Background <p>The COVID-19 pandemic disrupted healthcare systems worldwide, potentially affecting melanoma detection and treatment outcomes. This study evaluated the impact of the pandemic and associated lockdowns on melanoma diagnoses and prognostic indicators at the Plastic and Reconstructive Surgery Department of Galilee Medical Center (GMC), Nahariya, Israel, examining how the COVID-19 pandemic influenced melanoma detection, diagnosis timing, and disease severity. We hypothesized that pandemic-related disruptions led to delayed diagnoses and more advanced disease presentations.</p> Methods <p>A retrospective analysis was conducted on 124 patients with 133 melanoma lesions diagnosed between 2017 and 2022. Patients were stratified into three periods: pre-COVID (January 2017-February 2020, <i>n</i> = 59), COVID (February 2020-February 2021, <i>n</i> = 25), and post-COVID (February 2021-November 2022, <i>n</i> = 40). Primary outcomes included demographic characteristics, Breslow thickness, lymph node involvement, and the need for adjuvant therapy.</p> Results <p>Compared to the post-COVID period, patients during the pandemic presented with significantly greater Breslow thickness (median 2.4&#xa0;mm vs. 0.76&#xa0;mm, <i>p</i> = 0.012), increased lymph node involvement (40.9% vs. 16.3%, <i>p</i> = 0.038), and higher rates of requiring adjuvant therapy (34.8% vs. 14.0%, <i>p</i> = 0.051).</p> Conclusions <p>The COVID-19 pandemic was associated with delayed melanoma diagnoses and worsened short-term prognostic indicators. However, by the post-pandemic period, significant improvements in tumor thickness, lymphatic involvement, and adjuvant therapy requirement were observed. Delayed melanoma diagnoses during COVID-19 highlight the need for resilient healthcare systems to ensure early detection during global health crises.</p> Level of evidence: Level III, risk / prognostic study.