244 The Lessons Learned from Managing Malignant Melanoma During COVID-19 Pandemic in a Plastic Surgery Unit in Ireland

Abstract

Abstract Aim The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in practice of plastic surgery units worldwide. Many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and compare it to the UK, mainland Europe and North America. Method A Retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Results A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05) with the majority of referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node was higher in 2019 at 56% (n = 28) compared to 24% (n = 22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Conclusions Our study highlights that with prompt efficient restructuring of services, including governmental agreement to utilise private sector to continue urgent elective surgery, virtual triaging and follow-up and most importantly virtual complex skin multidisciplinary team meeting, we could reserve successful management of skin cancer even in the most devastating times.