Management of primary skin cancer during a pandemic: Multidisciplinary recommendations
Department of Dermatology
Dermatology | Health Services Administration | Infectious Disease | Neoplasms | Oncology | Skin and Connective Tissue Diseases | Virus Diseases
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 disease-specific 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.
Merkel cell carcinoma, Mohs surgery, basal cell carcinoma, coronavirus disease 2019, COVID-19, cutaneous squamous cell carcinoma, melanoma, radiotherapy, skin cancer, treatment delays
DOI of Published Version
Baumann BC, MacArthur KM, Brewer JD, Mendenhall WM, Barker CA, Etzkorn JR, Jellinek NJ, Scott JF, Gay HA, Baumann JC, Manian FA, Devlin PM, Michalski JM, Lee NY, Thorstad WL, Wilson LD, Perez CA, Miller CJ. Management of primary skin cancer during a pandemic: Multidisciplinary recommendations. Cancer. 2020 Jun 1:10.1002/cncr.32969. doi: 10.1002/cncr.32969. Epub ahead of print. PMID: 32478867; PMCID: PMC7301000. Link to article on publisher's site
Baumann BC, MacArthur KM, Brewer JD, Mendenhall WM, Barker CA, Etzkorn JR, Jellinek N, Scott JF, Gay HA, Baumann JC, Manian FA, Devlin PM, Michalski JM, Lee NY, Thorstad WL, Wilson LD, Perez CA, Miller CJ. (2020). Management of primary skin cancer during a pandemic: Multidisciplinary recommendations. COVID-19 Publications by UMMS Authors. https://doi.org/10.1002/cncr.32969. Retrieved from https://escholarship.umassmed.edu/covid19/60