Background: The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. Objective: To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018–2019) with the phase following the pandemic’s second wave (2021–2022). Methods: An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. Results: More cSCC lesions were excised prior to the interruption of services (n= 312 vs.n= 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm;p= 0.006) and more invasive (52% vs. 89%;p< 0.001), in the period 2021–2022. Surgical reconstructive techniques were significantly different (p= 0.001). Metastatic involvement was confirmed in three subjects (one in 2018–2019 and two in 2021–2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55–8.16,p< 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09–3.88,p= 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44–7.17,p= 0.004). Conclusions: Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.
背景：皮肤肿瘤的延迟诊断与预后恶化相关。COVID-19大流行封锁期间临床和外科医疗服务中断的影响已在多种疾病中得到记录，但其对皮肤鳞状细胞癌（cSCC）患者延迟诊断的影响尚不明确。目的：比较大流行前服务中断期（2018-2019年）与第二波疫情后阶段（2021-2022年）期间切除的cSCC患者特征、病灶特点及手术管理差异。方法：开展一项为期两年的观察性单中心横断面研究，纳入416例手术切除的cSCC病例，仅收录经组织学确诊的患者。数据收集包括患者人口统计学特征、病灶特点、手术等待时间、手术方式及组织学数据。结果：服务中断前切除的cSCC病灶数量更多（312例 vs. 186例）。2021-2022年期间病灶显著更大（1.7±1.2 cm vs. 2.1±1.5 cm；p=0.006），侵袭性更强（52% vs. 89%；p<0.001）。手术重建技术存在显著差异（p=0.001）。三例患者确诊转移（2018-2019年1例，2021-2022年2例）。手术等待时间及患者特征无显著差异。多变量回归分析显示：肿瘤侵袭风险增加4.7倍（OR 4.69，95%CI 2.55-8.16，p<0.001），真皮-表皮移植概率增加2倍（OR 2.06，95%CI 1.09-3.88，p=0.025），手术切缘阳性风险增加3.2倍（OR 3.21，95%CI 1.44-7.17，p=0.004）。结论：与大流行前相比，因患者临床诊疗服务可及性降低导致的皮肤鳞癌诊断延迟，与肿瘤侵袭严重程度风险增加4.7倍、手术切缘阳性风险增加3倍显著相关，并对手术管理产生重大影响，而患者队列特征与手术等待时间保持稳定。
肿瘤(癌症)患者之家