Objective:To evaluate whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers and whether handedness is associated with symmetry of superficial lymphatic anatomy.Background:Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation.Methods:Thirty-six normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. Thirteen lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer.Results:Among the 36 participants, 10 (28%) showed symmetry of all 8 upper extremity lymphatic pathways with ICG. However, only 2 (6%) participants demonstrated complete symmetry among the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in 7 (39%) participants with hand dominance and 3 (17%) participants without hand dominance (X2 = 2.215, P = 0.137).Conclusions:Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.

Skin adhesives containing 2-octyl cyanoacrylate are a common source of allergic contact dermatitis (ACD), a complication of postoperative wound healing. Few studies have described postoperative cutaneous reactions to skin adhesives and their clinical management. The aim of this study was to review the incidence, descriptions, and clinical management of surgical site ACD caused by 2-ocyl cyanoacrylate. A comprehensive systematic literature search was conducted in September 2023 of the PubMed/MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science (Clarivate Analytics, Philadelphia, PA), and Cochrane databases (Cochrane Library, John Wiley & Sons, Ltd., Hoboken, NJ) for studies reporting ACD after skin closure with liquid adhesives containing 2-octyl cyanoacrylate. Additionally, we queried the FDA Manufacturer and User Facility Device Experience (FDA MAUDE, U.S. Food and Drug Administration, Silver Spring, MD) in September 2023 and retrieved clinician-inputted records of ACD caused by liquid adhesives containing 2-octyl cyanoacrylate from 2014 to2023. Nine articles were included for review, with a median of 102 patients exposed to 2-octyl cyanoacrylate for surgical site skin closure. The reported incidence of cutaneous reactions to 2-octyl cyanoacrylate ranged from 0.5% to 14%. The review also included 609 unique FDA MAUDE records reporting surgical site skin reactions to 2-octyl cyanoacrylate. Orthopedic procedures were the most common type of procedure, representing 47% of FDA MAUDE records. Nineteen clinical descriptors of cutaneous reactions were utilized. Topical corticosteroids and oral antihistamines were the most commonly prescribed treatments to manage postoperative cutaneous reactions. Reported incidences of cutaneous reactions to 2-octyl cyanoacrylate vary widely and guidelines for clinical management remain unclear. The FDA MAUDE provides important insights to cutaneous reactions to 2-octyl cyanoacrylate including surgery-type, cutaneous descriptors, and clinical management. Future research is needed to identify patients at risk of 2-octyl cyanoacrylate skin reactions in the preoperative setting. LEVEL OF EVIDENCE: 3 (THERAPEUTIC):

Background As Gender Affirming Top Surgery (GATS) has become more common, educational resources have increased. To ensure healthcare accessibility, a better understanding of preferred platforms and comprehension of these resources is crucial. This study aimed to: determine commonly used resources for GATS patients of varying ages and assess the difficulty of each resource. Methods A public survey seeking perceptions on educational resource utilization related to GATS was administered to gender diverse individuals. Responses with reported gender identity and age were grouped by age. Online resources were categorized into institutional websites, plastic surgery (PRS) journals, YouTube (YT), internet forums, and educational websites. Perceived difficulty and objective readability of sample text from each category was compared using validated scales. Univariate analyses were performed. Results A total of 464 respondents were included, with over half aged 18 to 25, one third aged 25 to 34, and 13.8% aged 35 and older. The youngest cohort had lower education, were less likely to have undergone top surgery, and more often favored non-expert resources. When comparing readability, non-expert resources such as YT and internet forums had lower grade levels compared to institutional websites and PRS journals(all p-values ≤ 0.01). Conclusion Educational preferences and perceived difficulty of resources related to GATS differed significantly by patient age. Overall YouTube and internet forums were popular patient resources and rated as easier to understand by both objective and subjective measures. In order to improve the accessibility of high-quality healthcare information, improving the readability of expert-created resources is essential.

