COVID-19-Related Healthcare Disruptions and Melanoma Presentation in Italy: A Systematic Review of Stage and Breslow Thickness at Diagnosis

Background: The COVID-19 pandemic disrupted dermatologic and oncologic pathways in Italy and raised concern about delayed melanoma diagnosis. This systematic review evaluated whether pandemic-period healthcare disruption was associated with changes in melanoma presentation at diagnosis, focusing on Breslow thickness, stage-related clinicopathologic features, and diagnostic volume. Methods: Reporting was aligned with PRISMA 2020. The archived review record indicates searches of PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library. Five verifiable primary Italian studies were retained for the principal synthesis after reconciliation of the original candidate set with the corrected eligibility criteria. Because study design, setting, comparator periods, and outcome reporting were heterogeneous, findings were synthesized narratively. Results: Across the five primary studies, melanoma diagnostic activity generally decreased during pandemic periods. Some cohorts reported thicker tumors or less favorable pathological features, whereas others found no significant difference in Breslow thickness, demonstrating substantial heterogeneity. Conclusions: The available observational evidence supports an association between pandemic-related healthcare disruption and changes in melanoma diagnostic activity and presentation in Italy, but it does not establish that delayed follow-up caused an increase in the population incidence of advanced melanoma. The exact final date of the original search and the original reviewer workflow could not be reconstructed from the archived review records and are reported as methodological limitations.