A study of the effects of delayed patient presentation on cutaneous SCC progression

Abstract

A cohort study of patients, who underwent cutaneous squamous cell carcinoma (SCC) excision, was undertaken to evaluate the effects of the COVID-19 pandemic on treatment times and histopathological features. We identified all patients who had SCCs excised in October 2020 (pandemic group); the control group included all patients who underwent excision of SCCs during October 2019 (pre-pandemic group). Collected data included SCC subtype, thickness, size, clearance margins, referral details, patient comorbidities and operative data. There were 140 patients (174 SCCs; pre-pandemic group=74; pandemic group=100) identified for study inclusion. Both groups were well matched for age, sex, previous history of cancer, cutaneous SCC and histological subtype. There was a delay in median patient presentation time to the GP in the pandemic versus pre-pandemic group (106 days vs. 56 days, p <0.001); this led to a longer overall time to surgery (167 days vs. 110.5 days, p<0.001). Pandemic group SCCs had larger median Breslow depths (4mm vs. 3mm, p=0.01), a greater proportion of Clark's level 4 and 5 lesions (76.9% vs. 61.1%, p=0.03), and a higher rate of high (20-40mm) and very high (>40mm) risk SCCs as defined by British Association of Dermatology diameter criteria (56.1% vs. 39.2%, p=0.03), versus the pre-pandemic group. There was a 57-day median SCC treatment delay, and an associated development of higher risk SCCs by the time of surgery. Despite the challenges of a pandemic, patients should seek early consultation for suspicious skin changes, and healthcare systems should maintain skin cancer treatment pathways.