Department of General Surgery, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107, USA.
Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 620, Philadelphia, PA 19107, USA.
World J Surg. 2022 Aug;46(8):1820-1825. doi: 10.1007/s00268-022-06623-9. Epub 2022 Jun 12.
For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline.
Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: "pre-pandemic" from May 2019 to May 2020 and "pandemic," after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables were recorded and analyzed.
A total of 112 patients were identified: 51 patients from the "pre-pandemic" and 61 from the "pandemic" time period. The pandemic cohort more frequently presented with lesions greater than 1 mm thickness compared to pre-pandemic (68.8% v 49%, p = 0.033) and were found to have significantly more advanced T stage (p = 0.02) and overall stage disease (p = 0.022). Additionally, trends show that for pandemic patients more time passed from patient-reported lesion appearance/change to diagnostic biopsy (5.7 ± 2.0 v 7.1 ± 1.5 months, p = 0.581), but less time from biopsy to operation (42.9 ± 2.4 v 52.9 ± 5.0 days, p = 0.06).
"Pandemic" patients presented with thicker melanoma lesions and more advanced-stage disease. These results may portend a dangerous trend toward later stage at presentation, for melanoma and other cancers with rapid growth patterns, that will emerge as the prolonged effects of the pandemic continue to impact patients' presentation for medical care.
对于黑色素瘤患者而言，及时发现肿瘤和肿瘤厚度与治疗结果直接相关。COVID-19 不仅影响了患者就医的意愿，也影响了他们就医的能力。本研究旨在确定大流行是否与黑色素瘤患者就诊时肿瘤厚度的变化以及后续治疗时间的变化有关。
对在一家学术中心外科肿瘤学实践中接受黑色素瘤手术的患者进行了回顾性病历审查。这些患者被分为两组：“大流行前”组（2019 年 5 月至 2020 年 5 月）和“大流行”组（2020 年 5 月之后），即这些患者接受初始诊断性活检的时间。记录并分析了患者的人口统计学和黑色素瘤特异性变量。
共确定了 112 名患者：51 名来自“大流行前”组，61 名来自“大流行”组。与“大流行前”组相比，“大流行”组患者就诊时病变厚度大于 1mm 的比例更高（68.8%比 49%，p=0.033），T 分期和总体分期更晚（p=0.02 和 p=0.022）。此外，趋势表明，对于“大流行”组患者，从患者报告病变出现/变化到诊断性活检的时间间隔更长（5.7±2.0 比 7.1±1.5 个月，p=0.581），而从活检到手术的时间间隔更短（42.9±2.4 比 52.9±5.0 天，p=0.06）。
“大流行”组患者就诊时的黑色素瘤病变较厚，且分期更晚。这些结果可能预示着一种危险的趋势，即对于其他具有快速生长模式的癌症和黑色素瘤，就诊时的分期会更晚，随着 COVID-19 持续对患者的医疗服务产生影响，这种趋势将更加明显。
