New recommendations to guide dermatologic surgery during the COVID-19 pandemic are heavy on the deferral of skin cancer excisions including all BCCs, SCC-in-situ and melanoma-in-situ.
The advice, published in the Journal of the American Academy of Dermatology (JAAD), suggests deferring superficial BCCs for six months and other BCCs for 3-6 months.
Actinic keratosis and SCC-in-situ should also be deferred, the group of NSW doctors including dermatologists Dr Deshan Sebaratnam and Dr Eleni Yiasemides said.
“For invasive SCC, treatment will require triage according to prognostic factors such as differentiation, location, depth, perineural invasion and patient variables (e.g. immunosuppression).”
“For suspected melanoma we recommend excisional biopsies over shave or incision biopsy given the uncertainty as to when definitive treatment will take place, should it be needed.”
They said treatment of melanoma-in-situ may be deferred for three months.
Reinforcing similar advice from the Melanoma Institute of Australia, they added that if histological clearance has been achieved, wider excision can also be deferred for three months.
The recommendations said management of locally aggressive tumours (eg dermatofibroma sarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma etc) should proceed as soon as possible with consideration of patient and tumour variables.
However excision of benign tumours and lesions such as cysts and lipomas should be deferred.
Regarding other benign conditions, they recommended procedures which alleviate significant morbidity such as incision and drainage of hidradenitis suppurativa abscesses may proceed as soon as feasible.
“We acknowledge that any recommendations we propose are likely to shift in the coming weeks as the COVID19 pandemic evolves and we welcome feedback from our colleagues given the paucity of evidence in this unprecedented time,” they said.
“The setpoint of the equilibrium between minimising morbidity and mortality from infection and from malignancy will be mercurial and our response as doctors will have to be equally dynamic.”