[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model].
Identifieur interne : 002455 ( Main/Corpus ); précédent : 002454; suivant : 002456[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model].
Auteurs : A. Tejera-Vaquerizo ; J. Ca Ueto ; A. Toll ; J. Santos-Juanes ; A. Jaka ; C. Ferrandiz-Pulido ; O. Sanmartín ; S. Ribero ; D. Moreno-Ramírez ; F. Almazán ; M J Fuente ; S. Podlipnik ; E. NagoreSource :
- Actas dermo-sifiliograficas [ 1578-2190 ] ; 2020.
English descriptors
- KwdEn :
- Age Factors (MeSH), Algorithms (MeSH), Betacoronavirus (MeSH), COVID-19 (MeSH), Carcinoma, Squamous Cell (mortality), Carcinoma, Squamous Cell (pathology), Coronavirus Infections (epidemiology), Delayed Diagnosis (adverse effects), Delayed Diagnosis (statistics & numerical data), Female (MeSH), Head and Neck Neoplasms (mortality), Head and Neck Neoplasms (pathology), Health Services Accessibility (MeSH), Humans (MeSH), Male (MeSH), Melanoma (mortality), Melanoma (pathology), Pandemics (MeSH), Pneumonia, Viral (epidemiology), Public Health Surveillance (methods), Quarantine (MeSH), Retrospective Studies (MeSH), SARS-CoV-2 (MeSH), Sex Factors (MeSH), Skin Neoplasms (mortality), Skin Neoplasms (pathology), Spain (epidemiology), Time Factors (MeSH), Time-to-Treatment (MeSH), Tumor Burden (MeSH).
- MESH :
- geographic , epidemiology : Spain.
- adverse effects : Delayed Diagnosis.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- methods : Public Health Surveillance.
- mortality : Carcinoma, Squamous Cell, Head and Neck Neoplasms, Melanoma, Skin Neoplasms.
- pathology : Carcinoma, Squamous Cell, Head and Neck Neoplasms, Melanoma, Skin Neoplasms.
- statistics & numerical data : Delayed Diagnosis.
- Age Factors, Algorithms, Betacoronavirus, COVID-19, Female, Health Services Accessibility, Humans, Male, Pandemics, Quarantine, Retrospective Studies, SARS-CoV-2, Sex Factors, Time Factors, Time-to-Treatment, Tumor Burden.
Abstract
Background and objectives
Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma.
Material and methods
Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points.
Results
Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter >4cm or thickness >6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (>6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months.
Conclusions
In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.
DOI: 10.1016/j.ad.2020.05.001
PubMed: 32513393
PubMed Central: PMC7502279
Links to Exploration step
pubmed:32513393Le document en format XML
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Toll</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Santos Juanes, J" sort="Santos Juanes, J" uniqKey="Santos Juanes J" first="J" last="Santos-Juanes">J. Santos-Juanes</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.</nlm:affiliation></affiliation></author><author><name sortKey="Jaka, A" sort="Jaka, A" uniqKey="Jaka A" first="A" last="Jaka">A. Jaka</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Ferrandiz Pulido, C" sort="Ferrandiz Pulido, C" uniqKey="Ferrandiz Pulido C" first="C" last="Ferrandiz-Pulido">C. 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Moreno-Ramírez</name><affiliation><nlm:affiliation>Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, España.</nlm:affiliation></affiliation></author><author><name sortKey="Almazan, F" sort="Almazan, F" uniqKey="Almazan F" first="F" last="Almazán">F. Almazán</name><affiliation><nlm:affiliation>Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España.</nlm:affiliation></affiliation></author><author><name sortKey="Fuente, M J" sort="Fuente, M J" uniqKey="Fuente M" first="M J" last="Fuente">M J Fuente</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Podlipnik, S" sort="Podlipnik, S" uniqKey="Podlipnik S" first="S" last="Podlipnik">S. Podlipnik</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Nagore, E" sort="Nagore, E" uniqKey="Nagore E" first="E" last="Nagore">E. Nagore</name><affiliation><nlm:affiliation>Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32513393</idno><idno type="pmid">32513393</idno><idno type="doi">10.1016/j.ad.2020.05.001</idno><idno type="pmc">PMC7502279</idno><idno type="wicri:Area/Main/Corpus">002455</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">002455</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model].</title><author><name sortKey="Tejera Vaquerizo, A" sort="Tejera Vaquerizo, A" uniqKey="Tejera Vaquerizo A" first="A" last="Tejera-Vaquerizo">A. Tejera-Vaquerizo</name><affiliation><nlm:affiliation>Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España. Electronic address: antoniotejera@aedv.es.</nlm:affiliation></affiliation></author><author><name sortKey="Ca Ueto, J" sort="Ca Ueto, J" uniqKey="Ca Ueto J" first="J" last="Ca Ueto">J. Ca Ueto</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, España.