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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • shutterstock_1007094154
    You have recently been diagnosed with invasive melanoma, unless your cancer is at a very early stage or you have already undergone wide excision to remove the suspicious tissue
  • You have undergone surgery for melanoma and are experiencing complications related to the surgery

High/medium priority

Your outpatient appointment may be a high/medium priority if:

  • You have been living with melanoma for some time and are experiencing new symptoms or side effects from your treatment. In these cases, appointments may be conducted via telephone, depending on the severity of your symptoms. If you are receiving immunotherapy, any new symptoms of shortness of breath, moderate to severe diarrhoea or neurological problems would be treated as a high priority and you may be tested for COVID-19. If you are receiving targeted therapy and experience a fever that does not disappear when your treatment is paused, you may be tested for COVID-19

Medium priority

Your outpatient appointment may be a medium priority if:

  • You are receiving immunotherapy and the purpose of your appointment is a routine visit between treatment administration visits. In these cases, appointments may be conducted via telephone
  • You have undergone surgery for melanoma and are not experiencing any complications related to the surgery

Low priority

Your outpatient appointment may be a low priority if:

  • You are not receiving any active treatment for melanoma and the purpose of your appointment is for a routine follow up visit. In these cases, appointments may be conducted via telephone
  • The purpose of your appointment is to monitor a condition that places you at increased risk of melanoma, such as dysplastic naevi syndrome
  • The purpose of your appointment is for psychological support. In these cases, appointments may be conducted via telephone

Additional considerations for outpatient appointments in the management of melanoma

  • Patients receiving immunotherapy may have their regimen adjusted so that they receive a double dose and then have a longer interval between treatments. For example, pembrolizumab may be administered at 400 mg every 6 weeks rather than 200 mg every 3 weeks, and nivolumab may be administered at 480 mg every 4 weeks rather than 240 mg every 2 weeks. Appointments between treatments may be conducted via telephone and blood tests may take place at a local clinic
  • Patients receiving targeted therapy may have their follow-up visits conducted via telephone and blood tests may take place at a local clinic

Surgery

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo curative resection for stage III melanoma
  • You need to undergo surgery to treat a complication from a previous surgical procedure
  • You are scheduled to undergo surgery following neoadjuvant therapy as part of a clinical trial

High/medium priority

Your appointment may be a high/medium priority if:

  • You have recently been diagnosed with invasive melanoma that is at least 0.8 mm thick or is ulcerated, and you are scheduled to undergo wide excision and sentinel lymph node biopsy. In these cases, higher priority may be given to patients with melanoma that is at least 2 mm thick. Surgery may be delayed depending on the COVID-19 situation in your area
  • You are scheduled to undergo wide excision for melanoma that is less than 0.8 mm thick and is not ulcerated
  • You have a limited number of metastases and are scheduled to undergo resection to remove metastases   

Additional considerations for surgery in the management of melanoma

  • Participation in clinical trials of adjuvant and neoadjuvant therapies may be discouraged during the COVID-19 pandemic to reduce the number of hospital visits and minimise the risk of COVID-19

Radiotherapy for non-operable stage III/IV melanoma

High priority

Your appointment may be a high priority if:

  • shutterstock_621261359
    You are scheduled to undergo stereotactic radiotherapy for brain metastases
  • You are scheduled to undergo radiotherapy for a serious complication of metastases, such as risk of bone fracture, bleeding or spinal cord compression

High/medium priority

Your appointment may be a high/medium priority if:

  • You are scheduled to undergo radiotherapy to treat metastases that are causing symptoms. In these cases, treatment decisions will depend on the specific symptoms and the availability of radiotherapy

Low priority

Your appointment may be a low priority if:

  • You have undergone a radical lymphadenectomy and are scheduled to receive adjuvant radiotherapy
  • You are scheduled to undergo radiotherapy to treat metastases that are not causing symptoms and are not currently considered to be a threat

Additional considerations for radiotherapy in the management of non-operable stage III/IV melanoma

  • The use of steroids in relation to radiotherapy will be avoided or limited during the COVID‑19 pandemic to minimise the use of immunosuppressive drugs

Medical management of stage III melanoma

High priority

Your appointment may be a high priority if:

  • You are already receiving treatment as part of a clinical trial. In these cases, your doctor will ensure that the benefits of participating in the clinical trial outweigh the risks of COVID-19. The planned conduct of clinical trials may be adjusted during the COVID-19 pandemic

High/medium priority

Your appointment may be a high/medium priority if:

  • You have high-risk stage III melanoma and are scheduled to receive adjuvant targeted therapy or immunotherapy

Low priority

Your appointment may be a low priority if:

  • You have a lower-risk stage III melanoma and are scheduled to receive adjuvant treatment

Additional considerations for the medical management of stage III melanoma

  • Adjuvant therapy may be delayed for up to 12 weeks, depending on the COVID-19 situation in your area
  • In some cases, adjuvant treatment may be started with oral targeted therapy (which requires fewer hospital appointments) and then switched to immunotherapy when the risk of COVID-19 is reduced
  • Participation in clinical trials of adjuvant and neoadjuvant therapies may be discouraged during the COVID-19 pandemic to reduce the number of hospital visits and minimise the risk of infection with COVID-19
  • Patients receiving immunotherapy may have their regimen adjusted so that they receive a double dose and then have a longer interval between treatments. For example, pembrolizumab may be administered at 400 mg every 6 weeks rather than 200 mg every 3 weeks, and nivolumab may be administered at 480 mg every 4 weeks rather than 240 mg every 2 weeks. Appointments between treatments may be conducted via telephone and blood tests may take place at a local clinic

Medical management of non-operable stage III/IV melanoma

High priority

Your appointment may be a high priority if:

  • You have non-operable stage III or IV melanoma and are scheduled to receive treatment with targeted therapy or immunotherapy
  • You are already receiving treatment as part of a clinical trial. In these cases, your doctor will ensure that the benefits of participating in the clinical trial outweigh the risks of COVID-19. The planned conduct of clinical trials may be adjusted during the COVID-19 pandemic

Additional considerations for the medical management of non-operable stage III/IV melanoma

  • shutterstock_1055436881
    For patients receiving immunotherapy, the moderate benefits of using a combination of ipilimumab and nivolumab versus one immunotherapy alone must be balanced against the increased risk of serious immune-related side effects and the risks of steroid use. In these cases, your doctor will discuss the potential issues and will advise on the best approach for you
  • Patients receiving immunotherapy may have their regimen adjusted so that they receive a double dose and then have a longer interval between treatments. For example, pembrolizumab may be administered at 400 mg every 6 weeks rather than 200 mg every 3 weeks, and nivolumab may be administered at 480 mg every 4 weeks rather than 240 mg every 2 weeks. Appointments between treatments may be conducted via telephone and blood tests may take place at a local clinic
  • Patients receiving immunotherapy who have signs of pneumonitis will be tested for COVID‑19 before steroids are administered
  • Patients receiving targeted therapy may have their follow-up visits conducted via telephone and blood tests may take place at a local clinic 

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