Keratinocyte carcinoma more worrisome than COVID-19 for some patients during pandemic

Nearly one-quarter of patients with keratinocyte carcinoma who experienced delays in Mohs micrographic surgical procedures due to the pandemic were more concerned about their cancer than COVID, according to a study.

“In March 2020, the National Comprehensive Cancer Network (NCCN) recommended delaying treatment during the COVID-19 pandemic for keratinocyte carcinoma (KC) except for tumors determined to pose a risk of ‘metastasis or debilitating progression within 3 months,’” Emily Stamell Ruiz, MD, MPH, of the department of dermatology at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.

In the current analysis, Ruiz and colleagues assessed the impact of the pandemic on concerns among patients undergoing Mohs micrographic surgery (MMS) for KCs at Brigham and Women’s Micrographic Surgery Center and Memorial Sloan Kettering Cancer Center.

One group of patients was defined as the COVID delay cohort, which included those who had been rescheduled from April to August 2020, at the height of the first wave of the pandemic. Findings from that group were compared with control patients who had undergone MMS between May and August 2019.

Among the demographic and tumor-related information gathered by the researchers were Cancer Worry Scale findings from the FACE-Q Skin Cancer Module.

Results from the Cancer Worry Scale analysis showed scores of 45 (standard deviation [SD], 17.9) for the COVID delay group and 44.7 (SD, 44.7) among controls, which the researchers noted was a nonsignificant difference.

Higher equivalent multivariate analysis of variance cancer worry scores were observed in patients with tumor diameter of at least 20 mm (+ 7.9), patients aged younger than 65 years (+ 7.1) and women (+ 4.4).

Looking at the additional COVID-related questions asked of patients in the COVID-delay group, results showed that 22% were more concerned about their skin cancer than the virus. Just 10% were concerned about the surgical delay.

Univariate analysis showed that previous history of CSCC and tumor diameter of at least 20 mm were associated with being more worried about skin cancer than COVID. However, these associations failed to persist to significance in multivariable analysis.

“Surprisingly, a quarter of COVID-delay patients were more worried about their KC than a novel life-threatening viral illness despite surgical outcomes not being impacted,” the researchers concluded. “These data could be used to enhance patient-centered communication at the time of the surgical delay regarding the indolent nature of most KCs, which could alleviate cancer worry and improve the overall patient experience.”