Introduction: Several studies have described how the restrictive measures due to COVID-19 have delayed melanoma diagnoses, resulting in an increased rate of more severe cases. Summarizing the sparse results in this context might help to understand the real impact of the COVID-19 pandemic on melanoma. We conducted a systematic review and meta-analysis to investigate how the clinical and prognostic factors of new melanoma diagnoses changed after COVID-19. Methods: A literature search in MEDLINE, EMBASE, and Scopus was conducted in September 2023. We included studies published in peer-reviewed journals reporting histopathological data on new diagnoses of cutaneous melanoma in adult patients during and/or after the lockdown compared to those diagnosed before the COVID-19 pandemic. A meta-analysis was conducted utilizing a random effects model. The between-study heterogeneity was assessed via Higgins’s I2statistic. Publication bias was assessed using the Begg and Egger test. This study adhered to the updated PRISMA guidelines. The primary outcome was a comparison of melanoma thickness between the pre-COVID-19 and post-lockdown periods. The secondary outcomes were evaluations of the histopathological subtype, stage, and presence of ulceration and mitosis in melanomas diagnosed in these two pandemic phases. Results: The study included 45 articles. We found a significantly higher proportion of all factors indicating worse prognosis in the post-lockdown period compared to the pre-COVID-19 phase, including high thickness (SOR = 1.14, 95%CI 1.08–1.20 for 1–2 mm; SOR = 1.62, 95%CI 1.08–2.40, for >2 mm), the presence of ulcerations (SOR = 1.35, 95%CI 1.18–1.54), nodular subtype (SOR = 1.19, 95%CI 1.07–1.32), the presence of mitosis (SOR = 1.57, 95% CI 1.17–2.11), and stage III (SOR = 1.39, 95%CI 1.19–1.52) and IV (SOR = 1.44, 95%CI 1.26–1.63). Limitations include the limited studies’ geographical distribution and moderate heterogeneity affecting meta-analysis estimates. Conclusions: Our meta-analysis provided evidence of more advanced melanomas diagnosed in the post-COVID-19 pandemic period, emphasizing the importance of creating and updating pandemic preparedness plans to limit the impact of any future events on oncological care.
引言：多项研究指出，COVID-19相关的限制措施导致黑色素瘤诊断延迟，进而使得更严重病例的比例上升。整合该领域有限的研究结果有助于理解COVID-19大流行对黑色素瘤的真实影响。我们通过系统综述和荟萃分析，探讨了COVID-19疫情后新诊断黑色素瘤的临床及预后因素变化。方法：于2023年9月对MEDLINE、EMBASE和Scopus数据库进行文献检索。纳入经同行评审期刊发表的研究，这些研究对比了COVID-19大流行前与大流行期间和/或封锁后成年患者新诊断皮肤黑色素瘤的组织病理学数据。采用随机效应模型进行荟萃分析，通过Higgins I²统计量评估研究间异质性，使用Begg和Egger检验评估发表偏倚。本研究遵循更新版PRISMA指南。主要结局指标为COVID-19前与封锁后时期黑色素瘤厚度的比较；次要结局指标为对这两个大流行阶段诊断的黑色素瘤的组织病理学亚型、分期、溃疡存在情况及有丝分裂的评估。结果：共纳入45篇文献。研究发现，与COVID-19前阶段相比，封锁后时期所有提示预后不良的因素比例均显著更高，包括较大厚度（1-2 mm：SOR=1.14，95%CI 1.08-1.20；>2 mm：SOR=1.62，95%CI 1.08-2.40）、存在溃疡（SOR=1.35，95%CI 1.18-1.54）、结节性亚型（SOR=1.19，95%CI 1.07-1.32）、存在有丝分裂（SOR=1.57，95%CI 1.17-2.11）以及III期（SOR=1.39，95%CI 1.19-1.52）和IV期（SOR=1.44，95%CI 1.26-1.63）。局限性包括研究地域分布有限及影响荟萃分析估计的中度异质性。结论：本荟萃分析证实了COVID-19大流行后期诊断的黑色素瘤更具进展性，强调制定并更新大流行应对计划对限制未来任何事件对肿瘤诊疗影响的重要性。
Impact of COVID-19 Pandemic on Delay of Melanoma Diagnosis: A Systematic Review and Meta-Analysis
肿瘤(癌症)患者之家