Skin Cancer and COVID-19: Research and Links Between Diagnosis and the Pandemic

Researchers have made significant progress in understanding the impact of the COVID-19 virus on dermatologic conditions, and skin cancer and melanoma is no exception.

This week, Dermatology Times is highlighting recent COVID-19 research affecting skin, hair, and nails in recognition of 4 years since the start of the pandemic. Recent studies have delved into the correlation between COVID-19 infection and teledermoscopy, skin cancer monitoring during the pandemic, the impact of the pandemic on skin cancer diagnosis and management, and more.

Artificial Intelligence and Teledermoscopy Services

The COVID-19 pandemic caused a notable decrease in new skin cancer diagnoses worldwide due to reduced access to in-person dermatologic evaluations and procedures, according to one study.¹ Teledermatology, including teledermoscopy, has emerged as analternative for remote assessment of skin lesions. Teledermoscopy, which involves using dermoscopic images for evaluation, is useful for triage and monitoring, aiding in early skin cancer detection and reducing unnecessary referrals and costs, researchers noted in the review. Mobile teledermoscopy enables patients to monitor suspicious lesions and share images with healthcare providers through smartphone apps. While artificial intelligence-based apps for skin lesion assessment are gaining popularity, integrating dermoscopic images into these platforms could enhance diagnostic accuracy and improve skin cancer screening in the future, wrote Lee et al.

Another study, published in JAMA Dermatology, aimed to assess whether an artificial intelligence decision support tool, using a machine learning algorithm, could enhance the quality of images submitted for telemedicine by providing real-time feedback and explanations to patients.² It involved a retrospective analysis of telemedicine images followed by a clinical pilot study. The artificial intelligence tool effectively identified and provided reasons for poor-quality images in retrospective analysis. In the clinical pilot study, patients using the tool showed improved image quality, with a significant reduction in poor-quality images submitted. This suggests that integrating AI decision support into telemedicine could enhance the quality of skin disease photographs, potentially improving diagnostic accuracy and patient care, study authors wrote.

Delayed Access to Care and Impacts on Diagnosis

One study involved a retrospective review of patients with non-melanoma skin cancer (NMSC) in the head and neck region treated at a maxillofacial surgery unit in Siena, Italy, between January 2018 and December 2021.³ Patients were divided into 2 cohorts: pre-pandemic (2018-2019) and pandemic (2020-2021). Inclusion criteria comprised patients who underwent surgery for NMSC and had complete data. Data collected included patient demographics, lesion characteristics, biopsy results, surgical details, histological features, and follow-up data.

Results showed an increase in basal cell carcinoma diagnoses during the pandemic period, along with a significant decrease in surgical time. Additionally, various reconstructive techniques were employed, with local flap reconstruction being the most frequent. During the follow-up period, local recurrence was observed in some patients, with no significant difference in survival probabilities between the pre-pandemic and pandemic periods.

A multicenter economic evaluation focused on the impact of COVID-19 lockdowns on melanoma detection and subsequent public health and economic burdens.⁴ Data from patients with invasive primary cutaneous melanomas in Switzerland and Hungary were used to estimate upstaging rates and calculate years of life lost (YLL) and associated costs.

The study found that pandemic-related delays in melanoma diagnosis resulted in an estimated 111,464 YLL and additional costs of $7.65 billion in Europe. Indirect treatment costs were the main driver, comprising 94.5% of total costs. The analysis also estimated years lost due to disability and disability-adjusted life-years, highlighting the overall disease burden. The findings underscore the importance of maintaining secondary skin cancer prevention measures during pandemics and emphasize the need to consider indirect economic costs in decision-making processes, wrote Maul et al.

Skin Cancer Monitoring Service Delivery

During the COVID-19 pandemic, dermatological services faced disruptions, leading to decreased skin cancer screenings. In response, a private dermatology practice utilized semi-automated total body photography (TBP) for visual skin examinations. A cross-sectional study compared patient characteristics and self-reported melanoma risk factors associated with TBP between May and November 2020 with the same period in 2019.⁵

Results showed that patients opting for home TBP were younger, had higher self-reported skin cancer risk, and more previous TBP sessions. Overall, TBP sessions increased, while dermoscopy usage and biopsies decreased. However, there was no change in skin cancer diagnoses, and the Melanoma-In-Situ:Invasive Melanoma ratio exceeded the US ratio reported for 2020. Semi-automated TBP proved effective during the pandemic without compromising skin cancer detection, according to study authors.

References

1. Lee C, Witkowski A, Żychowska M, Ludzik J. The role of mobile teledermoscopy in skin cancer triage and management during the COVID-19 pandemic. Indian J Dermatol Venereol Leprol. 2023;89(3):347-352. Accessed March 20, 2024. doi:10.25259/IJDVL_118_2022
2. Vodrahalli K, Ko J, Chiou AS, et al. Development and clinical evaluation of an artificial intelligence support tool for improving telemedicine photo quality. JAMA Dermatol. 2023;159(5):496-503. Accessed March 20, 2024. doi:10.1001/jamadermatol.2023.0091
3. Benedetti S, Frosolini A, Catarzi L, Marsiglio A, Gennaro P, Gabriele G. Impact of the COVID-19 pandemic on the diagnosis and management of non-melanoma skin cancer in the head and neck region: A retrospective cohort study. Healthcare (Basel). 2024;12(4):501. Published 2024 Feb 19. Accessed March 20, 2024. doi:10.3390/healthcare12040501
4. Maul LV, Jamiolkowski D, Lapides RA, et al. Health economic consequences associated with COVID-19-related delay in melanoma diagnosis in Europe. JAMA Netw Open. 2024;7(2):e2356479. Published 2024 Feb 5. Accessed March 20, 2024. doi:10.1001/jamanetworkopen.2023.56479
5. Drugge ED, Sarac RM, Fay P, Drugge RJ. Semi-automated total body photography supports robust delivery of skin cancer monitoring services during the SARS-COV2/COVID-19 pandemic. Dermatol Online J. 2021;27(4):13030/qt2202r5hk. Published 2021 Apr 15.