Impact of the Covid-19 pandemic on melanoma and non-melanoma skin cancer inpatient treatment in Germany - a nationwide analysis

Abstract

Background: SARS-CoV-2 has massively changed the care situation in hospitals worldwide. Although tumour care should not be affected, initial reports from European countries were suggestive for a decrease in skin cancer during the first pandemic wave and only limited data are available thereafter.

Objectives: The aim of this study was to investigate skin cancer cases and surgeries in a nationwide inpatient dataset in Germany.

Methods: Comparative analyses were performed in a prepandemic (18 March 2019 until 17 March 2020) and a pandemic cohort (18 March 2020 until 17 March 2021). Cases were identified and analysed using the WHO international classification of diseases codes (ICDs) and process key codes (OPSs).

Results: Comparing the first year of the pandemic with the same period 1 year before, a persistent decrease of 14% in skin cancer cases (n = 19 063) was observed. The largest decrease of 24% was seen in non-invasive in situ tumours (n = 1665), followed by non-melanoma skin cancer (NMSC) with a decrease of 16% (n = 15 310) and malignant melanoma (MM) with a reduction of 7% (n = 2088). Subgroup analysis showed significant differences in the distribution of sex, age, hospital carrier type and hospital volume. There was a decrease of 17% in surgical procedures (n = 22 548), which was more pronounced in minor surgical procedures with a decrease of 24.6% compared to extended skin surgery including micrographic surgery with a decrease of 15.9%.

Conclusions: Hospital admissions and surgical procedures decreased persistently since the beginning of the pandemic in Germany for skin cancer patients. The higher decrease in NMSC cases compared to MM might reflect a prioritization effect. Further evidence from tumour registries is needed to investigate the consequences of the therapy delay and identify the upcoming challenges in skin cancer care.

Figure 1

(a) Comparison of skin cancer cases treated in German hospitals in a prepandemic cohort (18 March 2019 to 17 March 2020) and a pandemic cohort (18 March 2020 to 17 March 2021). The relative decrease in each entity is indicated in percentage. (b) Comparison of the first pandemic wave (March to May 2019 to the same period in 2020).

Figure 2

Timeline of skin cancer cases treated in German hospitals throughout from Jan 2019 to Sep 2021. Bars indicate the number of Covid‐19 patients hospitalized. Dotted lines represent the prepandemic mean of skin cancer cases (black line = total skin cancer cases, orange line = NMSC and green line = MM).

Figure 3

Decrease in surgical procedures in skin cancer throughout the Covid‐19 pandemic. (a) Total number of surgical procedures in invasive melanoma and non‐melanoma skin cancer cases treated in German hospitals in a prepandemic cohort (18 March 2019 to 17 March 2020) and a pandemic cohort (18 March 2020 to 17 March 2021). (b) Relative and absolute distribution of different surgical procedures identified by OPS code in the pre‐ and postpandemic dataset. Minor surgical procedures are defined as local skin excisions of diseased skin and subcutaneous tissue with a surface of ≤4 cm² (OPS 5–894). Extended surgery is defined by radical and expanded excision of diseased skin and subcutaneous tissue, including micrographic surgery ≥4 cm² (OPS 5–895); nail surgery was identified by OPS 5–898 and excisions of the skin not further classified were identified by OPS 5–899. (c) Inpatient cases of malignant melanoma that received sentinel lymph node surgery in the above defined prepandemic and pandemic period.