BACKGROUND: Improving diversity within plastic and reconstructive surgery (PRS) trainees is a crucial step to reduce inequities at the provider level. Trends in minority representation among independent program match applicants are understudied. We analyzed gender, racial, and ethnic demographic trends among independent PRS match applicants. METHODS: With the approval of the American Council of Educators in Plastic Surgery, the San Francisco Match provided data for the independent PRS match from 2013 to 2023. Trends in the independent PRS match were reviewed, and a Cochran- Armitage test was conducted to evaluate the significance of match trends in minority applicants (Female, Black, Asian, Other Race, Hispanic ethnicity) over time. RESULTS: A total of 1000 applicants participated in the independent plastic surgery match during the study period, of whom 735 matched. A 31% decrease in the number of independent PRS programs was observed. The match rate decreased from 86% to 60%. Statistical analysis by race (White, Black, Asian, Other) and match outcomes revealed significant differences in racial distributions between applicants and matched participants in 2014 (p = 0.002) and 2018 (p = 0.042). The proportion of female applicants and Hispanic applicants correlated yearly to the number of matched females and Hispanics, respectively (p > 0.05). Cochran- Armitage tests showed a significant increase in match trends among female participants over time (p = 0.004). CONCLUSIONS: We show a significant increase in female representation in the independent PRS match in the last decade. However, representation of racial and ethnic minorities has shown minimal change over the years. Ongoing efforts are needed to identify barriers and reduce inequities. ( J Surg Ed 82:103388. (c) 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background Variations of hand and forearm lymphatic drainage to upper-arm lymphatic pathways may impact the route of melanoma metastasis. This study compared rates of lymphatic drainage to epitrochlear nodes between anatomic divisions of the hand and forearm to determine whether the anatomic distribution of hand and forearm melanomas affects the likelihood of drainage to epitrochlear lymph nodes. Methods Using a single-institution lymphoscintigraphy database, we identified all patients with cutaneous melanoma on the hand and forearm. A body-map two-dimensional coordinate system was used to classify cutaneous melanoma sites between radial-ulnar and dorsal-volar divisions. Sentinel lymph nodes (SLNs) visualized on lymphoscintigraphy were recorded. Proportions of patients with epitrochlear SLNs were compared between anatomic divisions using chi(2) analysis. Results Of 3628 upper extremity cutaneous melanoma patients who underwent lymphatic mapping with lymphoscintigraphy, 1400 met inclusion criteria. Twenty-one percent of patients demonstrated epitrochlear SLNs. Epitrochlear SLNs were observed in 27% of dorsal forearm melanomas and 15% of volar forearm melanomas (p < 0.001). Epitrochlear SLNs were observed in 31% of ulnar forearm melanomas and 17% of radial forearm melanomas (p < 0.001). Conclusions Higher proportions of dorsal and ulnar forearm melanomas have epitrochlear SLNs. Metastasis to epitrochlear SLNs may be more likely from melanomas in these respective forearm regions.

BACKGROUND:Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. METHODS:Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. RESULTS:Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p < 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p < 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p < 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p < 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p < 0.001). CONCLUSIONS:Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. Levels II and III axillary, epitrochlear, and brachial nodes are possible sites of metastatic disease that should be considered in patients with a prior ALND.

Introduction Metabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, or dyslipidemia. This study aims to evaluate the association of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using component separation. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent ventral, umbilical, and epigastric hernia repair with component separation between 2015 and 2021. MetS status was defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Propensity matching was performed to generate two balanced cohorts with and without MetS. T-tests and Fisher's Exact tests assessed group differences. Logistic regression models evaluated complications between the groups. Results After propensity score matching, 3930 patients were included in the analysis, with 1965 in each group (MetS versus non-MetS). Significant differences were observed in the severity and clinical presentation of hernias between the groups. The MetS cohort had higher rates of incarcerated hernia (39.1% versus 33.2%; P < 0.001), and recurrent ventral hernia (42.7% versus 36.5%; P < 0.001) compared to the non-MetS cohort. The MetS group demonstrated significantly increased rates of renal insufficiency (P = 0.026), unplanned intubation (P = 0.003), cardiac arrest (P = 0.005), and reoperation rates (P = 0.002) than the non-MetS cohort. Logistic regression models demonstrated higher likelihood of postoperative complications in the MetS group, including mild systemic complications (OR 1.25; 95%CI 1.030-1.518; P = 0.024), severe systemic complications (OR 1.63; 95%CI 1.248-2.120; P < 0.001), and reoperation (OR 1.47; 95%CI 1.158-1.866; P = 0.002). There were no significant differences in the rates of 30-d wound complications between groups. Conclusions The presence of metabolic derangement appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the importance of optimizing preoperative comorbidities as surgeons counsel patients with MetS.

