Dermatologists combine in-person visits, telemedicine to care for patients during pandemic

Since elective procedures at Stanford Health Care resumed in April, clinicians and administrators in dermatology are caring for patients in the safest way possible.

Eugene Lewis, who was treated for skin cancer at Stanford Health Care, with his wife, Esther Lewis.
Steve Fisch

Eugene Lewis is no stranger to skin cancer. Early last spring, when the 89-year-old San Mateo resident and former airport designer noticed a sore that refused to heal on his right ear, he knew to bring it up with his regular dermatologist, who referred him to Stanford Health Care. 

Stanford Health Care was ready: Since elective procedures resumed there in April, clinicians and administrators in dermatology are caring for patients in the safest way possible to prevent the spread of the coronavirus. 

Lewis needed to undergo Mohs surgery, which involves removing layers of tissue and immediately examining them to determine whether the tumor has been completely excised. If it hasn’t, the doctor removes more layers in successive rounds of surgery.

“Eugene is in an age demographic that needs to be particularly careful about possible exposure to the virus that causes COVID-19,” said dermatologist Sumaira Aasi, MD, professor of dermatology and the director of Mohs and dermatologic surgery at Stanford Health Care. “But it’s so important not to ignore your overall health. We are operating with high safety measures, and we are open. The pandemic is ongoing, but we are still providing good health care.”

Safety measures

Safety protocols at Stanford Health Care include a health and symptom-screening check via phone the day before an appointment, another health screening upon arrival, mask wearing, social distancing and thorough sanitization of surfaces in the waiting areas and elevators. Appointments are planned to reduce contact among patients, and many patients are tested for COVID-19 prior to their appointments and surgical procedures. In addition, contactless check-in and checkout are available through the MyHealth digital application.

Sumaira Aasi

Some procedure protocols also have been modified to enhance patient safety and social distancing. “In the past, patients undergoing Mohs treatment would move to a common area to wait while the doctors assess whether additional tissue must be removed,” Aasi said. “Now, each patient stays in a separate room throughout the procedure. We were also able to fast-track this process for Mr. Lewis and perform a biopsy to confirm the cancer and perform the surgery to remove the cancer all during the same appointment.”

Lewis was impressed with the safety measures at the Stanford Medicine Outpatient Center in Redwood City, where he underwent the surgery. “There were signs and markers on the floor to remind people to socially distance, and mask usage was rigorously followed,” he said. “I wasn’t worried at all.”

Telemedicine as a triage tool

In addition to modifying surgical visits like Lewis’, Aasi and her colleagues have increasingly turned to telemedicine, which ensures patients will not be exposed to the virus during a consultation. “Many of our examinations in dermatology are very visual,” Aasi said. “So telemedicine, or video consultation, is perfectly suited to triage dermatology patients and sometimes even diagnose particular problems. We can help people decide whether it’s appropriate to delay care, or if they should make an appointment to see us sooner.”

These are principles and tools we’ve developed over years.

For example, patients concerned about a dermatological problem can discuss it with their primary care physicians, who can refer them to Stanford Health Care’s telemedicine clinic for a remote consultation that in most instances obviates the need for an in-person visit. When elective procedures were suspended Stanford Health Care in the spring, televisits made up about 70% of all clinical visits. Patients can download the MyHealth app to any computer or smartphone to launch the visit with a Stanford Health Care doctor, without leaving their homes.

“These are principles and tools we’ve developed over years,” said Justin Ko, MD, MBA, medical director and chief of medical dermatology, “and, particularly in the setting of COVID, they are transforming dermatological practice. They help us provide care for patients where they need it, when they need it. We can talk over their concerns, look at the problem area together. ‘Is this a safe spot, or is it a skin cancer that needs to be removed?’”

Despite the hurdles posed by the pandemic, Aasi and her colleagues are committed to providing timely, appropriate medical treatment for all types of dermatological problems.

“We need to continue to treat our patients regardless of challenges in our environment,” Aasi said. “One of the things I love about Mohs surgery is that we can treat a patient with cancer, and then in that same day look them in the eye and tell them they are cured. But we can do that only if patients don’t delay their care. If you miss that window, the situation can get much more dire.”

Lewis had no trepidation about visiting Stanford Health Care. “I know I will always be taken care of,” he said. “It’s a very caring, very streamlined process, and they fit me right in within a week or two of my referral. I’m never in any doubt that everyone there really knows what they are doing.” 

“Stanford has saved my life three times,” Lewis said, referring to previous medical procedures at Stanford Medicine. “My wife, Esther, and I tell people we are never going to live more than a 30-minute ambulance ride from Stanford.”



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