Safe and Timely Delivery of Essential Surgical Care for Skin Cancer in a Pandemic

Many surgical practices closed at the onset of the COVID-19 pandemic. We implemented operational changes to safely continue treating patients with cutaneous tumors during the pandemic. This study seeks to evaluate the impact of pandemic-based operational changes on safety, access, and treatment. Here, we report results from a retrospective study from a single academic office-based surgical practice that provided treatment to patients with skin cancer between November 2019 and September 2020. Time to treatment, tumor area, and upstaging after treatment were compared among patients seen "pre-pandemic" (November 2019 to March 2020), during the "pause" (March 2020 to June 2020), and in the "reopening" (June 2020 to September 2020). One-way ANOVA or Fisher Exact analyses were performed, and p < 0.05 was considered significant. Our study included 691 patients (22-101 years old) with a total of 912 tumors. No cases of COVID-19 transmission occurred during the study period. The time from consultation to treatment was reduced during the pause and reopening periods relative to pre-pandemic (p <= 0.002), and the average Mohs post-operative defect size remained unchanged throughout the study period (p = 0.75). Consistent with the prioritization of higher-risk tumors in the pandemic peak, a significant reduction in the treatment of basal cell carcinoma tumors was noted during the pause (p = 0.01), and cutaneous squamous cell carcinoma tumors were upstaged more frequently after treatment (p < 0.001). Our findings demonstrate that practice modifications can permit essential surgical care to be delivered safely to patients with high-risk skin cancers during a pandemic.