key: cord-1029123-7bqh1yas
authors: Capitelli-McMahon, Helen; Hurley, Anna; Pinder, Richard; Matteucci, Paolo; Totty, Joshua
title: Characterising non-melanoma skin cancer undergoing surgical management during the COVID-19 pandemic
date: 2020-11-02
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.10.042
sha: 3781355945de1493538c7b9ee08a7c5e8a885f85
doc_id: 1029123
cord_uid: 7bqh1yas

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In our study, we found no difference in the time from initial referral to definitive treatment between groups. This provides reassurance that although under operational pressure, with staff redeployed and operating theatres closed, the service continued to treat malignancy in a timely manner.

Our findings show that throughout the height of the COVID-19 pandemic our department saw significantly larger NMSC lesions, with a higher proportion of these being SCCs that required more complex reconstruction following excision. Reasons for this are likely to be multi-factorial. It is documented that patients have had delayed presentation to healthcare services throughout the pandemic (2) . Reduction in face-to-face appointments in primary care and potential hesitancy in the use of usual referral pathways to secondary care may also play a part.

The increase in incomplete excision rate seen in 2020 is clinically significant, and higher than an estimated 10% global rate found in a systematic review in press (3). Larger, more invasive lesions may be likely to result in an increase in incomplete excision margins. Timely diagnosis of these NMSC lesions and treatment with clear margins is important, as 31-41% of lesions without clear margins will recur (4). An increase in patients with incomplete excision margins will often lead to further surgical intervention and ultimately an increase in patient morbidity. In our study, since patients were well matched demographically and in terms of seniority of surgeon, this increase was likely to be related to lesion factors rather than surgical factors, or an as yet unexplored confounding factor.

Despite prioritisation of oncological services throughout the pandemic thus far, our findings show substantial differences in the patients accessing skin oncology services in our centre. It appears that current delays to definitive surgical treatment of smaller, less aggressive BCCs may mean patients are missing the opportunity to benefit from early excision of these lesions. There is a risk that should this trend continue, a large cohort of patients with these ostensibly less aggressive tumours may experience a delay in their treatment, requiring yet more complex reconstructive surgery as seen in this study. Further work is needed to streamline referral pathways and maintain access to services for patients, in the increasingly likely event of restrictions on elective services due to a second wave. 

Reduction in skin cancer diagnosis, and overall cancer referrals, during the COVID-19 pandemic

The Untold Toll -The Pandemic's Effects on Patients without Covid-19

Global incidence of incomplete surgical excision in adult patients with non-melanoma skin cancer: study protocol for a systematic review and meta-analysis of observational studies

Margins in skin excision biopsies: principles and guidelines