Microsoft Word - July 2020 - COVIDCON 908 - proof - returned.docx SKIN July 2020 Volume 4 Issue 4 Copyright 2020 The National Society for Cutaneous Medicine 335 COVID CONCEPTS Considerations for Dermatologic Patient Care during COVID-19 Clay J. Cockerell, MD, MBA1,2, Haley D. Heibel, MD3, Ashleigh Workman, DO4,5 1Cockerell Dermatopathology, Dallas, TX 2Departments of Dermatology and Pathology, UT Southwestern Medical Center, Dallas, TX 3Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY 4Department of Dermatology, Medical City Weatherford, Weatherford, TX 5Department of Dermatology, University of North Texas Health Science Center, Fort Worth, TX To the Editor: The COVID-19 pandemic has led to numerous challenges in dermatology. Dermatologists have experienced uncertainty regarding the extent of procedures that are permitted during the pandemic. For instance, the attorney general of Texas issued a statement that dermatologists were not allowed to perform “routine” procedures during the pandemic. The ambiguous nature of “routine” procedures was misinterpreted by many dermatologists, unfortunately leading to the delay of biopsies and surgeries for skin cancer. During the COVID-19 era, we have seen multiple metastatic melanomas, as well as cutaneous metastatic lung cancer and, in another patient, cutaneous metastatic breast cancer. Consideration should be placed on the potential for perceived and existing barriers for patients receiving dermatologic care with teledermatology during the COVID-19 era. Delaying surgery for skin cancer has the potential to increase tumor burden, which may lead to more complex surgeries and increase the risk for metastasis.1 Skin manifestations may be one of the first signs of COVID-19.2 Recalcati found that of the 20% of patients who developed cutaneous manifestations during the course of COVID, 44% had cutaneous involvement at disease onset.2 If patients developed concerning skin lesions or experienced complications from a pre-existing skin condition and had difficulty in connecting with or receiving care from a dermatologist, they likely sought care from an urgent care center or emergency room. These centers were already overwhelmed, and the patient ABSTRACT The COVID-19 pandemic has led to numerous challenges in dermatology. Here, we discuss our experience of diagnosing multiple metastatic cutaneous cancers during the COVID-19 era and consider how perceived and existing barriers for patients receiving dermatologic care in the pandemic may have led to the progression of cancer. In Texas, the attorney general issued a statement that dermatologists could not perform “routine” procedures. Unfortunately, many dermatologists delayed biopsies and surgeries for skin cancer due to misinterpreting the ambiguous nature of the term “routine.” Dermatologists provide valuable expertise and crucial services to society at all times, including during life-threatening pandemics, and this should be emphasized to the public and governmental agencies. SKIN July 2020 Volume 4 Issue 4 Copyright 2020 The National Society for Cutaneous Medicine 336 was placed in a circumstance that led to a higher chance of exposure to COVID-19. Unintended consequences of dermatologic patients seeking care from other facilities include utilization of resources reserved for COVID-19 patients and inappropriate diagnosis and treatment, leading to further spread of COVID-19. Dermatologists have experience in the recognition of cutaneous manifestations of systemic disease and were the first to recognize dermatologic signs of COVID-19, which is of value to society. Through early recognition of infected and contagious patients with cutaneous signs of COVID-19 and isolating these patients, dermatologists could have reduced the spread of COVID-19. Dermatologists must also consider the potential harm of delaying an in-person visit with a patient and/or procedure against the potential spread of COVID-19. Teledermatology allows for evaluation of patients without increasing the risk of infection, but not all patients have the desire, ability, or resources to participate in teledermatology. Additionally, it may not be possible to evaluate some dermatologic conditions or perform full body examinations via teledermatology.3 In the era of teledermatology, we encourage thoughtful considerations in providing access for patient care, while also considering reducing the transmission of COVID-19. It may be helpful for dermatologists to provide clear contact information and guidelines for the evaluation of an urgent patient.4 Dermatologists provide valuable expertise in the diagnosis and treatment of various skin conditions. This is a cautionary reminder of the importance of our specialty, not to be trivialized by third parties, such as governmental agencies. It must be emphasized to the public that the field of dermatology is not limited to cosmetic services. Dermatologists provide valuable and crucial services at all times, including during life-threatening pandemics. Conflict of Interest Disclosures: None Funding: None Corresponding Author: Clay J. Cockerell, MD, MBA 2110 Research Row Suite 100 Dallas, TX 75235 Phone: 214-530-5200 Email: ccockerell@dermpath.com References: 1. Der Sarkissian SA, Kim L, Veness M, Yiasemides E, Sebaratnam DF. Recommendations on dermatologic surgery during the COVID-19 pandemic. J Am Acad Dermatol. 2020. 2. Recalcati S. Cutaneous manifestations in COVID-19: A first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212-e213. 3. Pathoulas JT, Stoff BK, Lee KC, Farah RS. Ethical outpatient dermatology care during the coronavirus (COVID-19) pandemic. J Am Acad Dermatol. 2020;82(5):1272-1273. 4. Lee I, Kovarik C, Tejasvi T, Pizarro M, Lipoff JB. Telehealth: Helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation. J Am Acad Dermatol. 2020;82(5):1213-1214.