Impact of COVID-19 on dermatologic surgery: experience of a Midwestern academic practice

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice everywhere. The aim of this study was to quantify the specific impact of COVID-19 on skin cancer treatment at an academic dermatologic surgery practice. We conducted a retrospective chart review to compare metrics such as patient visits, histological upgrading, and Mohs stages per tumor between 60-day periods immediately before and after COVID-19 was declared a pandemic. Out of 1138 total encounters, decreases of 58% in total in-person visits and 38% in Mohs surgeries performed were observed following declaration of the pandemic. More squamous cell carcinoma and squamous cell carcinoma in situ (SCC/SCCIS) and less basal cell carcinoma (BCC) tumors were treated post-declaration compared to pre-declaration. There was a significantly higher histological upgrade rate for total tumors, as well as for the BCC subgroup, but not the SCC/SCCIS subgroup. While the overall number of dermatologic surgeries decreased after declaration of the pandemic, the higher histological upgrade rate reflects an appropriate triage of higher risk skin cancers. These findings may be useful both to assess the effectiveness of protocols for COVID-19 and to prepare for future resource-limited scenarios.

Short-Term and Long-Term Effects of the COVID-19 Pandemic on a Referral-Based Mohs Micrographic Surgery Private Practice

“…During the first surge, which directly followed the SHO, the ratio of BCCs to SCCs fell significantly, similar to the results of previous studies. 1–3 Despite fluctuating in subsequent periods, this ratio never returned to prepandemic levels during the 2-year post-SHO period. 5…”

“…During the first surge, which directly followed the SHO, the ratio of BCCs to SCCs fell significantly, similar to the results of previous studies. [1][2][3] Despite fluctuating in subsequent periods, this ratio never returned to prepandemic levels during the 2-year post-SHO period. 5 Significant increases in mean postoperative defect area in Periods 3 and 5 follow declines in case frequency in Periods 2 and 3.…”

“…Melanoma antigen recognized by T cells is a cytoplasmic protein found in early stages of melanosome development. 3 As melanosomes develop, they are transported toward the periphery of the melanocyte and into dendrites. 3…”

“…3 As melanosomes develop, they are transported toward the periphery of the melanocyte and into dendrites. 3…”

“…Although previous studies examined the short-term effects of the COVID-19 pandemic on MMS within academic institutions, the long-term consequences for private MMS offices are unknown. [1][2][3][4] We evaluated changes in case volume and tumor severity among keratinocytic carcinomas treated with MMS from six months before the pandemic until two years afterward.…”