- Clinics should be triaged to review only urgent patients in person, and using telemedicine where possible.
- Consider cancelling all elective surgeries.
- 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.
- 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:
Wide excision of in situ and invasive melanoma:
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.
- 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/
- 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.
- 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
- 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
- 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