Cutaneous disease
·       Basal cell carcinoma
            o   Defer when possible
            o   If advanced and/or symptomatic requiring therapy sooner, consider hedgehog inhibitors
·       Squamous cell carcinoma
            o   Consider deferring wide local excision (WLE) or Mohs by 8-12 weeks, or consider topical                   options for early stage disease (e.g., imiquimod)
            o   If advanced and/or symptomatic requiring therapy sooner, consider neoadjuvant                   non-surgical therapy (e.g., cemiplimab) to allow deferral past peak incidence of pandemic
·       Melanoma (detailed report can be found in the NCCN COVID-19 working group14)
            o   Melanoma in situ
                    §  Delay WLE of melanoma in situ for at least 3 months
            o   T1 melanoma
                    §  Delay WLE for up to 3 months or consider excision in office/outpatient setting
            o   Sentinel lymph node biopsy (SLNB)
                    §  Offer for melanoma >1 mm thickness, but defer SLNB for T1b melanoma (0.8-1.0 mm                          with or without ulceration), unless high risk features are evident (e.g., lympho-vascular                          invasion, very high mitotic rate, young patient age [≤40 years])
            o   T3/T4 melanomas should take priority over T1/T2 melanomas
                    §  Delay SLNB for up to 3 months, unless WLE in the OR is planned, in which case                         case                         WLE/SLNB may be performed at the same time
            o   Stage III (regional nodal) Melanoma
                    §  As per current NCCN guidelines15, defer completion lymph node dissection following a                         positive SLNB, and perform regional nodal ultrasound surveillance (if radiologic                          expertise available) or other imaging surveillance (CT, FDG PET-CT, MRI), as appropriate
                    §  Defer therapeutic neck dissection in the setting of clinically palpable regional nodes,                          and offer neoadjuvant systemic therapy immune checkpoint blockade or BRAF/MEK                           inhibitors instead 
                                ·       The NCCN Melanoma Panel does not consider neoadjuvant therapy as a                                          superior option to surgery followed by systemic adjuvant therapy for stage III                                         melanoma15, but available data suggests this is a reasonable                                         resource-conserving option during the COVID-19 outbreak
                    §  Metastatic resections (stages III and IV) should be placed on hold unless the patient is                         critical/symptomatic and patients should continue systemic therapy
            o   Merkel cell carcinoma
                    §  Favor primary radiation therapy
                    §  Consider starting immunotherapy for locally advanced/locoregional recurrent disease