BACKGROUND:The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.METHODS:A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.RESULTS:A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.CONCLUSION:The SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.

Immediate lymphatic reconstruction (ILR) is recognized as a surgical approach used to reduce the risk of developing secondary lymphedema, and evidence demonstrating the efficacy of ILR is favorable. Our Lymphatic Center has become a centralized location offering ILR for the risk-reduction in breast cancer-related lymphedema (BCRL) in New England. Over the course of our experience, we made several modifications and adapted our approach to enhance the operative success of this procedure. These include advancements in our use of indocyanine green (ICG) imaging to identify baseline lymphatic anatomical variation, utilization of fluorescein isothiocyanate for lymphatic vessel visualization, application of the lymphosome concept to guide arm injection sites, verification of anastomotic patency (using ICG), localization of reconstruction to guide radiation therapy, incorporation of intraoperative tools to facilitate better anatomic visualization of the axilla, and addition of a lower extremity vein graft to mitigate venous-related complications. Collecting information from each surgery in a standardized manner, including intraoperative lymphatic channel measurements, and deploying clips for possible future radiation exposure, enables future studies on ILR patient outcomes. In this contribution, we aimed to share our institutional modifications with the surgical community to facilitate further adoption, conversation, and advancement of ILR for the risk-reduction in BCRL.

Given recent efforts to legalize and decriminalize recreational marijuana, its use has become increasingly common in patients seeking plastic and reconstructive procedures, including gender affirming surgery. 1 Teven C.M. Song D.H. Times Are a Changin': Marijuana Use among Plastic Surgery Patients. Plast Reconstr Surg. Oct 1 2021; 148: 702e-704ehttps://doi.org/10.1097/PRS.0000000000008380 Crossref Scopus (3) Google Scholar Although the use of cannabis has generally been considered lower risk than other recreational substances, recent studies have suggested it may still be associated with an increased surgical complication rate. 2 Potnuru P.P. Jonna S. Williams 2nd, G.W. Cannabis Use Disorder and Perioperative Complications. JAMA Surg. Sep 1 2023; 158: 935-944https://doi.org/10.1001/jamasurg.2023.2403 Crossref Scopus (4) Google Scholar Moreover, individuals undergoing chest wall masculinization may exhibit higher rates of anxiety, depression, and marijuana usage. 3 Boskey E.R. Jolly D. Tabaac A.R. Ganor O. Behavioral Health Concerns and Eligibility Factors Among Adolescents and Young Adults Seeking Gender-Affirming Masculinizing Top Surgery. LGBT Health. 2020; 7: 182-189https://doi.org/10.1089/lgbt.2019.0213 Crossref Scopus (3) Google Scholar As a result, the aim of our study was to (1) examine the rate of cannabis usage in our cohort of patients undergoing chest wall masculinization, and (2) to determine the effect of cannabis use on clinical and patient reported outcomes (PRO).

