32.5% Decrease in Basal Cell Carcinoma Surgeries Reported Due to COVID-19 Pandemic

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A new study has analyzed how the COVID-19 pandemic has impacted basal cell carcinoma (BCC) surgery frequency and complexity.¹ It was found that the BCC surgeries have decreased by 32.5% and are being performed on older patients with more comorbidities but the difficulty of the procedures has not changed.

The retrospective, single-center, observational study took place at Klinik Hietzing in Vienna, Austria. Investigators evaluated 727 participants who underwent surgery pre-COVID (2017-2019) and during COVID (2020-2022). The pre-COVID group included 434 patients (205 females, 229 males) while the during-COVID cohort included 293 patients (151 females, 142 males). Relevant treatment delays were measured, and surgery complexities were assessed on a 6-point scale. Additional demographic data, such as the number of surgeries, comorbidities, and distance between home and hospital, were recorded.

Since the pandemic, a 32.5% decrease in BCC surgeries was observed (p < 0.001). The largest decrease occurred between 2019 and 2020, due to the initial outbreak and lockdown. But by 2022, these numbers still did not reach pre-pandemic levels.

“During the pandemic, physicians were faced with many challenges such as rearranging hospital capacities to make decisions about prioritized patient treatment while trying to keep the number of infections among patients and healthcare providers as low as possible,” the authors noted.

Additionally, the mean age pre-COVID was 73.9 years (min 33, max 98, 95% CI 1.1, median 76), but this rose to 75.6 years during COVID (min 32, max 101, 95% CI 1.3, median 79) for an increase of 1.7 years (p = 0.341). The number of comorbidities also rose from 2.6 to 2.9 (13.2%, p = 0.042), which could be because high-risk patients were prioritized for earlier treatment during the pandemic.

Tumor characteristics, such as area and surgery duration, altered slightly between the cohorts. The average area changed from 530.4 mm² to 422.2 mm² (20.4%, p = 0.087). Surgery length also increased by 11.8% from 26.2 minutes to 29.3 minutes (p = 0.055). However, the complexity of surgeries did not differ much, as both groups were described to have moderately complex surgeries. The head and neck were also the most common areas for excision, regardless of the year.

Even without the COVID-19 pandemic, treatment delay can be a typical practice for BCC surgeries. Guidelines from the National Comprehensive Cancer Network, the American College of Mohs Surgery, the British Association of Dermatologists, and the British Society for Dermatological Surgery provide recommendations for different timelines and patient circumstances.²

BCC is the most frequently occurring malignant tumor in White patients, and incidence rates have continued to rise.³ Despite this, previous studies in Australia and the US have reported a decreased number of skin cancer screenings and diagnoses, especially in the year 2020. This trial is one of the first to assess the complexity of BCC surgeries over the last few years, particularly with the use of a classification system.

“Nonetheless, the increase in comorbidities and the prolonged reduction in surgical procedures highlight the need for ongoing vigilance to prevent future morbidity increases,” the authors concluded.

References

1. Heinrich, H., Weber, L. and Posch, C. (2025), Complexity of Basal Cell Carcinoma Surgery Between 2017 and 2022: The Impact of the COVID-19 Pandemic. JEADV Clinical Practice. https://doi.org/10.1002/jvc2.70040

2. Baumann BC, MacArthur KM, Brewer JD, et al. Management of primary skin cancer during a pandemic: Multidisciplinary recommendations. Cancer. 2020;126(17):3900-3906. doi:10.1002/cncr.32969

3. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069-1080. doi:10.1111/j.1365-2133.2012.10830.x