Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 44
Filter
3.
Cutis ; 109(5): 272-276, 2022 May.
Article in English | MEDLINE | ID: covidwho-1912175

ABSTRACT

The COVID-19 pandemic has impacted the practice of Mohs micrographic surgery (MMS). We sought to determine the characteristics of skin cancers treated by MMS during the pandemic compared with prepandemic controls. A retrospective chart review was conducted. Tumors included were all treated in accordance with best practice guidelines set forth by state- and national-level professional governing bodies. Bivariate and multivariate analyses were performed to compare outcome variables. Changes in tumor characteristics during the pandemic are of clinical significance, potentially affecting extent of reconstructive surgery, cost, operating time, and future tumor characteristics.


Subject(s)
COVID-19 , Skin Neoplasms , COVID-19/epidemiology , Humans , Mohs Surgery , Pandemics , Retrospective Studies , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Skin Neoplasms/surgery
4.
J Plast Reconstr Aesthet Surg ; 75(9): 3616-3621, 2022 09.
Article in English | MEDLINE | ID: covidwho-1906809

ABSTRACT

The brisk remodeling in healthcare delivery observed after the COVID-19 outbreak led us to evaluate how the pandemic affected non-melanoma skin cancer's (NMSC) care and tumor burden. To address this topic, we set up a retrospective real-life multi-center study based on the cities of Bergamo and Varese, whose provinces were the worst hit in Italy by the pandemic. We analyzed medical and pathological data from patients that underwent surgery in the two months preceding the outbreak in Italy and compared them to those who did in the corresponding bimester of the following year, reaching 214 patients and 274 lesions. We observed a considerable and significant increase in NMSC's diameter, as well as in the proportion of squamous cell carcinomas. Both the average waiting time to obtain an evaluation visit and the average time in the surgical waiting list was shorter after the COVID-19 outbreak: the reason is that we evaluated and operated near-exclusive patients affected by high-priority lesions, who benefited from "fast-track" referrals. Conversely, less-concerning lesions were, and still are, left on hold, until they will become advanced enough to be labeled as "urgent". Plastic surgery departments should evade as soon as possible from this downward spiral, in order to provide our patients with timely cancer care and to be able to treat all plastic surgery-requiring pathologies.


Subject(s)
COVID-19 , Skin Neoplasms , COVID-19/epidemiology , Humans , Italy/epidemiology , Pandemics , Retrospective Studies , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Tumor Burden
5.
World J Surg ; 46(8): 1820-1825, 2022 08.
Article in English | MEDLINE | ID: covidwho-1888852

ABSTRACT

BACKGROUND: For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline. METHODS: Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: "pre-pandemic" from May 2019 to May 2020 and "pandemic," after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables were recorded and analyzed. RESULTS: A total of 112 patients were identified: 51 patients from the "pre-pandemic" and 61 from the "pandemic" time period. The pandemic cohort more frequently presented with lesions greater than 1 mm thickness compared to pre-pandemic (68.8% v 49%, p = 0.033) and were found to have significantly more advanced T stage (p = 0.02) and overall stage disease (p = 0.022). Additionally, trends show that for pandemic patients more time passed from patient-reported lesion appearance/change to diagnostic biopsy (5.7 ± 2.0 v 7.1 ± 1.5 months, p = 0.581), but less time from biopsy to operation (42.9 ± 2.4 v 52.9 ± 5.0 days, p = 0.06). CONCLUSIONS: "Pandemic" patients presented with thicker melanoma lesions and more advanced-stage disease. These results may portend a dangerous trend toward later stage at presentation, for melanoma and other cancers with rapid growth patterns, that will emerge as the prolonged effects of the pandemic continue to impact patients' presentation for medical care.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , COVID-19/epidemiology , Humans , Melanoma/epidemiology , Melanoma/surgery , Pandemics , Retrospective Studies , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Skin Neoplasms/surgery
6.
J Drugs Dermatol ; 21(5): 545-547, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1836610

