Oncological Care During a Crisis: A Systematic Review and Meta-Analysis of Non-Melanoma Skin Cancer of the Head and Neck Region in the COVID-19 Pandemic

Introduction: The COVID-19 pandemic profoundly disrupted healthcare, prompting adaptations in oncological practices. This systematic review evaluates the pandemic’s impact on the management of non-melanoma skin cancer (NMSC) of the head and neck (H&N) region. Methods: The review was reported according to PRISMA guidelines. Eligible studies compared pre-pandemic and pandemic periods in adult patients treated for head and neck NMSC reporting outcomes related to histological distribution, time to treatment initiation, reconstructive method, and surgical margin status. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed for outcomes with sufficient extractable data. Results: The review comprised five studies involving 1318 cases. The relative distribution of basal cell carcinoma and squamous cell carcinoma did not differ significantly between pre-pandemic and pandemic periods. Time to treatment initiation showed no significant overall change, although heterogeneity was high, indicating substantial variability among healthcare settings. Reconstruction shifted significantly toward primary closure compared with flap reconstruction during the pandemic period (OR 1.90; 95% CI: 1.46–2.47; p < 0.0001). Negative surgical margins were reported in 1119 of 1266 excisions/cases with available data (88.4%), with no significant difference between pre-pandemic and pandemic periods (OR 0.77; 95% CI: 0.46–1.32; p = 0.34). Conclusions: The pandemic was associated with a shift toward simpler reconstructive strategies, particularly increased use of primary closure, likely reflecting attempts to reduce operative complexity and resource use. While short-term oncologic outcomes appeared broadly preserved, long-term functional, aesthetic, and patient-reported outcomes remain insufficiently characterized. Future studies should evaluate these outcomes to better inform crisis-adapted oncologic and reconstructive care pathways.