| Abstract | CILJ ISTRAŽIVANJA: COVID-19 pandemija je imala jak utjecaj na globani i nacionalni
zdravstveni sustav, usmjeravajući ga prvenstveno na borbu protiv COVID-19 infekcije. Rana
dijagnoza maligne bolesti je glavni onkološki cilj koji garantira boljim ishodima u liječenju i
boljim preživljenjem bolesnika. Istražili smo utjecaj prve godine COVID-19 pandemije na broj
novooboljelih od melanoma, na patohistološke osobitosti i TNM-stadij melanoma te ih
usporedili s razdobljem prije pandemije.
ISPITANICI I METODE: Retrospektivno su analizirani podaci iz povijesti bolesti 126
bolesnika s novodijagnosticiranim melanomom u razdoblju od 1. ožujka 2019. do 28.veljače
2021. godine (69 bolesnika iz razdoblja pred pandemiju (1. ožujka 2019. - 28. veljače 2020.) i
57 bolesnika u vrijeme pandemije (1. ožujka 2020. - 28. veljače 2021.). Prikupljeni podaci
uključivali su životnu dob pri dijagnozi, spol i lokalizaciju primarne/metastatske promjene,
histološki podtip melanoma i TNM osobitosti bolesti, kao i udio novodijagnosticiranih
bolesnika prezentiranih na MDT za melanome i kožne tumore Klinike za onkologiju i
radioterapiju u oba razdoblja.
REZULTATI: Uočen je značajan pad broja novodijagnosticiranih bolesnika s melanomom u
razdoblju pandemije (57 naspram 69; 17,4%). Nisu uočene razlike u demografskim
karakteristikama između dvije kohorte. Medijan životne dobi u prepandemijskom razdoblju
iznosio je 66 godina (raspon 29-86), a u pandemijskom razdoblju 68 godina (raspon 31-88).
Prednjačio je muški spol (63.8% naspram 68,4%) te nije bilo razlike po lokalizaciji kožnih
promjena (p=0,36). Površinsko-šireći podtip melanoma je bio najčešće detektiran u oba
razdoblja (21,7% naspram 29,8%). Nije uočena razlika u dubini primarne lezije (p=0,204), u
postojanju ulceracije (p=0,334), limfovaskularne invazije (p=0,163), regresije (p=0,074) i TILa
(p=0,448). No, u razdoblju pandemije dijagnosticiran je statistički značajno veći broj
novodijagnosticiranih bolesnika s lokoregionalnom bolesti, u odnosu na prepandemiju
(p=0,024). Razlike u pojavnosti inicijalno sistemne bolesti (p=0,204) kao i u broju prezentiranih
bolesnika na MDT u razdoblju prepandemije i pandemije nije bilo (p=0,171).
ZAKLJUČAK: COVID-19 pandemija se odrazila na broj i osobitosti novodijagnosticiranih
melanoma u Klinici za onkologiju i radioterapiju u Splitu. U razdoblju pandemije prijavljen je
manji broj novodijagnosticiranih melanoma, a među njima detektiran je veći udio oboljelih s
diseminacijom u regionalne limfne čvorove. Ovakvi nalazi su rezultat kašnjenja u dijagnozi
nastalog zbog odgađanja pregleda od strane samih bolesnika zbog straha od COVID-19
infekcije kao i zbog poremećaja rutinske dermatološke i onkološke skrbi tijekom COVID-19
pandemije. |
| Abstract (english) | OBJECTIVE: The COVID-19 pandemic had a strong impact on the global and national health
system, focusing it primarily against the COVID-19 infection. Early diagnosis of malignant
diseases is the main oncological goal that guarantees better outcomes in treatment and better
patient survival. We investigated the impact of the first year of the COVID-19 pandemic on the
number of new cases of melanoma, on the pathohistological features and TNM stage of
melanoma, and compared them with the period before the pandemic.
PATIENTS AND METHODS: Data from the medical history of 126 patients with newly
diagnosed melanoma in the period from March 1, 2019 until February 28, 2021 were
retrospectively analyzed (69 patients from the period before the pandemic (03/01/2019 -
02/28/2020) and 57 patients during the pandemic (01/03/2020 - 28/02/2021). Collected data
included age at diagnosis, gender and location of the primary/metastatic changes, histological
subtype of melanoma and TNM characteristics of the disease, as well as the proportion of newly
diagnosed patients presented on MDT for melanomas in the Department of Oncology and
Radiotherapy in the both periods.
RESULTS: A significant decrease in the number of newly diagnosed melanoma patients was
observed during the pandemic period (57 vs 69; 17.4%). No differences in demographic
characteristics were observed between the two cohorts. The median age in the pre-pandemic
period was 66 years (range 29-86), and in the pandemic period 68 years (range 31-88). The
male gender was predominated (63.8% vs 68.4%) and there was no difference in the localization
of skin lesion (p=0.36). The superficial-spreading subtype of melanoma was the most frequently
detected in both periods (21.7% vs 29.8%). No difference was observed in the depth of the
primary lesion (p=0.204), in the presence of ulceration (p=0.334), lymphovascular invasion
(p=0.163), regression (p=0.074) and TILs (p=0.448). However, during the pandemic period, a
statistically significantly higher number of newly diagnosed patients with locoregional disease
were diagnosed, compared to the pre-pandemic period (p=0.024). There was no difference in
the incidence of initially systemic disease (p=0.204) as well as in the number of patients
presented to MDT in the pre-pandemic and pandemic period (p=0.171).
CONCLUSION: The COVID-19 pandemic was reflected on the number and characteristics of
newly diagnosed melanomas at the Department of Oncology and Radiotherapy in Split. During
pandemic, a smaller number of newly diagnosed melanomas were reported, and among them,
a higher proportion of patients with dissemination to regional lymph nodes was detected. Such
findings are the result of a delay in diagnosis caused by postponing the examination by the
patients themselves due to fear of a COVID-19 infection, as well as due to the disruption of
routine dermatological and oncological care during the COVID-19 pandemic. |
