COVID-19 and Timely Management of Skin Cancers
The effects of the COVID-19 pandemic have been far-reaching in all areas of healthcare. “For many specialties outside the scope of direct COVID-19 treatment, precautions, protocols, and fears led to substantially reduced patient volumes and even full practice closures, including dermatology practices.”(1) Reduced access to care has raised concerns about patients with potential skin cancers delaying diagnosis and treatment. A study published in The Journal of the American Academy of Dermatology was conducted to analyze the extent of these delays, attributable to COVID-19.(2)
Researchers examined data from January 2019 to August 2020, reviewing charts of 250 providers covering 4.7 million patients. The total number of skin diagnoses decreased among the providers in the study. There were 279 fewer cutaneous melanomas, 6,000 fewer squamous cell carcinomas and 9,914 fewer basal cell carcinomas detected.(2) “Extrapolating these findings to the full U.S. population (330 million) an estimated 19,600 cutaneous melanomas, 421,300 squamous cell carcinomas and 696,100 basal cell carcinomas have had materially delayed initial diagnosis or treatment.”(2) The authors express concern that the delays in treatment may lead to skin cancers presenting at more advanced stages, with potential increased morbidity.
Lidocaine is often used to numb the skin before a biopsy is performed. There are different biopsy types: save, punch and incisional and excisional.(3) Lidocaine is also commonly used for Mohs surgery.(4) Mohs surgery is a precise surgical technique used to treat skin cancer. In Mohs surgery, “thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.”(5)
(1) Zigrand, C., MEDPAGE TODAY, Timely Skin Cancer Diagnosis During COVID-19? Not So Much. https://www.medpagetoday.com/resource-centers/focus-basal-cell-carcinoma/timely-skin-cancer-diagnosis-during-covid-19-not-so-much/3212 (2) Marson, J. M.D, Maner, B. Journal of the American Academy of Dermatology, The Magnitude of COVID-19’s Effect on the Timely Management of Melanoma and Nonmelanoma Skin Cancers, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817517/ (3) DiChiara, T. PhD, (reviewed by Nelson, D. M.D.) verywell health, The Different Types of Skin Cancer Biopsies, https://www.verywellhealth.com/diagnosis-with-a-skin-cancer-biopsy-3010750 (4) Nouri, K. editor, Springer Science and Business Media, Mohs Micrographic Surgery, https://books.google.com/books
(5) Mayo Clinic, Mohs Surgery, https://www.mayoclinic.org/