing s ic lockdown, espec i ely,
emphasizing he co ela ion be ween delayed diagnosis
and poo p ognosis (26, 29). Howe e , o he s udies om
I aly and he Ne he lands showed p omp managemen
o se e e cases, main aining con inui y in heal hca e se -
ices (20, 25, 30). Colla e al damage om con ainmen
measu es unde sco es he need o adap able heal hca e
deli e y. The e o e, sc eening and managemen o skin
cance should pe sis wi h app op ia e p ecau ions du ing
u u e pandemics. No ably, eleconsul a ion became
wide sp ead du ing he pandemic, p o ing use ul in
keeping pa ien s in consul a ion and a oiding unneces-
sa y a el. Howe e , he e is a isk o unde -diagnosis,
as o al body examina ions may be los . Fu he mo e,
p o iding heal h p omo ion and p e en ion in o ma ion
h ough elede ma ology is challenging. The impac o
eleconsul a ion on skin cance p ognosis du ing he
pandemic emains unclea and wa an s assessmen in
u u e esea ch (45).
S eng hs
The s udy con ibu es signi ican ly o he li e a u e by
add essing a imely and ele an opic, in es iga ing he
impac o he COVID-19 pandemic on melanoma and
KC ou comes. I is he i s sys ema ic e iew o ana-
lyse he impac o COVID-19 pandemic on skin cance
beyond melanoma, using eal-wo ld da a and adding a
me a-analysis. O e all, he s udy ills a gap in ou unde -
s anding o he impac o he COVID-19 pandemic on
skin cance and p o ides use ul insigh s o heal hca e
p o essionals and policymake s.
Limi a ions
The COVID-19 pandemic is an ongoing si ua ion and
he e may no ye be su icien long- e m da a a ailable
o ully assess i s impac on skin cance ou comes. The
s udies included in ou e iew we e conduc ed mainly
in Eu ope and No h Ame ica, limi ing gene alisa ions,
as no s udies om Asia, Sou h Ame ica, o A ica we e
included. Mo eo e , he a ied implemen a ion o pan-
demic measu es ac oss egions hinde s compa isons
ac oss s udies.
Mos o he s udies we included a e e ospec i e and
wi h a c oss-sec ional design, impac ing hei le el o
e idence. Addi ionally, none o he s udies eached he
“good” ca ego y in ou quali y assessmen . Expe imen al
s udies o de e mine he eal e ec s o he pandemic
on skin cance would no be possible, and skin cance
ou comes can be in luenced by a ious ac o s, making i
challenging o sepa a e he e ec s o he pandemic om
o he a iables, such as pa ien age, umou s age, and
como bidi ies. He e ogenei y in a iables and in s udy
pe iods limi s compa abili y ac oss s udies. Fu he -
mo e, combining BCC and SCC in he analysis migh
Table IV. Sho e m e ec s o COVID-19 pandemic on ke a inocy e ca cinomas [AQ4]
Fi s au ho Asai (26) Hamel (34) Fe a a (29)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 11/03/2019–
21/04/2019 09/03/2020–
19/04/2020 11/01/2020–
10/03/2020 11/03/2020–
09/05/2020 11/03/2019–
19/05/2019,
12/03/2018–
20/05/2018
09/03/2020–
17/05/2020
Numbe o days in he s udy pe iod 41 41 59 59 69 69
Tumou s udied No speci ied SCC BCC SCC BCC No speci ied
Numbe o umou s 4,731 1,035 185 181 149 79 1,689 508
Age, yea s, mean (SD) 71.4 (13.6) 68.9 (13.0) NR NR NR NR NR NR
Sex, % males/ % emales 54.75/45.25 60.58/39.42 NR NR NR NR NR NR
B eslow index, mm, mean (SD) NR NR NR NR NR NR NR NR
Tis, % NR NR NR NR NR NR NR NR
T1, % NR NR NR NR NR NR NR NR
T2, % NR NR NR NR NR NR NR NR
T3, % NR NR NR NR NR NR NR NR
T4, % NR NR NR NR NR NR NR NR
Fi s au ho Sange s (20) Teje a-Vaque izo (36) Slo man (23)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 1/01/2019–
11/03/2020 12/03/2020–
31/05/2020 14/03/2019–
13/06/2019 14/03/2020–
13/06/2020 01/03/2017–31/05/2017,
01/03/2018–31/05/2018,
01/03/2019–31/05/2019
01/03/2020–
31/05/2020
Numbe o days in he s udy pe iod 436 80 91 91 92 92
Tumou s udied SCC SCC SCC BCC SCC BCC
Numbe o umou s 31,654 4,175 770 429 6,017 25,834 4,272 12,917
Age, yea s, mean (SD) 76.8 (10.5) 76.4 (10.2) 79.8 (10.9) 79.0 (11.3) NR NR NR NR
Sex, % males/ % emales 57.5/47.5 58.6/41.4 67.53/33.47 63.64/36.36 NR NR NR NR
B eslow index, mm, mean (SD) 3.09 (2.05) 3.19 (2.03) NR NR NR NR NR NR
Tis, % NR NR NR NR NR NR NR NR
T1, % 74.1 73.4 70.1 54.5 NR NR NR NR
T2, % 5.6 5.7 11.9 14.2 NR NR NR NR
T3, % 7.3 8.6 16.7 29.6 NR NR NR NR
T4, % 0.0 0.0 1.3 1.6 NR NR NR NR
SD: s anda d de ia ion; NR: No epo ed; SCC: squamous cell ca cinoma; BCC: basal cell ca ci-noma.
