The Recovery of Skin Cancer Services Following the COVID-19 Pandemic, Using Combined Speciality Clinics to Decrease Waiting Times and Improve Cost Efficiency

The unprecedented COVID-19 pandemic continues to have significant ramifications for nonurgent medical treatment and cancer care globally. Provision of healthcare for noncommunicable disease has been dramatically curtailed across the world, in order to redirect resources in a bid to gain control of the coronavirus. There are multiple reports internationally of significant reductions in urgent cancer referrals [1-4]. In England, patients diagnosed with a stage I primary fell for all types of cancer in the first 4 months of the pandemic compared to pre-pandemic levels (March to June 2019 vs 2020; 18400 vs 12400), equating to a drop of approximately 1500 people per month [5]. Skin cancer primaries are amongst the most impacted1, as by September 2020 the estimated number of malignant cancer diagnoses had reached 95% of pre-pandemic activity in all groups except non-melanoma skin cancer [5]. A Canadian study examined the pandemic’s influence on skin biopsies and demonstrated a precipitous drop to just 15% of expected biopsy numbers compared to the same period in the year prior to the pandemic [4]. Furthermore, the elderly, females and patients living in areas of greater socioeconomic deprivation were disproportionately affected and less likely to attend for skin biopsies when suspicion of cutaneous malignancy was present [4]. Whilst substantial improvements in biopsy rates have been noted, it is expected that a large backlog of cases will