Menu
  • Welcome
  • Resources
  • Webinars
  • News
  • Stats
  • Forums
  • Team
  • Contact
  • My Account
  • FR
  • Welcome
  • Resources
  • Webinars
  • News
  • Stats
  • Forums
  • Team
  • Contact
  • My Account
  • FR
home/Knowledge Base/Surgery

Dermatological Surgery

124 views 2 04/16/2020 05/09/2020 Noémie Desgagnés

  1. Clinics should be triaged to review only urgent patients in person, and using telemedicine where possible.
  2. Consider cancelling all elective surgeries. 
  3. To minimize COVID-19 spread during office-based excisional surgery: 
    • All surgical patients should be considered as potentially COVID-19 positive. 
    • Smoke extractor systems are the most effective way to minimise risk. Using bipolar diathermy rather than hyfrecation is suggested. 
    • Use N95 masks and face shields for periorofacial surgery. 
    • Reduce to minimum the number of healthcare professionals required for the procedure. 
    • Use dissolving sutures to minimize multiple presentations.
  4. The following table shows suggestions for management of skin cancer: 
Benign lesions  Defer for now. 

** Procedures which alleviate significant morbidity (eg incision and drainage of hidradenitis suppurativa abscesses)  should be pursued as soon as feasible 

Basal cell carcinoma Superficial : defer treatment for 6 months

All other: defer surgery for 3-6 months 

Squamous cell carcinoma (SCC) Actinic keratosis and SCC-in-situ : defer for now 

SCC: prioritise these tumors: rapidly-enlarging, poorly-differentiated, perineural, ulcerated and symptomatic, immunosuppression.

Merkel cell carcinoma Should not be deferred:

  • Office-based wide local excision may be undertaken with deferral of sentinel lymph node biopsy if OR are unavailable.
  • Management of patients with clinical stage III should be discussed with a multidisciplinary team : definitive resection of the primary  with complete lymphadenectomy versus immunotherapy.
Melanoma  Diagnostic biopsy: 

  • Attempt excisional/complete biopsy with 2 mm border when melanoma suspected with intent to remove the clinical lesion. 
  • Broad shave biopsy for larger suspected melanoma in situ and lentigo maligna type lesions. 

Wide excision of in situ and invasive melanoma: 

  • Melanoma-in-situ and T1: defer treatment for 2-3 months even for positive margin on biopsy.
  • Invasive melanoma: if histological clearance obtained, defer wide excision and/or sentinel lymph node biopsy for 3 months.
  • Surgical management of T3/T4 melanomas should be prioritized over T1/T2 melanomas.

These recommendations come from documents produced by the British Association of Dermatologists and British Society of Dermatological Surgery, and the National Comprehensive Cancer Network on melanoma and non-melanoma skin cancer management. Der Sarkissian et al and Geskin et al propose perspectives for management of dermatologic surgery during the COVID-19 outbreak.

 

Sources: 

  1. British Association of Dermatologists and British Society of Dermatological Surgery. Clinical Guidance for the Management of Skin Cancer Patients During the Coronavirus Pandemic. Retrieved from https://www.bsds.org.uk/
  2. Der Sarkissian SA, Kim L, Veness M. et al. (2020, April 10) Recommendations on dermatologic surgery during the COVID-19 pandemic, Journal of the American Academy of Dermatology, https://doi.org/10.1016/j.jaad.2020.04.034.
  3. Geskin LJ., Trgaer MH., Aasi SZ., et al (May 1, 2020) Perspectives on the Recommendations for Skin Cancer Management During the COVID-19 Pandemic, Journal of American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.05.002 
  4. National Comprehensive Cancer Network. (April 22, 2020) Advisory Statement for Non-Melanoma Skin Cancer Care During the COVID-19 Pandemic. Retrieved from https://www.nccn.org/covid-19/default.aspx
  5. National Comprehensive Cancer Network. Short-Term Recommendation for Cutaneous Melanoma Management During COVID-19 Pandemic. Retrieved from https://www.nccn.org/covid-19/default.aspx
Tags:Basal cell carcinomasquamous cell carcinomamelanoma

Was this helpful?

2 Yes  No
Related Articles
  • ILDS / AAD Registry : a case series on pernio-like skin lesions
  • Health Literacy
  • Guidelines: Aesthetic Clinic Reopening
  • Thrombotic occlusive vasculopathy
  • An Update on the Management of Patients with Pernio-like Lesions
  • Isotretinoin Prescription During the Pandemic
Surgery
  • Dermatological Surgery
  • Colorectal Cancer: Management Suggestions
  • Localized Breast Cancer: Management Suggestions
  • Laparoscopy Procedure
  • Considerations for Gynecological Surgery
  • Cancer Surgery in the Time of Pandemic
View All 10  
Popular Articles
  • Acute Acro-Ischemic Lesions in Children
  • Insights About Reinfection and Immunization
  • What Is the Efficacy of Masks in Preventing Transmission?
  • Rationale of Old Antimalarial Drugs Against New Pandemic
  • PPE requirement for Aerosol Generating Medical Procedures
Specialties
  • Endocrinology
  • Anesthesiology
  • Cardiology
  • Dental Surgery
  • Dermatology
  • Emergency Medicine
  • ENT
  • Geriatrics and Palliative Care
  • Gastroenterology
  • Hematology
  • Infectious Diseases
  • Intensive Care
  • Neurology
  • OB-GYN
  • Oncology
  • Ophthalmology
  • Pediatrics
  • Pharmacology
  • Preventive Medicine
  • Protection of Healthcare Workers
  • Psychiatry
  • Public health
  • Other Internal Medicine Specialties
  • Radiology
  • Respirology
  • Stages of COVID-19 Infection
    • Presumption & Prevention
    • Screening & Diagnosis
    • Mild Infection
    • Moderate Infection
    • Severe Infection
    • Outcomes
  • Surgery
About How I Treat COVID-19

Our website is dedicated to helping healthcare professionals find accurate and up-to-date information about the best ways to manage and treat patients affected by the COVID-19 outbreak.

Navigation
  • Resources
  • News
  • Webinars
  • Forum
Useful Links
  • COVID-19 Protocols
  • Health Canada
  • WHO
  • CDC
Practice

  • Privacy Policy
  • Terms & Conditions
  • How I Treat Covid-19 © 2020 Made with ♥ by Mondien