</nlm:affiliation></affiliation></author><author><name sortKey="Toll, A" sort="Toll, A" uniqKey="Toll A" first="A" last="Toll">A. Toll</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Santos Juanes, J" sort="Santos Juanes, J" uniqKey="Santos Juanes J" first="J" last="Santos-Juanes">J. Santos-Juanes</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.</nlm:affiliation></affiliation></author><author><name sortKey="Jaka, A" sort="Jaka, A" uniqKey="Jaka A" first="A" last="Jaka">A. Jaka</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Ferrandiz Pulido, C" sort="Ferrandiz Pulido, C" uniqKey="Ferrandiz Pulido C" first="C" last="Ferrandiz-Pulido">C. Ferrandiz-Pulido</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Universitario Vall d'Hebron, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Sanmartin, O" sort="Sanmartin, O" uniqKey="Sanmartin O" first="O" last="Sanmartín">O. Sanmartín</name><affiliation><nlm:affiliation>Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.</nlm:affiliation></affiliation></author><author><name sortKey="Ribero, S" sort="Ribero, S" uniqKey="Ribero S" first="S" last="Ribero">S. Ribero</name><affiliation><nlm:affiliation>Departamento de Dermatología, Hospital Universitario de Turín, Turín, Italia.</nlm:affiliation></affiliation></author><author><name sortKey="Moreno Ramirez, D" sort="Moreno Ramirez, D" uniqKey="Moreno Ramirez D" first="D" last="Moreno-Ramírez">D. Moreno-Ramírez</name><affiliation><nlm:affiliation>Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, España.</nlm:affiliation></affiliation></author><author><name sortKey="Almazan, F" sort="Almazan, F" uniqKey="Almazan F" first="F" last="Almazán">F. Almazán</name><affiliation><nlm:affiliation>Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España.</nlm:affiliation></affiliation></author><author><name sortKey="Fuente, M J" sort="Fuente, M J" uniqKey="Fuente M" first="M J" last="Fuente">M J Fuente</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Podlipnik, S" sort="Podlipnik, S" uniqKey="Podlipnik S" first="S" last="Podlipnik">S. Podlipnik</name><affiliation><nlm:affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</nlm:affiliation></affiliation></author><author><name sortKey="Nagore, E" sort="Nagore, E" uniqKey="Nagore E" first="E" last="Nagore">E. Nagore</name><affiliation><nlm:affiliation>Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Actas dermo-sifiliograficas</title><idno type="eISSN">1578-2190</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Age Factors (MeSH)</term><term>Algorithms (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Carcinoma, Squamous Cell (mortality)</term><term>Carcinoma, Squamous Cell (pathology)</term><term>Coronavirus Infections (epidemiology)</term><term>Delayed Diagnosis (adverse effects)</term><term>Delayed Diagnosis (statistics & numerical data)</term><term>Female (MeSH)</term><term>Head and Neck Neoplasms (mortality)</term><term>Head and Neck Neoplasms (pathology)</term><term>Health Services Accessibility (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Melanoma (mortality)</term><term>Melanoma (pathology)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (epidemiology)</term><term>Public Health Surveillance (methods)</term><term>Quarantine (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>SARS-CoV-2 (MeSH)</term><term>Sex Factors (MeSH)</term><term>Skin Neoplasms (mortality)</term><term>Skin Neoplasms (pathology)</term><term>Spain (epidemiology)</term><term>Time Factors (MeSH)</term><term>Time-to-Treatment (MeSH)</term><term>Tumor Burden (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Spain</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Delayed Diagnosis</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Public Health Surveillance</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Carcinoma, Squamous Cell</term><term>Head and Neck Neoplasms</term><term>Melanoma</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Carcinoma, Squamous Cell</term><term>Head and Neck Neoplasms</term><term>Melanoma</term><term>Skin Neoplasms</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Delayed Diagnosis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Age Factors</term><term>Algorithms</term><term>Betacoronavirus</term><term>COVID-19</term><term>Female</term><term>Health Services Accessibility</term><term>Humans</term><term>Male</term><term>Pandemics</term><term>Quarantine</term><term>Retrospective Studies</term><term>SARS-CoV-2</term><term>Sex Factors</term><term>Time Factors</term><term>Time-to-Treatment</term><term>Tumor Burden</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background and objectives</b></p><p>Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma.