COVID-19 precautions linked with delays in skin cancer treatment

Results from a nationwide survey showed that the COVID-19 pandemic significantly impacted Mohs micrographic surgeries and the treatment of skin cancer, according to an editorial published in the Journal of Drugs in Dermatology.

“Initial uncertainty during the COVID-19 pandemic led most medical organizations to recommend postponing all nonessential visits,” Edward W. Seger, MD, MS, of the University of Kansas Medical Center, and colleagues wrote. “Unfortunately, for patients with newly diagnosed skin cancers, many Mohs surgeries were included in this delay.”

To assess the impact of the pandemic on Mohs micrographic surgery (MMS) and skin cancer treatment, Seger and colleagues developed an institutional review board-approved 15-question survey. The survey was electronically sent to fellowship trained Mohs surgeons practicing 6 months after the onset of the pandemic.

Of the 303 respondents, 81% were private practice and 57% were working in suburban settings. Also, 82% noted a decline in case volume for at least 3 months and 68.5% noted an increase in case difficulty following treatment delays.

Respondents reported that adverse outcomes were common, including 69% who reported cases of local tumor spread, 49% who reported cases of advancement in tumor stage and 20% who reported cases of regional or systemic metastasis.

Other details from the survey included an observation of overall harm from delays (78%) and worsened emotional health (76%).

While 45% of surgeons agreed with practice restrictions at the onset of the pandemic, only 29% maintained that position currently. Overall, 39% of respondents had a “less favorable view of recommendations now than they initially did” compared with 4% reporting a more favorable view.

Cases of COVID-19 were rare, however, with eight respondents reporting positive tests from staff and seven respondents reporting positive testes from patients following MMS procedures.

Overall, 97% of respondents felt they could take reasonable precautions to prevent the spread of COVID-19 and were comfortable performing MMS surgeries.

“While skin cancer surgery is not typically considered ‘emergency’ care, these current results demonstrate that delays in care may lead to increases in local tumor spread and upstaging of skin cancers,” Seger and colleagues wrote. “Combining the risks of delaying treatment alongside infrequency of spread amongst patients and staff, it is evident that surgeries should proceed and can be performed safely.”