The COVID-19 pandemic has substantially impacted disease dynamics in all medical specialties, and dermatology is no exception. Recent evidence suggests that a substantial decrease in dermatology department attendance has been observed1, which hampers the management and follow-up of dermatologic pathologies, especially in low- and middle-income countries where difficulties in access to health care are marked1. Exposure to risk factors and care of oncology patients during this season is a real challenge. We would like to make a few comments on a presentation on the impact of the pandemic lockdown on skin cancer, and the prognosis for this condition in the coming years.
To counter the devastation caused by the COVID-19 pandemic, nations have put in place a number of strategies to ensure the safety of citizens, most notably, confinement2. This method of controlling the spread of disease has had both benefits and detriments in fields such as health, economics, and social relations2,3. Being locked up for long periods of time does not allow informal workers and small businesses to continue their activities, which has a negative impact on the sustainability of mainly middle-class and lower-class households2,3. In contrast, this decision has substantially delayed the scheduling of appointments, the attention to patients with acute or chronic diseases for fear of contagion, scheduled surgeries, interventions that are mandatory face-to-face, has not allowed the mobilization to high complexity hospitals due to transportation restrictions, among others3.
However, with respect to skin cancer, many authors have expressed concern about the management of the oncological patient during the pandemic, essentially because of the inability to continue chemotherapeutic treatment, or because of the difficulty in diagnosing skin cancer4–7. However, there is another side to the coin, and that is the involuntary control of one of the main risk factors for skin cancer, exposure to ultraviolet rays. Studies have reported a dramatic decrease of >50% in the referral of patients to dermatology departments5, necessitating the publication of recommendations suggesting that priority be given to the management of subtypes of cancers such as cutaneous melanoma, Merkel cell carcinoma and squamous cell carcinoma, which are at high risk of metastasis and have poor survival as they are diagnosed in advanced stages6.
However, when reviewing the main risk factors for the development of skin cancer, it is evident that of the modifiable factors, intermittent and occupational exposure to the sun increase the risk of skin cancer up to 1.7 times8,9. Therefore, it can be clearly observed that confinement and virtual work could indirectly and paradoxically help to decrease the risk of suffering from this cancer, especially in those individuals with nonmodifiable risk factors such as family history of malignant melanoma, presence of multiple benign nevi, personal history of skin cancer, and having red or blond hair color, which increase the risk of suffering from this type of cancer up to 70, 11, 8.5, and 2.4 times, respectively8,9.
This can be more visible in tropical climates where temperatures are higher and people tend to wear more uncovered clothing. Therefore, it is worth questioning, will there be a decrease in the incidence of skin cancer due to less time in the sun exposure during such a long period (almost a full year), even knowing that by complying with the social distancing, a large part of the population only goes out to the streets to perform mandatory work, but higher mortality due to difficulties in the care of those with diagnosis and staging? It is necessary to strictly monitor the epidemiological variables of this cancer, and to analyze in detail the behavior of skin cancer in the coming years and in people at high risk of developing it.
Sources of funding
All authors equally contributed to the analysis and writing of the manuscript.
Conflicts of interest disclosure
The authors declare that they have no financial conflict of interest with regard to the content of this report.
Research registration unique identifying number (UIN)
Sabrina Rahman, Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh.
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