ABSTRACT

BACKGROUND: At the onset of the COVID-19 pandemic, many Mohs micrographic surgeries (MMS) were delayed over concerns for propagating further infectious spread and scarcity of medical resources. OBJECTIVE: To assess the impact of the pandemic on MMS and the treatment of skin cancer Methods and Materials: An electronic survey was sent to fellowship trained Mohs surgeons to assess patient outcomes, practice viability, and physician sentiment related to performing MMS during the COVID-19 pandemic. RESULTS: Of the 303 respondents, 82% reported declines in case volume for at least 3 months, and average case difficulty increased for 69% of surgeons following these delays. Instances of local tumor spread following delays were seen by 69% of respondents, and 20% noted cases of regional or systemic metastasis. Only 8 cases of staff testing positive (and 7 cases of patients) were reported, and 97% of respondents felt comfortable performing MMS during the pandemic. Private practice surgeons more often viewed practice restriction recommendations negatively initially (42% vs 26% in academics, P=0.03) and in hindsight (63% vs 36% in academics, P<0.001). CONCLUSIONS: Mohs surgeon’s ability to minimize spread of COVID-19 during routine patient care, alongside potential risks of delaying treatment of skin cancers, should be considered in future recommendations for patient care. J Drugs Dermatol. 2022;21(5):545-547. doi:10.36849/JDD.6189.


Subject(s)
COVID-19 , Skin Neoplasms , Surgeons , COVID-19/epidemiology , Humans , Mohs Surgery/methods , Pandemics/prevention & control , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Surveys and Questionnaires
7.
J Plast Reconstr Aesthet Surg ; 75(9): 3608-3615, 2022 09.
Article in English | MEDLINE | ID: covidwho-1803612

ABSTRACT

BACKGROUND: In response to the COVID-19 pandemic, our tertiary skin cancer service had to adapt rapidly to reduce hospital footfall. Consequently, all clinic appointments for skin cancer patients were converted to telephone consultations. This study aims to provide a comprehensive review of this new service. METHODS: This study consisted of three domains: patient and staff experience, efficacy and productivity. Patient and staff experience was assessed through prospective surveys. Efficacy of telephone appointments was assessed through prospective review of clinic coding to evaluate outcomes including rate of conversion to face-to-face appointment. Markers of treatment pathway efficacy included time from referral to surgical listing and the incidence of benign lesions placed on skin cancer pathways. Productivity was evaluated through review of the cumulative number of completed and missed appointments over a 1-month period before and during the pandemic. RESULTS: All patients were satisfied with the telephone consultation and were preferred to previous experience of face-to-face appointments by 67%. Over 80% of responding clinicians felt telephone clinics should remain as a legacy of COVID-19. Time from referral to scheduling for surgery was significantly shorter for urgent lesions when listed through a teleclinic compared to face-to-face appointment. The telephone service allowed us to maintain 46% of the plastic surgery outpatient activity of May 2019 and missed appointments almost halved. CONCLUSION: Patients and clinicians have responded positively to the new service. This study highlights the merits of an ongoing telephone clinic service for select patients on resolution of the COVID-19 impact on health services.


Subject(s)
COVID-19 , Skin Neoplasms , Surgery, Plastic , Telemedicine , COVID-19/epidemiology , Humans , Pandemics , Prospective Studies , Referral and Consultation , Skin Neoplasms/surgery , Telephone
9.
World J Surg Oncol ; 19(1): 350, 2021 Dec 24.
Article in English | MEDLINE | ID: covidwho-1637517

ABSTRACT

BACKGROUND: The outbreak of COVID-19 pandemic led to a 2-month lockdown in Europe. Elective surgeries, including skin cancer excisions, were postponed. The purpose of this prospective case-control study was to assess the impact of the treatment delay on patients with non-melanoma skin cancer (NMSC) or melanoma operated in the first post-lockdown period. METHODS: A comparative study of skin cancer operations performed in a 4-month period either in 2020 or in 2019 was conducted. All data were collected from a prospectively maintained clinic database and the pathological reports. Continuous variables were compared with t test or Mann-Whitney U test according to their distribution. Categorical variables were compared with Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) was used to assess the risk of excising high-risk NMSC in 2020 compared with 2019. RESULTS: Skin cancer excision was performed in 158 cases in 2020 compared to 125 cases in 2019 (26.4% increase). Significantly, more SCC were excised in 2020 (p = 0.024). No significant difference for several clinical parameters regarding BCC, SCC, and melanoma was identified. However, the reconstructive method applied, following NMSC excision, was significantly different, requiring frequently either skin grafting or a flap. CONCLUSION: These results indicate that skin cancer treatment delay, due to COVID-19 pandemic, is related to an increased incidence of SCC and more complicated methods of reconstruction. Considering the relapsing COVID-19 waves, significant skin cancer treatment delays should be avoided. TRIAL REGISTRATION: The study adhered to the STROBE statement for case-control studies.


