Primary cutaneous lymphomas and coronavirus disease-2019: A critical overview of primary cutaneous lymphoma management in pandemic

Abstract

Coronavirus disease-2019 (COVID-19) is a serious cause of respiratory tract infection, and its severe course has been associated with some risk factors, including malignancies and immunosuppressive treatments. Primary cutaneous lymphomas (PCL) are a heterogeneous group of immune system neoplasms, which are subclassified as indolent and aggressive types according to their survival rates. PCL treatment ranges from skin-based therapies to systemic treatments, of which immunosuppressive effects occur in some. During the COVID-19 pandemic, patients with PCL should be protected from possible COVID-19 complications, and the optimal treatment should be provided to control the disease taking into account the treatment-related risks. Therefore, recommendations about the management of patients with PCL during the COVID-19 pandemic were overviewed in light of the literature. Topical treatments can generally be considered low-risk therapies and can be continued without interruption. Phototherapy, skin radiotherapy, and total skin electron beam therapy increase the risk of COVID-19 exposure due to hospital visits. Moderate-risk therapies like interferons, systemic retinoids, methotrexate, and systemic corticosteroids might be used with caution. Advanced-stage patients with COVID-19 related comorbidity and who previously received immunosuppressive therapy should be carefully evaluated. Biological agents and systemic chemotherapeutics, which are considered high-risk, should not be delayed when needed. However, increasing intervals between treatments or switching to alternative therapies may be preferable in stable diseases. Most importantly, all patients with PCL should be ensured to comply with general protection measures as long as the pandemic continues.