Ac aDV Ac aDV
Ad ances in de ma ology and ene eology Ac a De ma o-Vene eologica
9/12 P. Díaz-Cal illo e al. “E ec s o COVID-19 pandemic on skin cance ”
Ac a De m Vene eol 2024
in oduce limi a ions. BCC ypically exhibi s a slowe
g ow h a e, a ely me as asizes and may no ha e been
signi ican ly impac ed by he pandemic. Finally, we
acknowledge ha many s udies in he li e a u e we e
excluded om ou e iew, pa icula ly le e s o he
edi o , which may limi he assessmen o me hodology
and quali y o e idence.
In conclusion, ou e iew indica es ha he COVID-19
pandemic has had a signi ican impac on skin cance ou -
comes. Despi e limi a ions in he e iewed s udies, hey
p o ide aluable insigh s in o he e ec s o he pandemic
on skin cance . The esul s sugges ha he pandemic may
ha e led o delays in skin cance diagnosis and ea men ,
which may ul ima ely a ec pa ien ou comes. Howe e ,
u he esea ch is needed o ully unde s and he long-
e m e ec s o he pandemic on skin cance ou comes
and o iden i y s a egies o mi iga ing i s impac .
ACKNOWLEDGEMENTS
The esul s o his s udy a e pa o he PhD p ojec o Pablo
Díaz-Cal illo.
Da a sha ing is no applicable o his a icle as no da ase s we e
gene a ed o analysed du ing he cu en s udy.
The au ho s ha e no con lic s o in e es o decla e.
REFERENCES
1. Wo ld Heal h O ganiza ion (WHO). No el Co ona i us
(2019-nCoV) si ua ion epo s. 2023 [ci ed 2023 17 Sep].
A ailable om: www.who.in /eme gencies/diseases/no el-
co ona i us-2019/si ua ion- epo s.
2. Fe an e G, Camussi E, Piccinelli C, Seno e C, A ma oli P,
O ale A, e al. Did social isola ion du ing he SARS-CoV-2
epidemic ha e an impac on he li es yles o ci izens? Epi-
demiol P e 2020; 44: 353–362.
3. Roge s MC, Wallace MM, Wheless L, Dewan AK. Impac o
he COVID-19 pandemic on inpa ien de ma ology consul
Fi s au ho Kleeman (16) Sange s (20)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic (pos - i s
lockdown) Pandemic (second
lockdown) Pandemic (pos -
second lockdown)
Da es o s udy pe iod 18/03/2019–
17/03/2020 18/03/2020–
17/03/2021 01/01/2019–
11/03/2020 01/06/2020–
13/10/2020 14/10/2020–
27/04/2021 28/04/2021–
22/07/2021
Numbe o days in he s udy
pe iod 366 365 436 135 225 146
Tumou s udied No speci ied No speci ied SCC SCC SCC SCC
Numbe o umou s 98734 82519 31654 11541 14930 6532
Age, yea s, mean (SD) NR NR 76.8 (10.5) 77.2 (10.2) 77.2 (10.3) 77.2 (10.0)
Sex, % males/ % emales 58.4/41.2, 53.8/46.2a58.9/41.1, 55.3/44.7a57.5/42.5 56.4/43.6 58.2/41.8 56.8/43.2
B eslow index, mm, mean (SD) NR NR NR NR NR NR
Tis, % 3.8 3.4 NR NR NR NR
T1, % NR NR 74.1 73.0 74.0 73.4
T2, % NR NR 5.6 5.6 6.2 6.2
T3, % NR NR 7.3 6.9 6.8 6.1
T4, % NR NR 0.0 0.0 0.1 0.0
SD: s anda d de ia ion; NR: no epo ed; SCC: squamous cell ca cinoma; BCC: basal cell ca cinoma; asex epo ed o in asi e umou s and non-in asi e umou s.
Table V. Long- e m e ec s o COVID-19 pandemic on ke a inocy e ca cinomas
Fi s au ho Shahid (21) Sil ia (22) Se e is (35) Valen i (38)
S udy pe iod P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic P e-pandemic Pandemic
Da es o s udy pe iod 01/10/2019–
31/10/2019 01/10/2020–
31/10/2020 01/12/2019–
31/01/2020 01/12/2020–
31/01/2021 20/05/2019–
20/09/2019 20/05/2020–
20/09/2020 18/05/2019–
18/11/2019 18/05/2020–
18/11/2020
Numbe o days in he s udy pe iod 31 31 62 62 123 123 184 184
Tumou s udied SCC No speci ied SCC SCC
Numbe o umou s 74 199 121 93 29 55 461 224
Age, yea s, mean (SD) 81.4 (9.3) 81.0 (9.5) NR NR 77.21 (11.58) 77.82 (10.40) 64.3 65.4
Sex, % males/ % emales 58.73/41.27 72.73/27.27 NR NR 72.41/27.59 72.73/27.27 51.79/48.21 56.96/43.03
B eslow index, mm, mean (SD) NR NR NR NR NR NR
Tis, % NR NR NR NR NR NR
T1, % 45.9 31.3 55.2 52.7 NR NR
T2, % 52.7 61.5 31.0 34.5 NR NR
T3, % 1.4 6.3 10.3 12.7 NR NR
T4, % 0.0 1.0 3.4 0.0 NR NR
Fi s au ho Cocuz (28)
S udy pe iod P e-pandemic Pandemic
Da es o s udy pe iod 01/04/2019–
29/02/2020 01/04/2020–
28/02/2021
Numbe o days in he s udy pe iod 335 81 31 334 28 6
Tumou s udied SCC BCC Basosquamous
ca cinoma SCC BCC Basosquamous
ca cinoma
Numbe o umou s 39 11
Age, yea s, mean (SD) NR NR NR NR NR NR
Sex, % males/ % emales NR NR NR NR NR NR
B eslow index, mm, mean (SD) NR NR
Tis, % NR NR
T1, % NR NR
T2, % NR NR
T3, % NR NR
T4, % NR NR