ABSTRACT
Skin cancer is the most common malignancy worldwide. The COVID-19 pandemic has caused an unprecedented reorganization of healthcare services. This study established what effect the pandemic has had on the provision of skin cancer surgery by plastic surgeons in the U.K., one of the worst affected countries globally. A national, multicentre, prospective cohort study of nonmelanoma skin cancer excisions was undertaken. Retrospective data were collected on melanoma surgery. Consecutive monthly surveys from plastic surgeons ascertained how national guidance was implemented. The primary outcome was surgical provision by tumour type. In total, 2050 patients (1549 with nonmelanoma skin cancer and 501 with melanoma) from 32 plastic surgery units were enrolled between 16 March and 14 June 2020. Surgeon surveys were received from 34 plastic surgery units. The number of nonmelanoma skin cancers treated per week fell by 27% to 44% during lockdown. The median number of general anaesthetic operating lists per week per institution fell sixfold from three before the pandemic to 0.5 in April (P < 0.001) and gradually increased in May and June but did not reach pre-'lockdown' levels. Excision of squamous cell carcinomas (SCCs) was prioritized over basal cell carcinomas (BCCs). At the peak of the pandemic, SCCs made up 71% of excisions (normally 28%;P < 0.001). Sentinel lymph node biopsies for melanoma (Breslow thickness ≥ 0.8 mm) occurred in only 26%, suggesting many patients were not accurately staged, restricting their access to adjuvant therapy. Two patients (0.7%) developed COVID-19 after melanoma surgery. High-risk tumours were particularly affected, as 77% of surgeons reported Mohs micrographic surgery was stopped and radiotherapy was run at a reduced service in 70% of units. Surgeons reported that surveillance for melanoma and SCC stopped in 10% and operating on BCCs was stopped in 73% of units. All skin cancers suffered a significant and abrupt disruption, but high-risk and complex lesions were worst affected. The majority of changes observed were in line with speciality association pandemic guidelines. In contrast to previous studies, we have demonstrated that operating on skin cancer during the pandemic was safe. To reduce further mortality and morbidity from the COVID-19 pandemic, skin services must be resumed urgently.