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Streamlining skin cancer services during the COVID-19 pandemic
British Journal of Dermatology ; 183(SUPPL 1):206-207, 2020.
Article in English | EMBASE | ID: covidwho-1093718
ABSTRACT
The COVID-19 pandemic has enforced drastic changes in dermatological practice with skin cancer services prioritized. Two-week-wait referrals from April to May 2019 were compared with the same period from 2020 - at the height of the pandemic - and analysed using Stata version 16 in order to inform a long-term change in practice. There were 695 referrals across both years (4 months);441 (63.4%) in 2019 and 254 (36.5%) in 2020. The rate of attendance was higher in 2019 (pre-COVID-19) 418 (95%) vs. 227 (90%) in 2020 (P = 0.008). Mean patient age in 2019 was 56 years and in 2020 it was 52 years. There was no change in sex distribution. Among the attendees, 45.3% required a biopsy. The rate of biopsy requirement was lower in 2020 than in 2019 (38% vs. 49%;P = 0.007);however, more of the biopsies were carried out on the day in 2020 than in 2019 (33% vs. 11%;P < 0.001). The most common reason for not performing a biopsy in those requiring one in 2019 was due to elective booking (85%);however, in 2020 there were only 10 patients who did not have a biopsy when one was required and the reasons were mainly unknown. Across both years, there were 17 histologically confirmed cases of malignant melanoma 2.6% of all attendees. This rate was slightly higher in 2020 (3.1% vs. 2.4%) but was not statistically significant (P = 0.6). The rated of basal cell carcinoma, squamous cell carcinoma and other malignancies were 6.8%, 5.1% and 5.9%, respectively, and were not statistically significant different between 2019 and 2020. The rate of melanocytic naevus was 6.2% and other melanocytic lesions was 1.1%. The rate of histological confirmation of 'other benign' conditions was 14.6%;this was significantly lower in 2020 (9.3%) compared with 2019 (17.5%;P = 0.005). Overall, 47% were discharged on the same day;57.6% in 2020 vs. 40.7% in 2019 (P < 0.001). Among those requiring follow-up, the majority in 2019 had face-to-face appointments (56%);however, in 2020 the majority had telephone appointments (65%), which was statistically significant (P = 0.001). Our data suggest that the changes incurred by COVID-19 have driven a more effective and accurate skin cancer service;similar amounts of malignancies were identified with a simultaneous reduction in biopsy-proven benign conditions. In the future, there is an important role for on-the-day biopsies with more telephone follow-up consultations.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: British Journal of Dermatology Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: British Journal of Dermatology Year: 2020 Document Type: Article