INTRODUCTION
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious enveloped single stranded sense RNA virus that results in a life-threatening pulmonary illness known as COVID-19.1 Today, the COVID-19 pandemic has resulted in society experiencing unprecedented challenges for healthcare practitioners and facilities serving at the frontlines of this pandemic. As healthcare practitioners we are implementing measures that aim to mitigate the spread of the virus and to conserve resources including personal protective equipment (PPE) while still caring for patients. Currently the majority of the mandates on healthcare practitioners have been to stratify patients based on risk for severe illness per the Centers for Disease Control and Prevention (CDC) guidelines (Figure 1) while also considering the necessity for patients to be evaluated in person in the outpatient setting and to assess the “urgency” of any surgical procedure(s) to be performed.2
Irrespective of the nature of any healthcare crisis, patients suffering from cancer always receive significant attention due to the morbidity and mortality rate associated with cancer, which is the leading cause of death in countries with developed economies.3 Today, there is a paucity of literature on the impact of pandemics on the progression/evolution of cancer with most of the literature being devoted to the impact of viral illness on cancer patients.4 For example, Chemaly and colleagues published a multicenter study evaluating the impact of the 2009 H1N1 influenza pandemic on adult patients with solid tumors and reported a mortality rate of 9.5% in these patients in comparison to the global mortality rate which was 0.001 – 0.007%.4 With regards to oral cancer, there is a complete absence of literature regarding the long-term impact of pandemics on patients with oral potentially malignant disorders (OPMDs) and early stage oral cancer. Therefore, for practitioners who manage OPMDs and oral cancer, a great concern is the risk of progression of these lesions and the detriments patients will incur in the long term. Prior to this pandemic, even with readily available access for the majority of patients to a fully intact healthcare infrastructure, less than 50% of patients with oral cancer were diagnosed at an early stage.5 Such concerns for delays in diagnosis and care of patients with oral cancer have been extensively addressed in the medical literature in the pre-COVID-19 era. Murphy and colleagues reported that 25% of patients with head and neck cancer in the United States experienced treatment delay.6 Furthermore, an increase in the time to treatment initiation (TTI) by 46 – 52 days resulted in an increased risk of death with the most detrimental impact once TTI extends beyond 60 days.6 Therefore, early diagnosis and early time to treatment are mainstays for the care of patients with oral cancer to reduce such adverse outcomes, with the most opportune time to prevent and treat oral cancer in its earliest stage through the methodical evaluation and management of OPMDs.
OPMDs are a heterogeneous group of lesions with varying clinical features, risk factors, biologic behavior, and malignant transformation rates (Figure 2A and 2B)4,5. It is estimated that OPMDs affect about 2% of the world’s population, with a combined malignant transformation rate of 7.9%.7,8 Herein, we describe a collaborative and multidisciplinary (oral and maxillofacial surgery, otorhinolaryngology, oral medicine) perspectives on our approach for the evaluation and management of OPMDs during the COVID-19 pandemic.