Background: The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. Objective: To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018–2019) with the phase following the pandemic’s second wave (2021–2022). Methods: An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. Results: More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021–2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018–2019 and two in 2021–2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55–8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09–3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44–7.17, p = 0.004). Conclusions: Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.

Introduction. Medial canthus reconstruction is challenging, especially due to the required mobility of new eyelids to assure satisfactory closure of the eye rim and avoid the development of ectropion and/ or lagophthalmos. Moreover, reconstruction must also assure a valid functional replacement of the medial canthal retinaculum and an aesthetically acceptable result. Various reconstructive options have been described, including full thickness skin grafts, cartilage grafts, mucous membrane grafts, and various flaps like local rotational, glabellar, finger, myocutaneous orbicularis muscle island and forehead flaps. We present a case of two-stage medial canthus reconstruction obtained using a paramedian, interpolated, two-pronged forehead flap. Clinical case. An 81-year-old male was admitted to our Clinic, following a diagnosis of a second recurrence of BCC on the right medial canthus. Previous reconstructions were achieved using a local rotation flap in 2009 and a rotational glabellar flap with a full-thickness graft in 2013. However, in 2021 another local BCC recurrence was confirmed; the lesion involved both the medial canthus and eyelids. Given previous local flap interventions, surrounding tissue was expected to be poorly vascularized with a scarce mobility so our choice fell on a distal paramedian forehead flap. During the first surgical step we prepared the flap and split its distal portion into two even extremities, which were sutured to the correspondent medial portion of the eyelids. In the second surgical step, 40 days later, the flap was autonomized. Nine months after the surgery, during the clinical examination a mild microphthalmia was reported but there was no limitation to the eye movement or eyelid closure. There were no signs of lagophthalmos, ectropion or entropion. The patient referred a satisfying quality of life, referring only a mild epiphora and a subjective reduction of visual field during eye movement in the horizontal plane. These symptoms were not considered invalidating by him. Conclusions. In this specific case reconstructive options were limited due to the patient’s surgical history.