Impact of the COVID Pandemic on Mohs Micrographic Surgery: A Nationwide Survey

May 2022 | Volume 21 | Issue 5 | 545 | Copyright © May 2022


Published online April 22, 2022

Edward W. Seger MD MSa, Brett C. Neill MDa, Thomas L.H. Hocker MDa, Omar A. Ibrahimi MD PhDb

aDivision of Dermatology, University of Kansas Medical Center, Kansas City, KS
bConnecticut Skin Institute, Stamford, CT

Abstract

Background: At the onset of the COVID-19 pandemic, many Mohs micrographic surgeries (MMS) were delayed over concerns for propagating further infectious spread and scarcity of medical resources.
Objective: To assess the impact of the pandemic on MMS and the treatment of skin cancer
Methods and Materials: An electronic survey was sent to fellowship trained Mohs surgeons to assess patient outcomes, practice viability, and physician sentiment related to performing MMS during the COVID-19 pandemic.
Results: Of the 303 respondents, 82% reported declines in case volume for at least 3 months, and average case difficulty increased for 69% of surgeons following these delays. Instances of local tumor spread following delays were seen by 69% of respondents, and 20% noted cases of regional or systemic metastasis. Only 8 cases of staff testing positive (and 7 cases of patients) were reported, and 97% of respondents felt comfortable performing MMS during the pandemic. Private practice surgeons more often viewed practice restriction recommendations negatively initially (42% vs 26% in academics, P=0.03) and in hindsight (63% vs 36% in academics, P<0.001).
Conclusions: Mohs surgeon’s ability to minimize spread of COVID-19 during routine patient care, alongside potential risks of delaying treatment of skin cancers, should be considered in future recommendations for patient care.

J Drugs Dermatol. 2022;21(5):545-547. doi:10.36849/JDD.6189

INTRODUCTION

Initial uncertainty during the COVID-19 pandemic led most medical organizations to recommend postponing all nonessential visits.1 Unfortunately for patients with newly diagnosed skin cancers, many Mohs surgeries were included in this delay. With most procedures now resumed, it is possible to assess the impact of these recommendations.

An IRB approved 15-question survey was created to assess patient outcomes, practice viability, and physician sentiment. The survey was electronically sent to fellowship trained Mohs surgeons practicing in the United States six months after the onset of the pandemic. Data was collected using redcap software and analyzed using Fisher’s exact tests, with P<0.05 considered statistically significant.

A total of 303 surgeons completed the survey (73% response rate) with an average age of 46.3±10.6 years. Respondents were mostly in private practice (81%) and suburban settings (57%, Table 1). Over 80% of respondents noted a decline in case volume for at least 3 months (Figure 1). Average case difficulty increased following treatment delays for 68.5% of surgeons, and suburban/rural surgeons were most impacted (76.3% vs 59.6% in urban settings, P=0.027). Adverse outcomes following delays were common: 69% reported cases of local tumor spread, 49% reported cases of advancement in tumor stage, and 20% reported cases of regional or systemic metastasis (Table 1). Pandemic delays were felt to be overall harmful to patients (78% of respondents) and contributed to worsened emotional health and anxiety (76% of respondents). At the onset of the pandemic, 45% of surgeons were in agreement with practice restrictions (39% in disagreement). In hindsight, only 29% of surgeons now agree with initial recommendations (58% in disagreement, Table 1). Overall, 39% of respondents had a less favorable view of recommendations now than they initially did (versus 4% reporting a more favorable view). Private practice surgeons more often viewed these recommendations negatively initially (42.2% vs 25.9% in academics, P=0.03) and currently (62.8% vs 35.8% in academics, P<0.001).

Incidences of COVID infection were rare: 8 respondents (2.6%) reported cases of staff testing positive and 7 respondents (2.3%) reported cases of patients tested positive following their procedure. No further spread was reported in these cases. Each