key: cord-1003476-t2k64igt
authors: Tian, T.M.; Ghura, V.
title: Changes in UK dermatological surgery during the COVID‐19 pandemic
date: 2020-11-20
journal: Clin Exp Dermatol
DOI: 10.1111/ced.14519
sha: 981c655899971de5cda05076f4284e7925368699
doc_id: 1003476
cord_uid: t2k64igt

COVID‐19 has seen over 1.2 million cases and over 61,000 deaths (1) in the UK with a “lockdown” introduced in March. The British Society for Dermatological Surgery (BSDS) published guidance to dermatologists on 30(th) March, with recommendations of ‘avoid, restrict, and abbreviate’‐ ‘avoid’ non‐urgent clinics/surgeries, ‘restrict’ number of visits, staff, and aerosol generation, and ‘abbreviate’ waiting and treatment times(2). UK Dermatology departments have experienced severe impacts across their services. We sought to determine the impact of COVID‐19 on UK Dermatological Surgery through anonymous surveys electronically distributed to all BSDS members May‐June 2020.

dermatologists on 30 th March, with recommendations of 'avoid, restrict, and abbreviate'-'avoid' nonurgent clinics/surgeries, 'restrict' number of visits, staff, and aerosol generation, and 'abbreviate' waiting and treatment times (2) . UK Dermatology departments have experienced severe impacts across their services. We sought to determine the impact of COVID-19 on UK Dermatological Surgery through anonymous surveys electronically distributed to all BSDS members May-June 2020. 51 respondents consisted of 21 (41%) general dermatology consultants, 19 (35%) Mohs surgeons, and 11 (24%) registrars/other dermatology doctors from at least 30 departments, 87% working in England.

87% of respondents reported cancelling some or all routine/non-cancer work and over 90% reported cancelling some/all non-head and neck BCCs. In contrast, almost 90% continued all/some 2-week-wait

This article is protected by copyright. All rights reserved (2WW) activity. BCCs on the head and neck as well as Mohs cases were most subject to case-by-case assessment with respondents regarding symptomatic lesions as the most important triaging factor. Other key prioritisation factors were patient age, comorbidities and not being immunosuppressed, though the latter did not affect 2WW activity. 68% of respondents reported deferring "less urgent" cases e.g. melanoma in situ, wide local excisions (WLE) and low risk SCCs. Seventeen (33%) respondents increased referrals to other surgical specialties particularly plastic surgery (77%). These case management strategies corresponds with recommendations by Der Sarkissian and colleagues (3).

Other strategies employed were one-stop clinics (13/51; 25%) and tele-dermatology (28/51; 55%). The PPE usage is shown in figure 2 with surgical masks, visors, and aprons always used by 89%, 95%, and 95% of respondents respectively. Use of FFP3 masks was relatively low-'always used' by only one-third of respondents, and 'never used' by almost 50%. Several respondents stated FFP3 masks were not available and/or their trust "did not recognize guidelines on skin surgery from the BAD", or "dermatology was not a priority area". Almost two-thirds respondents always used bipolar cautery to try to reduce plume; only one-third always used smoke extractors.

Respondents described different challenges at different stages of the pandemic (Table 1 ).

In the coming months, over half respondents plan to screen patients with at least symptom questionnaires, and ideally pre-operative antigen swabbing and advising patients to self-isolate prior to surgery. Many respondents felt staff themselves should also undergo regular testing.

The pandemic has significantly reduced face-to-face opportunities for dermatologists to discuss, understand, and develop practices with other dermatology departments. This survey highlights the common themes many dermatologists have faced during the pandemic and potential solutions ( Table 2) .  'careful balance between the need to remove an individual skin cancer against the risks associated'.

 conducting surgery with PPE: "it's hot, sticky, more tiring, and more time consuming"

COVID-19) in the UK

British Society for Dermatological Surgery

Recommendations on dermatologic surgery during the COVID-19 pandemic