Melanoma and COVID ‐19: A narrative review focused on treatment

Abstract

Melanoma is the most severe form of skin cancer and its incidence has increased over the past few decades. COVID-19 pandemic affected the diagnosis and management of many diseases including melanoma. In this study, we aimed to provide a review focused on the diagnosis and management of melanoma in the era of COVID-19. A comprehensive search was conducted on PubMed, Web of Science, and Google Scholar databases using the keywords "melanoma," "coronavirus," "COVID 19," and "SARS-CoV-2." The relevant guidelines published by the European Society for Medical Oncology and the National Comprehensive Cancer Network were also included. The current guidelines recommend that surgical interventions for new diagnosis of invasive primary melanoma, patients with postoperative complications, wide resection and sentinel lymph node biopsy for newly diagnosed T3-T4 melanoma, and planned surgical procedures for patients in neo-adjuvant trials should be prioritized. Surgical treatment of T3/T4 melanomas should be prioritized over T1/T2 melanomas except for any melanoma in which large clinical residual lesion is visible. Adjuvant therapies can be postponed for up to 12 weeks depending on the local center circumstances. PD-1 inhibitor monotherapy is recommended for patients starting immunologic therapy. Combination immunotherapy is still considered suitable for patients with higher-risk disease. Encorafenib and binimetinib should be prioritized for patients requiring BRAF-targeted therapy due to the lower chance of symptoms mimicking COVID-19 infection.

Clinical and immunologic implications of COVID-19 in patients with melanoma and renal cell carcinoma receiving immune checkpoint inhibitors

“… 93 With no clear evidence suggesting that ICIs worsen the risk or course of a COVID-19 infection, many sources have concurred that patients with melanoma, particularly those of an advanced stage, be treated without hesitation via standard of care regimens including ICIs and targeted therapy pending individual serine–threonine protein kinase B-RAF (BRAF) mutational status. 30 95 104 We therefore agree with recently published consensus guidelines from the UK, 105 106 including continued use of front-line ICI therapies and to consider the approved alternative dosing regimens of either pembrolizumab 400 mg every 6 weeks as opposed to initial 3-week standard of care dosing per KEYNOTE-555 Cohort B data as well as nivolumab 480 mg every 4 weeks compared with every 2-week standard of care for those on nivolumab maintenance regimens. 107 …”

Potential protective role of the anti-PD-1 blockade against SARS-CoV-2 infection

“…The European Society for Medical Oncology (ESMO), the National Comprehensive Cancer Network (NCCN), S.H. Nahm et al, and Brian C. Baumann et al, both with an emphasis on melanoma treatment throughout the pandemic, have released guidance and suggestions, which were recently outlined by Ömer Faruk Elmas et al [81] , [82] , [83] , [84] , [85] . The alternative approach to ICI care may include supplementary immunosuppressive therapies, which may help control the ICI-related immune-related adverse events (irAEs), including SARS-CoV-2 infection.…”

Pemphigus and COVID ‐19: Critical overview of management with a focus on treatment choice

“…Due to the COVID‐19 crisis, numerous scheduled medical activities have been postponed. This interruption to the healthcare system can negatively modify the diagnosis and management of many cutaneous conditions 5,6 . Patients with pemphigus are susceptible to immunosuppression and circulatory failure and are more prone to infections than healthy people.…”