Sir, we write to draw attention to the impact that the lockdown associated with COVID-19 is having on mouth cancer USC referrals. Here at the University Dental Hospital in Cardiff, which serves a population of approximately 480,000, the mean number of USC referrals received per week has been 11 with a range, over the six months prior to 23 March 2020, of between seven and 18 referrals per week. These USC referrals come from both general dental and general medical practitioners working in primary care of Cardiff & Vale University Health Board. However, since the introduction of lockdown and clinical restrictions on 23 March 2020, the number of referrals per week has fallen in consecutive weeks from 11 to three, then to one with no USC referral in the week beginning 6 April 2020. Only two USC referrals have been received in the last two weeks. The University Dental Hospital is running an emergency dental service every day and no patient has presented with mouth cancer via this route since 23 March. There will undoubtedly be an adverse impact on patients who may present after lockdown restrictions with tumours at an advanced stage that will require more complex treatment and ultimately have a poorer five-year survival.

It is important that the profession is aware that during this pandemic USC patients will still be triaged and seen. A clear referral with photographs will greatly aid this process. Biopsy under local anaesthesia and axial imaging remain available and virtual multi-disciplinary team meetings are running. Surgery involving free tissue transfer is extremely limited at present. However, if a tumour is detected at an early stage then wide local excision even under local anaesthesia is possible.

Sadly, mouth cancer is a condition that will be affected by the coronavirus pandemic. Only time will tell the true nature and enormity of this impact.