Management of primary skin cancer during a pandemic: Multidisciplinary recommendations

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making regarding the pros and cons of early versus delayed interventions for localized skin cancer. Patients at highest risk of COVID-19 complications are older; are immunosuppressed; and have diabetes, cancer, or cardiopulmonary disease, with multiple comorbidities associated with worse outcomes. Physicians must weigh the patient's risk of COVID-19 complications in the event of exposure against the risk of worse oncologic outcomes from delaying cancer therapy. Herein, the authors have summarized current data regarding the risk of COVID-19 complications and mortality based on age and comorbidities and have reviewed the literature assessing how treatment delays affect oncologic outcomes. They also have provided multidisciplinary recommendations regarding the timing of local therapy for early-stage skin cancers during this pandemic with input from experts at 11 different institutions. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, but a short delay can be considered for patients with favorable T1 disease who are at higher risk of COVID-19 complications. For patients with melanoma, the authors recommend delaying the treatment of patients with T0 to T1 disease for 3 months if there is no macroscopic residual disease at the time of biopsy. Treatment of tumors ≥T2 can be delayed for 3 months if the biopsy margins are negative. For patients with cutaneous squamous cell carcinoma, those with Brigham and Women's Hospital T1 to T2a disease can have their treatment delayed for 2 to 3 months unless there is rapid growth, symptomatic lesions, or the patient is immunocompromised. The treatment of tumors ≥T2b should be prioritized, but a 1-month to 2-month delay is unlikely to worsen diseasespecific mortality. For patients with squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless the individual is highly symptomatic.

Impact of COVID-19 pandemic on dermatology practices: Results of a web-based, global survey

“…Excision was performed less often than Mohs surgery. This possibly indicates a priority on treating high-risk tumors, ie, performing Mohs surgery for high-risk squamous cell carcinoma, while deferring treatment of low-risk tumors and deciding on a case-by-case basis for intermediate-risk tumors, as per current guidelines on management of skin cancer patients during this pandemic (National Comprehensive Cancer Network, 2020a , British Association of Dermatologists and British Society for Dermatological Surgery, 2020, Baumann et al, 2020 , Geskin et al, 2020 ). Cosmetic procedures were uncommon.…”

COVID-19 in a Patient with Advanced Merkel Cell Carcinoma Receiving Immunotherapy

“…Guidelines have been published to guide and allow safe patient care, without jeopardizing the ongoing oncological treatment [ 22 ], including recommendations for skin cancer management [ 23 ]. In this context, preventive measures must be implemented in oncology departments, in order to minimize patient exposure to COVID-19.…”

“…Early diagnosis of SARS-Cov-2 with RT-PCR is essential, even in asymptomatic patients, preventing nosocomial spread in cancer clinics [ 24 ]. Shared decision making with physicians and patients about delays in the oncologic treatment must occur, considering an individual’s risk of COVID-19 complications against the worse prognosis from postponed cancer therapy [ 23 ]. Retrospective data suggest that chemo–immunotherapy can be safely delivered even in this pandemic scenario, but sometimes may require regimen modifications or alternative schedules that should also be determined on an individual basis [ 25 ].…”

https://researchopenworld.com/management-of-cancer-patients-undergoing-radiation-therapy-during-the-novel-coronavirus-disease-2019-covid-19-pandemic-a-review-of-the-literature/#

“…5-15 fraction regimens). Skin cancer management and triage was discussed by Baumann et al and Tagliaferri et al [49,50]. For patients with Merkel cell carcinoma, the authors recommend prioritizing treatment, unless favorable T1 disease.…”

“…The treatment of tumors ≥T2b should be prioritized, but a 1-month to 2-month delay is considered acceptable. For squamous cell carcinoma in situ and basal cell carcinoma, treatment can be deferred for 3 months unless symptomatic [49]. With respect to gynecological cancers Martinelli et al carried out a survey showing that responders prioritized treatment of early stage high-risk uterine cancers (45%), newly diagnosed epithelial ovarian cancer (41%), and locally advanced cervical cancer (41%) [51].…”