IntroductionThe quality and readability of online health information are sometimes suboptimal, reducing their usefulness to patients. Manual evaluation of online medical information is time-consuming and error-prone. This study automates content analysis and readability improvement of private-practice plastic surgery webpages using ChatGPT.MethodsThe first 70 Google search results of “breast implant size factors” and “breast implant size decision” were screened. ChatGPT 3.5 and 4.0 were utilized with two prompts (1: general, 2: specific) to automate content analysis and rewrite webpages with improved readability. ChatGPT content analysis outputs were classified as hallucination (false positive), accurate (true positive or true negative), or omission (false negative) using human-rated scores as a benchmark. Six readability metric scores of original and revised webpage texts were compared.ResultsSeventy-five webpages were included. Significant improvements were achieved from baseline in six readability metric scores using a specific-instruction prompt with ChatGPT 3.5 (all P ≤ 0.05). No further improvements in readability scores were achieved with ChatGPT 4.0. Rates of hallucination, accuracy, and omission in ChatGPT content scoring varied widely between decision-making factors. Compared to ChatGPT 3.5, average accuracy rates increased while omission rates decreased with ChatGPT 4.0 content analysis output.ConclusionsChatGPT offers an innovative approach to enhancing the quality of online medical information and expanding the capabilities of plastic surgery research and practice. Automation of content analysis is limited by ChatGPT 3.5's high omission rates and ChatGPT 4.0's high hallucination rates. Our results also underscore the importance of iterative prompt design to optimize ChatGPT performance in research tasks.

Background:Wellness programs are especially important in residency. However, the resources available to plastic surgery residents through residency wellness programs have not been described. This study reports current plastic surgery residency wellness programs' organization, leadership, and resources.Methods:An anonymous and voluntary e-mail survey was sent to 106 plastic surgery residency program directors through May and June 2022. Features of residency wellness programs were detailed, and program directors' sentiments towards residency wellness programs were evaluated.Results:A 30.2% (32 of 106) complete response rate was achieved. Nearly 90% (87.5%, 28 of 32) of program directors indicated the presence of a wellness program. More than 75% (21 of 28) of programs are supported by the Office of Graduate Medical Education. Wellness events were offered by 92.9% (26 of 28) of programs. More than half of programs offered resources for mental health, physical health, mentorship, and protected time. Several resources were associated with the presence of wellness leadership roles, suggesting residents can positively shape wellness program offerings. Program directors strongly indicated that wellness programs are important, relevant, and effective. Additionally, 75% (24 of 32) report a desire to learn about wellness programs at other plastic surgery residency programs.Conclusions:Resources offered through plastic surgery residency wellness programs are comparable to those in other specialties. However, plastic surgery programs vary in the resources offered to residents and barriers to access exist. Greater involvement of residents in plastic surgery wellness programs may better support physician wellness.

BackgroundGender-affirming top surgery is becoming increasingly common, with greater diversity in the patients receiving top surgery. The purpose of this study was to examine national trends in patient demographics, characteristics, wound complication rates, and concurrent procedures in patients receiving gender-affirming top surgeries. MethodsPatients with gender dysphoria who underwent breast procedures, including mastectomy, mastopexy, breast augmentation, or breast reduction by a plastic surgeon between 2013 and 2022, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. These procedures were considered to be gender-affirming "top surgery." Univariate analyses were performed to examine trend changes in the patient population and types of additional procedures performed over the last decade. ResultsThere was a 38-fold increase in the number of patients who received top surgery during the most recent years compared to the first 2 years of the decade. Significantly more individuals receiving top surgery in recent years were nonbinary (P < 0.01). There was a significant decrease in percentage of active smokers (P < 0.01) while there was an increase in percentage of patients with diabetes (P = 0.03). While there was a significant increase in the number of obese patients receiving top surgery (P < 0.01), there were no differences in postoperative wound complications between the years. Significantly more patients received additional procedures (P < 0.01) and had about a 9-fold increase in distinct number of additional CPT codes from 2013-2014 to 2021-2022. ConclusionsOur study found that there has been (1) a significant increase in the number of top surgery patients from 2013 to 2022 overall and (2) a particular increase in patients with preoperative comorbidities, such as a higher body mass index and diabetes. Understanding current and evolving trends in patients undergoing surgical treatment for gender dysphoria can inform individualized care plans that best serve the needs of patients and optimize overall outcomes.

