key: cord-0836506-yb9p08t5
authors: Andrew, T.W.; Alrawi, M.; Lovat, P.
title: Reduction in Skin Cancer Diagnoses in the UK during COVID‐19 Pandemic
date: 2020-08-05
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14411
sha: 5dc3ecb79479fd0885ff32d488fd57a10ed8d8f6
doc_id: 836506
cord_uid: yb9p08t5

The UK healthcare system has been profoundly affected by the COVID‐19 Pandemic, including skin cancer departments. Despite service capacity and a worldwide increase in incidence, anecdotal reports suggest a decline in skin cancer diagnoses following COVID‐19. To determine if there is a decrease in skin cancer diagnosis in the UK in the COVID‐19 era, we analysed data from the Northern Cancer Network from March 23(rd) 2020 to June 23(rd) 2020 and compared it to the same period last year. In the COVID Period there was a decrease in skin cancer diagnoses of 68.61% from 3619 to 1136 (p<0.0028). Surprisingly, skin cancer waiting times were also reduced in the COVID Period compared to Before COVID Period (median 8 days and 12 days respectively; p<0.0001). Collectively these data highlight a statistically significant reduction in both skin cancer diagnoses and waiting times during the COVID Period.

The UK healthcare system has been profoundly affected by the COVID-19 Pandemic, currently responsible for over 45,000 deaths 1 . Skin cancers are the most common cancer in the Caucasian population and present significant morbidity and mortality. The British Association of Dermatologists suggest using teledermatology to triage wait referrals for patients with suspected skin cancer and book patients surgery where possible during the current pandemic 2 . Despite service capacity and a worldwide increase in incidence, anecdotal reports suggest a decline in skin cancer diagnoses.

To determine if there is a decrease in skin cancer diagnosis in the UK in the COVID-19 era, we analysed data from the Northern Cancer Network from March 23 rd 2020 to June 23 rd 2020. March 23 rd 2020 was identified as the beginning of the COVID-19 period (CP), corresponding with the start of the UK national lockdown and significantly affecting medical operations. We compared waiting times to the same period last year, before COVID-19 period (BCP) and calculated the percentage change in skin cancer diagnoses in the CP compared to the BCP.

3619 skin cancer diagnoses were made in the BCP. However, in the corresponding CP there was a decrease in skin cancer diagnoses of 68.61% to 1136 (p<0.0028). Surprisingly, skin cancer waiting times were also reduced in the CP compared to BCP (median 8 days and 12 days respectively; p<0.0001). These findings have been summarised in Figure 1 . Collectively these data highlight a statistically significant reduction in both skin cancer diagnoses and waiting times during the CP.

COVID-19 Pandemic has affected global health trends 3 . Our preliminary analysis during the first three months of the COVID pandemic shows a decrease in overall skin cancer diagnoses, and interestingly a reduction in waiting time from referral to initial appointment in the UK. These findings suggest continued capacity in skin cancer services despite COVID-19. Potential aetiologies for the reduction in waiting time include prioritisation of cancer referrals and an overall decrease in skin cancer referrals from primary care. Additionally, the successful adoption of telemedicine allowed appropriate triage of those lesions requiring face-to-face assessment by a specialist 4 . The decrease in referrals may be due to patient's reluctance to seek medical attention during the CP and may be confounded by challenges in primary care services. As the pandemic endures, it is particularly crucial for both doctors and patients to be aware of the decreasing presentation of skin cancers and shortened waiting times to facilitate thoughtful and transparent decision making 5,6

British Association of Dermatologists. CLINICAL GUIDANCE FOR THE MANAGEMENT OF SKIN CANCER PATIENTS DURING THE CORONAVIRUS PANDEMIC

Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic

Teledermatology for diagnosing skin cancer in