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.