key: cord-0691268-03ujktie
authors: Tee, Michael W.; Stewart, Claire; Aliessa, Saud; Polansky, Max; Shah, Kalee; Petukhova, Tatyana; Rossi, Anthony; Lipner, Shari R.; Minkis, Kira
title: Dermatologic surgery during the COVID-19 pandemic: Experience of a large academic center
date: 2020-12-05
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.12.003
sha: 1d2599fa883dd3d1cfda57ad27dc4831d813546b
doc_id: 691268
cord_uid: 03ujktie

nan

Dermatologic surgery during the COVID-19 pandemic: Experience of a large academic center

To the Editor: The novel coronavirus disease 2019 (COVID-19) pandemic has required significant modifications to clinical practice. 1 In the hardest-hit areas, such as New York City, triaging of personnel and supplies, as well as prioritization of certain skin cancers, was required in dermatology practices. Although clinical judgment should be used to evaluate patients on a case-by-case basis, general guidelines from the National Comprehensive Cancer Network recommend postponing treatment for lowrisk lesions by 3 months, except in cases in which ''debilitating progression within 3 months'' was estimated by the physician. 2,3 However, for certain skin cancers types, including invasive melanoma, Merkel cell carcinoma, and high-risk cutaneous squamous cell carcinoma, the decision to delay care is of higher risk. 2, 3 Prior studies have reported that delays to treatment for stage 1 melanomas may increase the risk of poor prognosis and decrease overall survival. 4 Providers must also weigh the significant anxiety faced by patients who have received a diagnosis of skin cancer but are unable to receive definitive treatment. As such, for patients who require surgery during the pandemic via Mohs micrographic surgery or wide local excision, it is crucial that dermatology practices have protocols in place to provide necessary care while protecting patients and health care personnel from COVID-19. Our goal is to share our experience in practicing dermatologic surgery in the heart of the COVID-19 pandemic with an abundance of caution.

Dermatologic societies have created a living document to grade evidence regarding measures to minimize the transmission risk of COVID-19, covering topics including hand washing, personal protective equipment, risk of aerosolizing COVID-19, ventilation, and eye protection. 5 To add to this work, we summarize measures taken at New York PresbyterianeWeill Cornell Medicine, a large academic center greatly affected by the pandemic (Table I) . We also summarize our approach to J AM ACAD DERMATOL n 2020 1 handling COVID-19epositive patients who require care (Fig 1) . From March 1, 2020, to July 14, 2020, 235 nonmelanoma skin cancers and 27 melanoma excisions were performed at Weill Cornell Dermatology. With our measures, there has been no known transmission of COVID-19 associated with dermatologic surgery, even when COVID-19epositive patients were treated.

With regional variability in the prevalence of COVID-19, personal protective equipment shortages, and hospital policies, we acknowledge the complexity of this issue and that our solution may not be a one-size-fits-all solution. We appreciate that alternative methods for transmission prevention, including a ''pod system'' in which staff work in small, unchanging groups to limit the number of exposures, may be a better option for other facilities or regions. We also appreciate that in some situations, practices have to temporarily pause surgeries. We foresee COVID-19 to be a long-term issue, particularly in New York City, where there has been a secondary increase in cases. Given the lack of proven treatments or vaccines for COVID-19, the paucity of information on practice standards for dermatologic surgery, and concerns about how delays can affect patients, we hope that sharing our experience will add to the body of information and may enable other practices to continue to serve their patients during this difficult situation. 

The coronavirus (COVID-19) epidemic and patient safety

Perspectives on the recommendations for skin cancer management during the COVID-19 pandemic

Advisory statement for non-melanoma skin cancer care during the COVID-19 pandemic

Determination of the impact of melanoma surgical timing on survival using

Fig 1. Current protocol regarding handling coronavirus disease 2019epositive patients

the National Cancer Database

American Society of Dermatologic Surgery Association (ASDSA) and American Society for Laser Medicine & Surgery (ASLMS) guidance for cosmetic dermatology practices during COVID-19

None disclosed.