Cutaneous disease
- Basal cell carcinoma
- Defer when possible
- If advanced and/or symptomatic requiring therapy sooner, consider
hedgehog inhibitors
- Squamous cell carcinoma
- Consider deferring wide local excision (WLE) or Mohs by 8-12 weeks,
or consider topical options for early stage disease (e.g.,
imiquimod)
- If advanced and/or symptomatic requiring therapy sooner, consider
neoadjuvant non-surgical therapy (e.g., cemiplimab) to allow
deferral past peak incidence of pandemic
- Melanoma (detailed report can be found in the NCCN COVID-19 working
group14)
- Melanoma in situ
- Delay WLE of melanoma in situ for at least 3 months
- T1 melanoma
- Delay WLE for up to 3 months or consider excision in
office/outpatient setting
- Sentinel lymph node biopsy (SLNB)
- Offer for melanoma >1 mm thickness, but defer SLNB
for T1b melanoma (0.8-1.0 mm with or without ulceration), unless
high risk features are evident (e.g., lympho-vascular invasion,
very high mitotic rate, young patient age [≤40 years])
- T3/T4 melanomas should take priority over T1/T2 melanomas
- Delay SLNB for up to 3 months, unless WLE in the OR is planned, in
which case WLE/SLNB may be performed at the same time
- Stage III (regional nodal) Melanoma
- As per current NCCN guidelines15, defer
completion lymph node dissection following a positive SLNB, and
perform regional nodal ultrasound surveillance (if radiologic
expertise available) or other imaging surveillance (CT, FDG
PET-CT, MRI), as appropriate
- Defer therapeutic neck dissection in the setting of clinically
palpable regional nodes, and offer neoadjuvant systemic therapy
immune checkpoint blockade or BRAF/MEK inhibitors instead
- The NCCN Melanoma Panel does not consider neoadjuvant therapy as a
superior option to surgery followed by systemic adjuvant therapy
for stage III melanoma15, but available data
suggests this is a reasonable resource-conserving option during
the COVID-19 outbreak
- Metastatic resections (stages III and IV) should be placed on hold
unless the patient is critical/symptomatic and patients should
continue systemic therapy
- Merkel cell carcinoma
- Favor primary radiation therapy
- Consider starting immunotherapy for locally advanced/locoregional
recurrent disease