Close Up With Rebecca I. Hartman, MD, MPH

During the early stages of the COVID-19 pandemic, the world came to a thundering halt. Many dermatology practices shut their doors and could only see patients who were experiencing a medical emergency. As a result, yearly skin cancer screening exams fell by the wayside, and many people didn’t see a doctor even if they noticed a suspicious mole. This is why Rebecca I. Hartman, MD, MPH, an assistant professor of dermatology at Brigham and Women’s Hospital in Boston, and Daniel Y. Kim, set out to see how the lockdown affected melanoma diagnoses.

She discussed the results of the study, which appeared in a research letter published in JAMA Dermatology.

Why is this topic important to study?

It’s important to understand what happened during the pandemic to see who may have been left behind. In many ways, we are still doing a post-mortem analysis of the pandemic. There’s a lot of interest in skin cancer screening and a concern about the overdiagnosis of melanoma. In this sense, the pandemic was a natural experiment to see what would happen to melanoma rates if we reduced screening and dermatology access.

Describe the research and your findings.

We analyzed data from the Surveillance, Epidemiology, and End Results program to see if there were changes in melanoma incidence during the COVID-19 pandemic. During 2020, there were decreases seen for in situ and invasive melanoma diagnoses. There were a total of 76,846 new cases of histologically confirmed first primary in situ or invasive cutaneous melanoma diagnosed between January 2018 and December 2020.

Between 2018 and 2019, in situ melanoma incidence rates were stable, but significant decreases were observed in 2020 versus 2019. In addition, no significant difference was seen in invasive melanoma incidence rates in 2019 versus 2018, but significant decreases occurred in 2020 versus 2019. This may reflect decreased skin cancer screening examinations or lack of access to dermatologic care during the pandemic, both of which may lead to reduced melanoma diagnoses. Prior research had suggested increased odds of advanced melanoma diagnoses during 2020, but our findings indicate that this was primarily due to an absolute decrease in early-stage melanoma diagnoses rather than an absolute increase in advanced melanoma diagnoses. It’s unclear whether early-stage melanomas that we failed to diagnose in 2020 will lead to worse outcomes in the future or if they were more indolent tumors that may not significantly impact melanoma outcomes.

What is the next step?

The real question is how can we, as dermatologists, learn from this data and improve melanoma mortality at a population level. We need longer-term data to see if there is a rise in melanoma mortality or later diagnoses of more advanced tumors as a result of the lockdowns. I anticipate that within the next few years, we should start to see if the undiagnosed early tumors progress to more advanced tumors at diagnosis. I am not sure if we will see any mortality changes if the early tumors are more indolent since early-stage melanoma tends to recur over a longer time horizon and fortunately, early-stage melanoma carries an excellent prognosis with a low risk of mortality.