Table I.
Recommendations regarding dermatologic surgery during the COVID-19 pandemic
| Area | Recommendation |
|---|---|
| Clinic structure | Triage clinics, rebooking according to clinical priority and use telehealth where possible |
| Waiting rooms | Screen patients before attendance to prevent high-risk cases from entering the practice |
| Stagger appointment times to minimize patients in waiting room together | |
| Patient chairs spaced a minimum of 1.5 m apart | |
| Limit support persons to 1 | |
| Remove possible sources of infection (such as magazines) in the waiting room | |
| Ensure all attendees hand sanitize on arrival | |
| Procedures | PPE being rationed to allow for the best protective practices while also preventing a complete shortage. This is a dynamic process dependent on supply |
| Consider N95 masks for perioroficial surgery | |
| Use dissolving sutures to minimize multiple presentations | |
| Benign lesions | Cysts, lipomas, cosmetic procedures: defer for now |
| Procedures that alleviate significant morbidity (eg incision and drainage of hidradenitis suppurativa abscesses) may proceed as soon as feasible | |
| BCC | Superficial: defer treatment for 6 months |
| All other: defer surgery for 3 to 6 months | |
| SCC | Actinic keratosis and SCC in situ: defer for now |
| SCC: guided by prognostic variables: location, size >2 cm, depth >2 mm, differentiation, perineural or lymphovascular invasion, recurrence immunosuppression5 | |
| Melanoma | Excisional biopsy with 2-mm border when melanoma suspected |
| Melanoma in situ: defer treatment for 3 months | |
| Invasive melanoma: if histologic clearance obtained, defer wide excision and/or sentinel lymph node biopsy for 3 months | |
| Other tumors | Benign tumors: defer for now, where medical investigation required (for fibrofolliculoma, tricholemmoma, sebaceous carcinoma, etc), this may be deferred |
| Locally aggressive tumors (eg, dermatofibroma sarcoma protuberans, Merkel cell carcinoma, microcystic adnexal carcinoma, etc): proceed as soon as feasibly possible with consideration of patient and tumor variables |
BCC, Basal cell carcinoma; PPE, personal protective equipment; SCC, squamous cell carcinoma.