</p></div><div type="abstract" xml:lang="en"><p><b>Material and methods</b></p><p>Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter >4cm or thickness >6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (>6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions</b></p><p>In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32513393</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>07</Day></DateCompleted><DateRevised><Year>2020</Year><Month>12</Month><Day>18</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1578-2190</ISSN><JournalIssue CitedMedium="Internet"><Volume>111</Volume><Issue>8</Issue><PubDate><Year>2020</Year><Month>Oct</Month></PubDate></JournalIssue><Title>Actas dermo-sifiliograficas</Title><ISOAbbreviation>Actas Dermosifiliogr</ISOAbbreviation></Journal><ArticleTitle>[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model].</ArticleTitle><Pagination><MedlinePgn>629-638</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0001-7310(20)30142-3</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.ad.2020.05.001</ELocationID><Abstract><AbstractText Label="Background and objectives" NlmCategory="UNASSIGNED">Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma.</AbstractText><AbstractText Label="Material and methods" NlmCategory="UNASSIGNED">Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points.</AbstractText><AbstractText Label="Results" NlmCategory="UNASSIGNED">Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter >4cm or thickness >6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (>6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months.</AbstractText><AbstractText Label="Conclusions" NlmCategory="UNASSIGNED">In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.</AbstractText><CopyrightInformation>© 2020 Published by Elsevier España, S.L.U. on behalf of AEDV.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Tejera-Vaquerizo</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España. Electronic address: antoniotejera@aedv.es.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cañueto</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Toll</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Santos-Juanes</LastName><ForeName>J</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jaka</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ferrandiz-Pulido</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Universitario Vall d'Hebron, Barcelona, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sanmartín</LastName><ForeName>O</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ribero</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Departamento de Dermatología, Hospital Universitario de Turín, Turín, Italia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Moreno-Ramírez</LastName><ForeName>D</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica, Hospital Universitario Virgen Macarena, Sevilla, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Almazán</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Unidad de Gestión Clínica de Dermatología, Hospital Universitario San Cecilio, Granada, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fuente</LastName><ForeName>M J</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Germans Trial i Pujol, Badalona, Barcelona, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Podlipnik</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Hospital Clìnic de Barcelona, Barcelona, España.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nagore</LastName><ForeName>E</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.</Affiliation></AffiliationInfo></Author></AuthorList><Language>spa</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><VernacularTitle>Estimación del efecto en el tamaño y la supervivencia de los tumores cutáneos debido al confinamiento por COVID-19: modelo basado en un crecimiento exponencial.</VernacularTitle><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>11</Day></ArticleDate></Article><MedlineJournalInfo><Country>Spain</Country><MedlineTA>Actas Dermosifiliogr</MedlineTA><NlmUniqueID>0373062</NlmUniqueID><ISSNLinking>0001-7310</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000367" MajorTopicYN="N">Age Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000465" MajorTopicYN="N">Algorithms</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002294" MajorTopicYN="N">Carcinoma, Squamous Cell</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D057210" MajorTopicYN="N">Delayed Diagnosis</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006258" MajorTopicYN="N">Head and Neck Neoplasms</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006297" MajorTopicYN="N">Health Services Accessibility</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008545" MajorTopicYN="N">Melanoma</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName 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