Metabolic syndrome (MetS) represents cardiometabolic dysregulation, defined by hypertension, obesity, diabetes, and dyslipidemia. There remains a significant gap in our understanding of whether MetS impacts outcomes of abdominal body contouring procedures. We aimed to assess the influence of MetS on postoperative outcomes of abdominal body contouring by concurrent abdominoplasty and panniculectomy. The ACS-NSQIP database was utilized to identify patients who underwent concurrent abdominoplasty and panniculectomy procedures from 2012 to 2022. Through propensity score matching, distinct cohorts were established based on the presence of MetS, characterized by patients receiving medical interventions for diabetes mellitus and hypertension, with a body mass index exceeding 30 kg/m2. Univariate and multivariate analyses were conducted to evaluate differences between groups. A total of 14,642 patients underwent abdominal body contouring from 2012 to 2022. Following propensity score matching, 730 patients were included in the analysis, with 365 in each group (MetS vs. non-MetS). Bivariate analysis revealed a longer hospital length of stay (2.3 vs. 1.6 days; p = 0.007) in the MetS cohort compared to the non-MetS cohort. Patients diagnosed with MetS had an average length of stay of 0.6 days longer than non-MetS patients (95 This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

OBJECTIVE:To evaluate whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers and whether handedness is associated with symmetry of superficial lymphatic anatomy. BACKGROUND:Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation. METHODS:Thirty-six normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. Thirteen lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer. RESULTS:Among the 36 participants, 10 (28%) showed symmetry of all 8 upper extremity lymphatic pathways with ICG. However, only 2 (6%) participants demonstrated complete symmetry among the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in 7 (39%) participants with hand dominance and 3 (17%) participants without hand dominance (X 2 = 2.215, P = 0.137). CONCLUSIONS:Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.

Background: Bakuchiol is a topical cosmeceutical marketed as a retinoid alternative. Human clinical trial data on bakuchiol's efficacy for the treatment of dermatologic conditions has not been thoroughly evaluated. Objective: To review human clinical trials using topical formulations containing bakuchiol in the re treatment of facial skin disorders. Materials and Methods: A comprehensive electronic search of Cochrane Library, PubMed, EMBASE, and Web of Science was conducted on August 28, 2022, using the search terms "bakuchiol" and "UP256," Study characteristics, measured outcomes, significant, results, and stated limitations were extracted. Results: Fifteen human clinical trials were analyzed. Dermatologic conditions treated included aging, acne, and post-inflammatory hyperpigmentation. Twelve trials were unblinded, open-label trials without a control group. Tien trials used a combination therapy containing bakuchiol. Four trials did not specify the dose or concentration of bakuchiol in treatment regimens. The heterogeneity of treatments, study designs, and measured outcomes makes meta-anatysis unfeasible. Conclusion: Trials lack methodologic rigor, which introduces a high risk of bias in reported outcomes, The use of combination topical formulations containing bakuchiol limits the comparison of bakuchiol's efficacy with retinoids. Continued research with an improved trial design is needed,

The ongoing challenges posed by COVID-19 are concerning for their impact on successful detection and recognition of melanoma as total body skin examinations and skin biopsies are critical for identifying early-stage melanoma and intervening before progression to metastatic disease. A comprehensive electronic search of PubMed/MEDLINE was conducted on or before August 1, 2022, using the search terms ("skin" AND "COVID-19"), (["skin cancer" AND "COVID-19"] OR ["skin cancer" AND "coronavirus"]), (["melanoma" AND "COVID-19"] OR ["melanoma" AND "coronavirus"]), ("dermatology" AND "COVID-19"), and ("cutaneous" AND "COVID-19"). Eight articles representing Belgium, Chile, France, Germany, Spain, the United Kingdom, and the United States were included. Four articles analyzed changes in the proportion of in situ melanoma at diagnosis and consistently reported decreases, with an overall decrease ranging from 7.6 to 40.4%. Five studies analyzed changes in the proportion of melanoma diagnoses by staging, but no clear changes in staging patterns were observed. Five studies analyzed changes in the mean Breslow thickness of melanoma diagnoses and consistently reported increases, with an overall increase ranging from 4.0 to 38%. Disruptions to proper diagnosis and treatment of melanoma are creating undue morbidity, mortality, and healthcare costs as the pandemic continues. Continued research with improved, centralized data collection is needed to better address the COVID-19 pandemic's ongoing challenge to appropriate detection and treatment of melanoma.