Managing Patients With Skin Cancer During the COVID-19 Pandemic
Posted: Wednesday, May 27, 2020
Faramarz Samie, MD, PhD, of the Columbia University Irving Medical Center, New York, and colleagues proposed guidelines for the optimal management of patients with skin cancer during the COVID-19 pandemic. The editorial, which was published in the Journal of the American Academy of Dermatology, provides suggestions to maintain a high standard of care while preserving resources and minimizing exposure.
The authors advised that telemedicine be implemented for all nonessential visits. Ideally, only the most high-risk patients who require in-office therapies and those who present with highly suspicious lesions warranting an immediate biopsy should make office visits at this time. Infusion therapy and immunotherapy pose a variety of risks during the pandemic. Therefore, the authors recommended health-care professionals refer to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for alternative treatment regimens.
Basal cell carcinoma, cutaneous squamous cell carcinoma either in situ or without high-risk factors, melanoma in situ, and indolent cutaneous lymphomas were categorized as low-risk skin cancers. The authors recommended that treatment of such diseases be deferred for at least 3 months; however, the individual risks for each patient should be considered. Wide local excisions and sentinel lymph node biopsies may be performed on a case-by-case basis for patients with intermediate-risk skin cancers, such as T1b melanoma without high-risk characteristics, T1 melanoma with clear margins after biopsy, and T1 melanoma without clear margins after postoperative intervention.
The risk of therapy-related travel should be considered for patients with high-risk skin cancers, such as cutaneous squamous cell carcinoma with high-risk characteristics; invasive, thick, and ulcerated melanoma; Merkel cell carcinoma; histologically aggressive tumors; and tumors in sensitive areas. The authors noted that more immediate action may be warranted for patients with rapidly spreading cutaneous squamous cell carcinoma or symptomatic lesions. If surgical intervention is required, physicians should consider performing the least complicated procedure possible to reduce further exposure to COVID-19.
Disclosure: The study authors reported no conflicts of interest.
