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Skin Cancer Surgery in the United Kingdom During COVID-19 Pandemic

By: Melissa E. Fryman, MS
Posted: Wednesday, November 4, 2020

The overall rates of skin cancer surgery in the United Kingdom have decreased since the start of the COVID-19 pandemic, according to a research letter published in the British Journal of Surgery by Abhilash Jain, MBBS, MRCS, MSc, FRCS, of the University of Oxford and Imperial College London, and colleagues. This multicenter prospective cohort survey of 34 plastic surgery units in the United Kingdom analyzed the treatment patterns of 2,050 patients from mid-March 2020 to mid-June 2020.

“As the lockdown is reduced, skin cancer services should be resumed urgently, as the risk of untreated skin cancer may now be considered greater than COVID-19,” the authors concluded.

The number of non-melanoma skin cancers treated per week fell by 27% to 47% throughout April and May. During this period, squamous cell carcinomas were prioritized over basal cell carcinomas, and at the height of the pandemic, the former comprised 71% of excisions, compared with 28% before the pandemic. Only 26% of patients who had melanoma with a Breslow thickness of at least 0.8 mm underwent sentinel lymph node biopsies, and many high-risk basal cell carcinomas were not treated.

Of all surgeons surveyed, 77% reported not performing Mohs micrographic surgery during this time, and 70% of surgeons reported reduced radiotherapy service. During April, 60% of surgeons reported performing no sentinel lymph node biopsies, with implications for increased future false-negative results. During May and June, between 8% and 15% of surgeons surveyed reported a normal schedule of immunotherapy for patients with melanoma.

Other changes implemented during the pandemic, in line with national guidelines, included increased use of absorbable sutures and decreased face-to-face reviews (in favor of telemedicine). The authors concluded that skin cancer surgery was safe during the pandemic, citing low rates of complications.

Disclosure: The authors reported no conflicts of interest.



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