Urgent – Proceed with Surgery
The majority of the cases that fall into this category are mucosal
HNSCC. As previously mentioned, there is evidence to suggest that
delayed time to treatment initiation in HNSCC patients may result in
poorer oncologic outcomes.15-22 In our opinion, during
triage levels 1 and 2 of the pandemic, it is reasonable to proceed with
these oncologic cases to avoid delay in treatment. There is some
evidence to suggest that time from diagnosis to surgery may be more
significant in HPV-negative than HPV-positive
disease.21 Therefore, if necessary, HPV-negative
patients should be prioritized.
Additionally, we identified high-risk thyroid cancers including
anaplastic thyroid carcinoma, medullary thyroid carcinoma, metastatic
papillary thyroid carcinoma (PTC), locally aggressive PTC, revision PTC
with active progression of disease, and greater than 4 cm follicular
lesions as urgent cases. Skull base cancers should proceed with surgery
with additional precautions and PPE consideration as mentioned
previously. We consider melanoma greater than 1 mm thick, Merkel cell
carcinoma, advanced-stage high-risk cutaneous squamous cell carcinoma,
as well as basal cell carcinoma in close proximity to critical areas as
urgent. High-risk cutaneous squamous cell carcinomas include those
greater than 4 cm, having deep invasion beyond subcutaneous structures,
perineural invasion, or poor differentiation.34Additional urgent cases include surgery for high-grade salivary tumors
and parathyroidectomy in patients with nephrologist or endocrinologist
documentation of declining renal function.