COVID-19 impacts on dermatologic surgery patients: A single institution experience.

/pdf/mohs-micrographic-surgery-during-the-covid-19-pandemic-462yokqk83.pdf

Mohs Micrographic Surgery During the COVID-19 Pandemic: Considering the Patient Perspective.

Azathioprine/estradiol-congener-compounds/progesterone-congener-compounds

COVID-19 has greatly impacted patients’ ability to receive medical care. Early on during the pandemic, skin cancer diagnosis and treatment were often delayed due to fear of viral spread. In certain locales, executive orders have prevented physicians from performing procedures that were not immediately lifesaving. This study aims to assess patient-reported quality of care and sense of safety while receiving Mohs micrographic surgery (MMS) during the pandemic. The intent of this study is to identify patient-specific factors that influence concerns and feelings of safety, and thus guide future safety measures. A telephone survey was administered to assess patient concerns about treatment delay, feelings of safety, and satisfaction. A retrospective chart review was performed to collect demographics, comorbidities, tumor characteristics, etc. A total of 144 patients (102 male, 42 female; average 71.9 years old) completed the study. Overall, patients felt safe and satisfied, with 75.7% reporting 10/10 safety (average 9.5/10) and 84% reporting 10/10 satisfaction (average 9.7/10). Patients had more notable levels of concern regarding pandemic-related treatment delays (median 2/10), compared to the risk of contracting COVID during their visit (median 1/10). Concerns regarding treatment delay included an increase in cancer size, spread, pain, and scarring. This study demonstrates that high levels of patient feelings of safety and satisfaction can be obtained with MMS during the pandemic. As the pandemic continues, it is imperative that patients can receive high quality and timely care without compromising safety. Outpatient dermatologic surgery can continue without jeopardizing patients' overall feeling of safety and satisfaction.

/pdf/assessing-patient-reported-quality-of-care-and-safety-in-uksu7b22.pdf

Assessing Patient Reported Quality of Care and Safety in Mohs Surgery During the COVID-19 Pandemic

Many surgical practices closed at the onset of the COVID-19 pandemic. We implemented operational changes to safely continue treating patients with cutaneous tumors during the pandemic. This study seeks to evaluate the impact of pandemic-based operational changes on safety, access, and treatment. Here, we report results from a retrospective study from a single academic office-based surgical practice that provided treatment to patients with skin cancer between November 2019 and September 2020. Time to treatment, tumor area, and upstaging after treatment were compared among patients seen “pre-pandemic” (November 2019 to March 2020), during the “pause” (March 2020 to June 2020), and in the “reopening” (June 2020 to September 2020). One-way ANOVA or Fisher Exact analyses were performed, and p < 0.05 was considered significant. Our study included 691 patients (22–101 years old) with a total of 912 tumors. No cases of COVID-19 transmission occurred during the study period. The time from consultation to treatment was reduced during the pause and reopening periods relative to pre-pandemic (p ≤ 0.002), and the average Mohs post-operative defect size remained unchanged throughout the study period (p = 0.75). Consistent with the prioritization of higher-risk tumors in the pandemic peak, a significant reduction in the treatment of basal cell carcinoma tumors was noted during the pause (p = 0.01), and cutaneous squamous cell carcinoma tumors were upstaged more frequently after treatment (p < 0.001). Our findings demonstrate that practice modifications can permit essential surgical care to be delivered safely to patients with high-risk skin cancers during a pandemic.

/pdf/safe-and-timely-delivery-of-essential-surgical-care-for-skin-3pmzqngr.pdf

Safe and Timely Delivery of Essential Surgical Care for Skin Cancer in a Pandemic

Dermatologic surgery during the COVID-19 pandemic: Experience of a large academic center

Azathioprine (AZA) is a commonly used immunosuppressive therapy that has been implicated in a number of cutaneous and systemic inflammatory reactions. Initiation of AZA has been associated with a hypersensitivity syndrome manifesting as acute pancreatitis and Sweet syndrome. Subcutaneous Sweet syndrome is a rare variant of Sweet syndrome where the dominant localization of inflammation is within the subcutaneous fat; it is commonly associated with underlying myeloproliferative disease. However, it has not been reported in the literature as a cutaneous manifestation of AZA hypersensitivity syndrome. We present a unique case of acute pancreatitis and biopsy‐proven subcutaneous Sweet syndrome following the initiation of AZA with resolution upon discontinuation.

Azathioprine hypersensitivity syndrome manifesting as subcutaneous Sweet syndrome and acute pancreatitis

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Dermatologic surgery during the COVID-19 pandemic: Experience of a large academic center

Azathioprine hypersensitivity syndrome manifesting as subcutaneous Sweet syndrome and acute pancreatitis