Advanced Melanoma Management in the COVID-19 Era

Insights into the management of advanced melanoma in the coronavirus disease 2019 (COVID-19) era have been provided by academic dermatology researchers from Italy in a letter to the editor of Dermatologic Therapy.

Most outpatient procedures, including dermatologic treatments, have been postponed because of the virus. Patients with melanoma who receive immunosuppressive or immunomodulating therapies for chronic skin diseases have been managed on a case-by-case basis in an effort to quell the risk for infection. Greater concern exists for more severe dermatologic diseases, such as advanced melanoma. Currently, there are no coherent or conclusive data on how COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), affects advanced melanoma and its management.

What is known, however, is that many cancer therapies can result in immunosuppression, with some data suggesting that COVID-19 may increase the risk for mortality to a greater degree in patients with cancer. Guidelines that discuss management of patients with cancer who have tested positive for COVID-19 indicate that ongoing therapy for their cancer should not be discontinued; however, these guidelines do not describe management approaches in those treated with targeted therapy or immunotherapy. The European Society for Medical Oncology (ESMO) indicate that patients should be swabbed for SARS-CoV-2 if they are scheduled to undergo surgery, radiotherapy, immunotherapy, or chemotherapy.

In their letter, dermatology experts suggest that, based on current considerations and guidelines, patients with advanced melanoma should not discontinue their ongoing therapy or immunotherapy independently. Patients are encouraged to contact their oncologist or dermato-oncologist immediately if they begin to demonstrate flu symptoms. In addition, the authors recommend swabbing for the virus prior to initiation or continuation of medical chemotherapy/immunotherapy or before major surgeries.

The authors also wrote that in symptomatic or paucisymptomatic cases of COVID-19, clinicians should “evaluate patients on a case-by-case basis and if necessary consider suspending a cycle of treatment for both treatments.”

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Conforti C, Giuffrida R, Di Meo N, Zalaudek I. Management of advanced melanoma in the COVID-19 era [published online April 22, 2020]. Dermatol Ther. doi: 10.1111/dth.13444