key: cord-0812577-ev6prh5x
authors: Guhan, Samantha; Boland, Genevieve; Tanabe, Kenneth; Lin, William; Reddy, Bobby; Hawryluk, Elena B.; Sober, Arthur J.; Tsao, Hensin
title: Surgical Delay and Mortality for Primary Cutaneous Melanoma
date: 2020-07-22
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.07.078
sha: 8c9c9a474712c0f7da6b01fe95fe37d3d4b00bc8
doc_id: 812577
cord_uid: ev6prh5x

nan

Each author has no conflicts of interest to disclose.

Attachments: None 28 29

Keywords: COVID-19, melanoma, oncology, surgery, biopsy, policy 30 31 During the COVID-19 shutdown, the standard of care for melanoma treatment has been 32 temporarily modified. The National Comprehensive Cancer Network (NCCN) and Society of 33 Surgical Oncology (SSO) recommended that excisional biopsies be performed whenever 34 possible and wide local excision and sentinel lymph node biopsy (WLE+SLNBx) be deferred for 35 up to three months for lesions with clear histologic margins. 1, 2 This decision was justified by the 36 claim that "most time-to-treat studies show no adverse patient outcomes following a 90-day 37 treatment delay", but the supporting evidence has not been clearly presented. In summary, one large retrospective study reported a significant association of mortality with 60 surgical delay in Stage 1 melanoma patients, but several other smaller studies did not detect any 61 significant hazards. There is insufficient evidence to definitively conclude that delayed wide 62 resection after gross removal of the primary melanoma is without harm. Like many of the 63 COVID-19 policy decisions, the NCCN/SSO guidelines were not strictly evidence-based and 64

were drafted expeditiously when resources were limited and COVID-19 mortality was mounting. 65

Melanoma patients are typically older (average age 65), often have medical comorbidities, and 66 may have increased all-cause mortality if they contract COVID-19. The contradictory evidence 67 cannot be resolved until a sufficiently-powered prospective trial that measures harms from 68 surgical delay and controls for factors such as the effect of patient concern is published. 69 

List: 80 81 1. Resource for Management Options of Melanoma During COVID-19. Society of Surgical 82 Oncology

Short Term Recommendations for Cutaneous Melanoma Management During the COVID-19

National Comprehensive Cancer Network

The time from diagnostic excision biopsy to 86 wide local excision for primary cutaneous malignant melanoma may not affect patient survival

Determination of the impact of melanoma 89 surgical timing on survival using the National Cancer Database

Effect of a delay in definitive surgery in 92 melanoma on overall survival: A NCDB analysis