Commentary

Skin Cancer Management During the COVID-19 Pandemic

Cutis. 2020 December;106(06):E4-E8 | doi:10.12788/cutis.0146

References

Moletta L, Pierobon ES, Capovilla G, et al. International guidelines and recommendations for surgery during COVID-19 pandemic: a systematic review. Int J Surg. 2020;79:180-188.
Ueda M, Martins R, Hendrie PC, et al. Managing cancer care during the COVID-19 pandemic: agility and collaboration toward common goal. J Natl Compr Canc Netw. 2020:1-4.
Center for Medicare & Medicaid Services. Non-emergent, elective medical services, and treatment recommendations. Published April 7, 2020. Accessed October 15, 2020. https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf
Muddasani S, Housholder A, Fleischer AB. An assessment of United States dermatology practices during the COVID-19 outbreak. J Dermatolog Treat. 2020;31:436-438.
Coronavirus Resource Center, Johns Hopkins University & Medicine. Rate of positive tests in the US and states over time. Updated December 11, 2020. Accessed December 11, 2020. https://coronavirus.jhu.edu/testing/individual-states
Middleton J, Lopes H, Michelson K, et al. Planning for a second wave pandemic of COVID-19 and planning for winter: a statement from the Association of Schools of Public Health in the European Region. Int J Public Health. 2020;65:1525-1527.
Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335-337.
National Comprehensive Cancer Network. Advisory statement for non-melanoma skin cancer care during the COVID-19 pandemic (version 4). Published May 22, 2020. Accessed December 11, 2020. https://www.nccn.org/covid-19/pdf/NCCN-NMSC.pdf
National Comprehensive Cancer Network. Short-term recommendations for cutaneous melanoma management during COVID-19 pandemic (version 3). Published May 6, 2020. Accessed December 11, 2020. www.nccn.org/covid-19/pdf/Melanoma.pdf
Conforti C, Giuffrida R, Di Meo N, et al. Management of advanced melanoma in the COVID-19 era. Dermatol Ther. 2020;33:e13444.
ESMO [European Society for Medical Oncology]. Cancer patient management during the COVID-19 pandemic. Accessed Decemeber 11, 2020. https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic?hit=ehp
Guhan S, Boland G, Tanabe K, et al. Surgical delay and mortality for primary cutaneous melanoma [published online July 22, 2020]. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.07.078
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Tips for Performing Dermatologic Surgery

Careful consideration should be made to protect both the patient and staff during office-based excisional surgery during the COVID-19 pandemic. To minimize the risk of transmission of SARS-CoV-2, patients and staff should (1) be screened for symptoms of COVID-19 at least 48 hours prior to entering the office via telephone screening questions, and (2) follow proper hygiene and contact procedures once entering the office. Consider obtaining a nasal polymerase chain reaction swab or saliva test 48 hours prior to the procedure if the patient is undergoing a head and neck procedure or there is risk for transmission.

Guidelines from the ESMO recommended that all patients undergoing surgery or therapy should be swabbed for SARS-CoV-2 before each treatment.¹¹ Patients should wear a mask, remain 6-feet apart in the waiting room, and avoid touching objects until they enter the procedure room. Objects that the patient must touch, such as pens, should be cleaned immediately after such contact with either alcohol or soap and water for 20 seconds.

Office capacity should be reduced by allowing no more than 1 person to accompany the patient and ensuring the presence of only the minimum staff needed for the procedure. Staff who are deemed necessary should wear a mask continuously and gloves during patient contact.

Once in the procedure room, providers might be at elevated risk of contracting COVID-19 or transmitting SARS-CoV-2. A properly fitted N95 respirator and a face shield are recommended, especially for facial cases. N95 respirators can be reused by following the latest Centers for Disease Control and Prevention recommendations for reuse and decontamination techniques,¹³ which may include protecting the N95 respirator with a surgical mask and storing it in a paper bag when not in use. Consider testing asymptomatic patients in facial cases when they cannot wear a mask.

Steps should be taken to reduce in-person visits. Dissolving sutures can help avoid return visits. Follow-up visits and postprocedural questions should be managed by telehealth. However, patients with a high-risk underlying conditions (eg, posttransplantation, immunosuppressed) should continue to obtain regular skin checks because they are at higher risk for more aggressive malignancies, such as Merkel cell carcinoma.

Conclusion

The future trajectory of the COVID-19 pandemic is uncertain. Dermatologists should continue providing care for patients with skin cancer while mitigating the risk for COVID-19 infection and transmission of SARS-CoV-2. Guidelines provided by the NCCN and ESMO should help providers triage patients. Decisions should be made case by case, keeping in mind the availability of resources and practicing in compliance with local guidance.

Skin Cancer Management During the COVID-19 Pandemic

References

Tips for Performing Dermatologic Surgery

Conclusion

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