Article Text
Abstract
Introduction The COVID-19 pandemic has changed aspects of patient care in the many scheduled medical activities, restricted access to healthcare facilities, and affected the diagnosis and organisation of patients with other health problems, specifically skin cancer. Skin cancer, the uninhibited progress of atypical skin cells, happens with unrepaired DNA genetic faults that lead them to multiply and create malignant tumours. Currently, dermatologists perform skin cancer diagnosis based on their specialised experience using the results of pathological tests from the skin biopsy. Sometimes, some specialists advise sonography imaging to check the skin tissue as a non-invasive method. The outbreak has led to postponements in the treatment and diagnosis of patients with skin cancer, including diagnostic delays because of limitations of diagnostic capacities and delays in referring patients to the physician. The purpose of this review is to improve our understanding of the impact of the COVID-19 outbreak on the diagnosis of patients with skin cancer and conduct a scoping review to identify whether routine skin cancer diagnoses are affected by the persistent incidence of COVID-19.
Methods and analysis The structure of research was compiled using Population/Intervention/Comparison/Outcomes/Study Design and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. First, we will find the main keywords to capture scientific studies related to the impact of the COVID-19 pandemic on the diagnosis of skin cancer: COVID-19 and skin neoplasms. To warrant sufficient coverage and identify potential articles, we will search the combination of four electronic databases PubMed/MEDLINE, Scopus, Web of Science and EMBASE, and ProQuest from 1 January 2019 until 30 September 2022. The screening, selection and data extraction of studies will be performed by two independent authors, who will then assessed the quality of the included studies according to Newcastle–Ottawa Scale.
Ethics and dissemination As this study will be a systematic review without human participants’ involvement, no formal ethical assessment is required. Findings will be presented at conferences related to this field and will be disseminated in a peer-reviewed journal.
PROSPERO registration number CRD42022361569.
- COVID-19
- Dermatological tumours
- Health & safety
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STRENGTHS AND LIMITATIONS OF THIS STUDY
This systematic review is the first qualitative review to evaluate the impact of the COVID-19 outbreak on the diagnosis of patients with skin cancer.
This systematic review will reduce the bias of analysis and ensure the synthesis output confidence using the Newcastle–Ottawa Scale tool.
The findings will be limited by the context and quality of the included studies as a qualitative systematic review.
Between the studies, there may be a variance in patient characteristics and complications, which may also lead to clinical heterogeneity.
Our study will include only English articles published in academic journals, which may bias the interpretation of the results.
Introduction
The universal outbreak of COVID-19 has presented a considerable threat to public health.1 Contact transmission and respiratory droplets are the predominant routes of transmission from the person-to-person shed of SARS-CoV-2, similar to that considered in other respiratory virus infections. Patients with severe COVID-19 may spread the virus to a larger degree through specific medical interventions, which put others in the location at greater risk.2 3
COVID-19 has affected regular lives and health systems globally. Most countries forced almost an entire lockdown to their people to restrict the spread of the virus and support medical care effectively.4 Dealing with this epidemic has become the centre of our daily clinical exercise and personal lives, and staying away from the disease has become one of our most significant goals.5
To decrease potential contacts and mobilise staff and resources for COVID‐19 care, physicians faced COVID-19 patient prioritisation.6 This disruption has changed every aspect of patient care in the many scheduled medical activities and procedures.7 This phase undesirably restricted access to healthcare facilities, postponed treatments normally deemed as critical, discouraged patients from seeking care, and affected the diagnosis and organisation of patients with other health problems, specifically skin cancer.5 8 The global incidence of skin cancer has increased quickly in the last decades, categorising one in three cancers.9 The common skin cancer aetiologies typically are divided into two large groups: non-melanoma and melanoma skin cancers.10
Currently, dermatologists perform skin cancer diagnosis based on their specialised experience using results of sonography imaging of the skin tissue and pathological tests from the skin biopsy.11 12 The outbreak has led to postponements in diagnosing and treating patients with skin cancer, including diagnostic delays due to limitations of diagnostic capacities and delays in referring patients to the physician.13
A significant reduction in skin cancer diagnoses through the lockdown months in 2020 has been stated in studies from several centres.14–16 Nevertheless, the intensity of the relationship between COVID-19 and skin cancer remains uncertain. Even though there have been diverse reviews that showed the consequence of this pandemic on cancers, this study is the first systematic review that offers wide-ranging information about the effects of COVID-19 on the diagnosis of skin cancer.17–19 Thus, we direct this systematic review based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist guideline.20
Objectives
Considering the effects of the temporary impact of the COVID-19 pandemic on the diagnosis of patients with skin cancer, and the importance of knowing about the decline in the number of diagnoses on forecasting the consequences in health planning based on the number of eligible patients diagnosed before and during the pandemic, we observed studies on Public Health’s data, comparing melanoma and non-melanoma skin cancer diagnoses during the years 2020 and 2019 (pre-COVID-19 pandemic). This review has been designed to improve our understanding of the impact of the COVID-19 outbreak on the diagnosis of patients with skin cancer and clinical cancer care, and conduct a scoping review to identify whether routine skin cancer diagnosis is affected by the persistent incidence of COVID-19.
