Mostafavi Zadeh Seyed Mostafa, Noroozi Elahe, Gheytanchi Elmira, Tajik Fatemeh, Madjd Zahra, Ahmadvand Davoud
Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
BMC Public Health. 2025 Aug 6;25(1):2684. doi: 10.1186/s12889-025-23926-3.
The COVID-19 pandemic significantly disrupted healthcare systems worldwide. Prioritizing emergency responses resulted in the postponement of routine medical care, including melanoma diagnoses. We performed a systematic review and meta-analysis to quantify the pandemic's effect on diagnosis rates, Breslow thickness, stage at presentation, ulceration, histologic subtypes, and patient age.
We performed a systematic review and meta-analysis following PRISMA guidelines. PubMed, Scopus, Web of Science, and Embase were searched up to 10 September 2024 for observational studies comparing melanoma outcomes in the pre-COVID era (before March 2020) with the COVID era (March 2020 onwards). Two reviewers independently screened records, extracted data on diagnostic counts, patient age, Breslow thickness, ulceration, and histopathological subtype, and assessed study quality using the Newcastle-Ottawa Scale (NOS). Random-effects models pooled rate ratios (RRs) or odds ratios (ORs); fixed-effects models pooled mean differences (MDs). Heterogeneity was evaluated with I², and sensitivity analyses were restricted to high-quality studies (NOS ≥ 7).
Sixty-two studies (38,676 pre-COVID and 46,846 COVID-era melanomas) met inclusion criteria. New melanoma diagnoses fell by 19% during the pandemic (RR = 0.81, 95% CI 0.75-0.86; I² = 98%). Mean age at diagnosis rose by 0.86 years (95% CI 0.58-1.14; I² = 45%). Tumors were thicker (MD = 0.24 mm, 95% CI 0.02-0.47; I² = 92%) and more frequently ulcerated (OR = 1.29, 95% CI 1.15-1.44; I² = 31%). Nodular melanoma, an aggressive subtype, became more common (OR = 1.34, 95% CI 1.08-1.67; I² = 81%), whereas superficial spreading, acral lentiginous, and lentigo-maligna subtypes showed no significant change. All the key findings persisted in good-quality-only analyses.
COVID-19-related service disruptions were associated with fewer melanoma diagnoses but a shift toward older patients and biologically adverse tumor features, signaling delayed detection at the population level. Strengthening resilient, rapid-access skin cancer pathways and integrating tele-dermatology with triaged in-person assessment are public-health priorities for future crises.
PROSPERO registration number CRD42022361569.
新冠疫情严重扰乱了全球医疗系统。优先处理应急响应导致包括黑色素瘤诊断在内的常规医疗服务被推迟。我们进行了一项系统评价和荟萃分析，以量化疫情对诊断率、 Breslow厚度、初诊分期、溃疡情况、组织学亚型和患者年龄的影响。
我们按照PRISMA指南进行了系统评价和荟萃分析。截至2024年9月10日，在PubMed、Scopus、Web of Science和Embase数据库中检索观察性研究，比较新冠疫情前时代（2020年3月之前）和新冠疫情时代（2020年3月起）的黑色素瘤结局。两名研究者独立筛选记录，提取有关诊断数量、患者年龄、Breslow厚度、溃疡情况和组织病理学亚型的数据，并使用纽卡斯尔-渥太华量表（NOS）评估研究质量。随机效应模型合并率比（RRs）或比值比（ORs）；固定效应模型合并平均差（MDs）。用I²评估异质性，敏感性分析仅限于高质量研究（NOS≥7）。
62项研究（新冠疫情前38676例黑色素瘤，新冠疫情时代46846例黑色素瘤）符合纳入标准。疫情期间新发黑色素瘤诊断减少了19%（RR = 0.81，95%CI 0.75 - 0.86；I² = 98%）。诊断时的平均年龄增加了0.86岁（95%CI 0.58 - 1.14；I² = 45%）。肿瘤更厚（MD = 0.24mm，95%CI 0.02 - 0.47；I² = 92%）且溃疡更频繁（OR = 1.29，95%CI 1.15 - 1.44；I² = 31%）。侵袭性亚型结节性黑色素瘤变得更为常见（OR = 1.34，95%CI 1.08 - 1.67；I² = 81%），而浅表扩散型、肢端雀斑样痣型和恶性雀斑痣型亚型无显著变化。所有关键结果在仅纳入高质量研究的分析中依然存在。
与新冠疫情相关的服务中断与黑色素瘤诊断减少相关，但患者年龄增大且肿瘤生物学特征更差，这表明在人群层面存在检测延迟。加强有弹性、快速就诊的皮肤癌诊疗途径，并将远程皮肤病学与分诊后的现场评估相结合，是应对未来危机的公共卫生优先事项。
PROSPERO注册号CRD42022361569。
