UK consensus recommendations on the management of oral epithelial dysplasia during COVID-19 pandemic outbreaks

Abstract

Objectives: Oral Epithelial Dysplasia (OED) is associated with an increased risk of oral cancer development. The SARS-CoV-2 pandemic is necessitating the suspension or dramatic reduction of face-to-face non-urgent elective services, including OED clinics. Little is known regarding the potential impact of elective services suspension upon the risk of OED progression, and whether alternative strategies (e.g. remote consultations) may be introduced to ensure OED surveillance. The aim of this paper is to provide expert-opinion consensus recommendations for the management of OED during the current and future pandemic outbreaks.

Materials and methods: A working group of nine UK-based senior clinicians and academics in Oral and Maxillofacial Surgery and Oral Medicine was created and twelve consensus statements were developed using a modified-Delphi process. Greater than 80% agreement was considered a consensus.

Results: Consensus was achieved for all twelve statements (89-100% agreement). The group agreed that, during the temporary suspension of elective services associated with COVID-19 pandemic outbreaks, patients with OED can be risk stratified to determine the length of accepted delay in face-to-face consultation. Remote consultations with patient-provided clinical photographs may be a useful way of maintaining a level of surveillance in this group of patients.

Conclusions: Using an expert working group methodology, we have developed consensus recommendations for the monitoring of individuals with OED during pandemic outbreaks associated with temporary suspension of elective services. This has identified areas of future research and highlighted the need for a stronger evidence base to inform the set-up and delivery of surveillance regimens for patients with OED.

Keywords: COVID-19; Consensus guidelines; Oral cancer prevention; Oral epithelial dysplasia; Potentially-malignant oral disorder; SARS-CoV-2.

Fig. 1

Approach to Risk Stratification of Patients with Oral Epithelial Dysplasia during pandemic outbreaks requiring reduction of routine clinical services. a.Verbal or written guidance should be provided for the purpose of achieving good-quality images suitable for surveillance (CS 5) b. All patients, including ‘Clinically Vulnerable’ and ‘Clinically Extremely Vulnerable’ individuals should be offered face-to-face appointments where there is clinical need for physical examination; likewise any patient who declines a remote consultations in preference of face-to-face examination should be accommodated where possible. (CS 11 & 12) c. Patients who initially decline a face-to-face consultation should be re-contacted in six weeks to offer an appointment.