For many, this year has been a blur, as we’ve been thrust from the known into the unimaginable. And, as with any ongoing intense challenge, it has meant existing in crisis mode. We, in effect, survive for the moment. The important is often postponed because it isn’t deemed essential. Sadly, this has included skin cancer checks and treatment.
Timely detection of skin cancer depends on performing screening skin checks. The earlier a skin cancer is detected the less invasive and simpler the treatment will be. Patients with legitimate skin cancer signs and symptoms have deferred seeking expert advice, or have reached out only to have a diagnosis missed due to restricted screening procedures. Others have put off assessment or treatment for the understandable fear of catching coronavirus.
As the novel coronavirus strain has made telehealth and videoconferencing consultations standard, their use has spiked. Across Australia, approximately one in three medical consultations took place virtually between April and June this year. The vast majority were over the phone. While this approach can be a blessing, there are drawbacks too; particularly in the field of skin cancer investigation.
Face-to-face consultations provide valuable information that can otherwise be overlooked. Melanomas can be difficult to diagnose as they can be any size, any colour (including skin coloured), raised or flat, rough or smooth and can occur on areas of the body that have never or rarely seen direct sun.
In diagnosing skin cancer, we rely on in-person dermoscopy and biopsy. A dermatoscope is a specialised tool that allows close inspection of the skin. An excision lets us remove and examine the suspicious skin spot under the microscope. It is nigh on impossible to reach a correct diagnosis without these technologies. Unaided eyesight alone is not enough. This means video consults and over-the-phone conversations held during the pandemic pose a risk of skin cancers going undetected.
During the lock down, many skin cancer clinics continued to do full skin checks with lymph node assessment for patients who had been previously diagnosed with more serious skin cancers or a melanoma. We also continued to do checks of individual spots concerning patients -for example because of noticeable change in size or colour, tenderness, or bleeding. A lot of skin cancer was detected this way at our clinic, but many established skin cancers and also melanomas went by unnoticed as a full skin check resulting in careful dermoscopic review of all skin spots by a trained skin cancer doctor could not be done. Despite thorough recall processes to have patients present once restrictions eased, there are still inevitably those who delay follow up appointments.
A national UK study involving plastic surgeons showed that most melanomas treated during the pandemic have missed out on being offered potentially lifesaving immunotherapy, while a study published in the renowned journal The Lancet confirmed that delays in skin cancer screenings, diagnosis, and referral to a specialist have resulted from the COVID-19 pandemic. In the UK, national screening programs have been suspended. These account for around 5% of annual cancer diagnoses. The pandemic-driven delays in skin cancer screening and identification could lead to later diagnosis, the need for more invasive treatment and, potentially, an increased risk of death. It’s scary to consider! But as the authors noted, a slower response to suspected cancer seems inevitable, and it is likely we will experience similar consequences here in Australia.
Sadly, Australia leads the world in skin cancer deaths, and two out of every three Australians will receive a skin cancer diagnosis before their 70th birthday. This makes the results of a Cancer Australia report even more concerning: Non-surgical treatments decreased by 30% and surgical treatments decreased by 18% from March to April 2020. Treating skin cancer has literally been put on hold! Between that and missed detections, we’re still catching up. Skin cancer diagnosis and treatments now lag behind. We have much work to do.
And while you may tell yourself that a slight delay doesn’t matter, this could regrettably far from the truth.
Now is the time to book a skin check with a qualified skin cancer doctor; not next week, nor next month. If you are high risk or you’ve previously experienced skin cancer, including melanoma, this is especially important. Your health and life may, quite literally, depend on it.
After all, cancer doesn’t halt its growth because the world stops business as usual.