Subject(s)
COVID-19 , Carcinoma, Basal Cell , Skin Neoplasms , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/surgery , Case-Control Studies , Communicable Disease Control , Humans , Neoplasm Recurrence, Local , Pandemics , SARS-CoV-2 , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Time-to-Treatment
15.
J Plast Reconstr Aesthet Surg ; 75(2): 722-729, 2022 02.
Article in English | MEDLINE | ID: covidwho-1458808

ABSTRACT

BACKGROUND: A cohort study of patients, who underwent cutaneous squamous cell carcinoma (SCC) excision, was undertaken to evaluate the effects of the COVID-19 pandemic on treatment times and histopathological features. METHODS: We identified all patients who had SCCs excised in October 2020 (pandemic group); the control group included all patients who underwent excision of SCCs during October 2019 (pre-pandemic group). Collected data included SCC subtype, thickness, size, clearance margins, referral details, patient comorbidities and operative data. RESULTS: There were 140 patients (174 SCCs; pre-pandemic group=74; pandemic group=100) identified for study inclusion. Both groups were well matched for age, sex, previous history of cancer, cutaneous SCC and histological subtype. There was a delay in median patient presentation time to the GP in the pandemic versus pre-pandemic group (106 days vs. 56 days, p <0.001); this led to a longer overall time to surgery (167 days vs. 110.5 days, p < 0.001). Pandemic group SCCs had larger median Breslow depths (4 mm vs. 3 mm, p = 0.01), a greater proportion of Clark's level 4 and 5 lesions (76.9% vs. 61.1%, p = 0.03), and a higher rate of high (20-40 mm) and very high (>40 mm) risk SCCs as defined by British Association of Dermatology diameter criteria (56.1% vs. 39.2%, p = 0.03), versus the pre-pandemic group. CONCLUSIONS: There was a 57-day median SCC treatment delay, and an associated development of higher risk SCCs by the time of surgery. Despite the challenges of a pandemic, patients should seek early consultation for suspicious skin changes, and healthcare systems should maintain skin cancer treatment pathways.


Subject(s)
COVID-19 , Carcinoma, Squamous Cell/surgery , Skin Neoplasms/surgery , Time-to-Treatment , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male
17.
Clin Exp Dermatol ; 47(3): 578-580, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1450538

ABSTRACT

The COVID-19 pandemic required people to confine themselves to their homes where possible, and disrupted normal hospital activities. We examine whether this lockdown generated changes in the size of the tumours. We compared the dimensions of the surgically removed malignant skin tumours from the first 150 patients treated after the confinement ended in Spain (22 May 2020) with those of the last 150 patients to receive such treatment before the confinement began (13 March 2020). Data on tumour surface area were collected from pathology reports. Overall, no significant difference was seen in the tumour sizes. However, among men, the tumours removed after confinement were significantly larger (P < 0.05). Controversy exists over how the reduction in the number of tumours diagnosed during lockdowns might have influenced the characteristics of tumours. In this study, no overall difference was seen in the size of the tumours removed, although those removed from men after confinement were larger.


Subject(s)
Quarantine , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Aged , COVID-19 , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Female , Humans , Male , Melanoma/pathology , Melanoma/surgery , Pandemics
18.
Acta Derm Venereol ; 101(8): adv00525, 2021 08 25.
Article in English | MEDLINE | ID: covidwho-1359145

ABSTRACT

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.


Subject(s)
COVID-19 , Carcinoma, Squamous Cell , Melanoma , Skin Neoplasms , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/surgery , Communicable Disease Control , Humans , Melanoma/epidemiology , Melanoma/surgery , Pandemics , SARS-CoV-2 , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Tumor Burden
SELECTION OF CITATIONS
SEARCH DETAIL