Methods and analysis
Eligibility criteria
We will elaborate the structure of the research question using PICOS (Population, Intervention, Comparison, Outcomes, Study Design).21 The specific PICOS parts for this study are presented in table 1.
Information sources
To warrant sufficient coverage and identify potential articles, we will search the combination of four electronic databases PubMed/MEDLINE, Scopus, Web of Science and Excerpta Medica Database (EMBASE) via Emase.com, and ProQuest from inception until 30 September 2022. In addition, secondary searches will be carried out in other sources, such as medRxiv and bioRxiv. The references of included papers will be hand-searched for additional relevant studies and the grey literature (conference papers and theses) will be searched for further studies.
Search strategy
The search strategy improves reproducibility and develops the finding’s methodological transparency, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.22 First, we will find the specific key search terms to capture scientific studies related to the impact of the COVID-19 pandemic on the diagnosis of skin cancer: COVID-19 and skin neoplasms.
Subsequently, the search strategy will be combined with Medical Subject Heading terms and keywords using the Boolean operators ‘AND’ and ‘OR’ in the PubMed/MEDLINE as an example and adjusted to the other databases as shown in table 2. There has been no restriction regarding the publication date, setting or language in this systematic review. The full search strategy for all databases (syntax) has been provided in online supplemental table 1.
Supplemental material
Selection process
Studies selected through the search strategy were first exported to EndNote (V.X9.3.3, Thomson Reuters, Philadelphia, USA), and the publications will undergo manual screening after removing any duplicate studies. Two independent authors will screen the titles and abstracts (SMMZ and RM). Following the previous screening step, two authors (SMMZ, YR) will independently be brought for the full-text publications manually. In the last step, any disagreement between these reviewers will be checked in consultation with the third author (AB).
Data collection process
Standardised forms in Excel will be used to extract data from the included studies, which will be performed by two reviewers (AB, EA) independently. Two reviewers will resolve disagreements through a consensus, and discrepancies between the reviewers will be checked for completeness and accuracy by a third reviewer (SMMZ).
Data items
To extract the information, the arranged checklist will be used and the following data will be extracted from each study: study characteristics (authors, year of publication, country), participant information (age and sex, sample size, period of evaluation), information related to diagnosis of skin cancer (number of diagnoses, stage at diagnosis), service utilisation (decrease or discontinuity of facilities, change in service transference mode), another diagnostic-oriented outcome if available and any other information including COVID-19-related data about the study observed as required.
Quality assessment
Newcastle–Ottawa Scale checklist will be used to assess the quality of this review that will be performed by two independent authors (SMMZ, AB). This tool includes three separate sections: selection, comparison and conclusion. The study will be scored according to overall scores and divided into three categories: good, fair and poor.23
Statistical analysis
Because of qualitative results that compare the impact of the COVID-19 pandemic on skin cancer and variation of data, meta-analysis and data synthesis will not apply.
Patient and public involvement
Since this is a systematic review protocol, no patients or members of the public will be involved in the development of the protocol.
Discussion
The emergence of the novel beta coronavirus has caused serious worries due to the virus’s rapid distribution worldwide. Many parts of the world have experienced COVID-19 outbreaks, with policy and government authorities implementing many violent isolation or containment procedures. Then, outbreaks brought substantial disruption to dermatology services through a reduction in skin cancer referrals, clinic capacity and cancellation of elective procedures.24–26 The modifications in healthy-looking behaviours and the availability of essential diagnostic services resulting from national pandemic processes will result in a marked negative impact on patient outcomes such as cost-related treatments and, consequently, an enormous number of additional deaths from cancer.27 28 Although several diseases have changed and various reactions have been related to COVID-19 vaccination, the vaccine is the primary weapon against COVID-19.29 Finally, it is critical to confirm that patients can be uninterruptedly diagnosed. It will take years before the comprehensive effect of the epidemic on cancer care can be considered.
Ethics and dissemination
Due to the characteristics of this study design, we will not directly collect the information from the subject; thus, no formal ethical approval is required. The results will be published via an international peer-reviewed journal publication and several scientific conference presentations.
Ethics statements
Patient consent for publication
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors The search strategy was developed by SMMZ. The draft of the protocol was organised by SMMZ and EA. The draft manuscript was reviewed by AB and YR and the final manuscript was revised by them. All the authors have read, provided feedback and agreed with the content of the protocol. Data screening and selection phases of the systematic review will be executed by SMMZ, YR and RM. Quality assessment will be performed by SMMZ and AB. Data extraction and preparation of the manuscript draft will be executed by SMMZ, YR. AB and EA will review the manuscript and edit the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.