Asunto(s)
Competencia Clínica , Medicina Interna/educación , Medicina Interna/métodos , Internado y Residencia/métodos , Atención Primaria de Salud/métodos , Neoplasias Cutáneas/diagnóstico , Competencia Clínica/normas , Curriculum/normas , Femenino , Humanos , Medicina Interna/normas , Internado y Residencia/normas , Masculino , Atención Primaria de Salud/normas , Encuestas y CuestionariosRESUMEN
Malignant melanoma ranks fifth in the number of new cases annually in the United States (US). Despite increasing incidence and lack of recent improvement in mortality, national melanoma screening guidelines are currently not in existence. Our purpose was to review the evidence regarding screening whole-body skin examinations for early detection and a possible mortality benefit for malignant melanoma. Data sources for our review were MEDLINE Complete, PubMed, Cochrane Library, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. Study selection included: epidemiologic data from the US and European cancer surveillance registries, population-based case-control screening trials, computer-simulated Markov model trials, and survey trials. Studies were limited to those published in the English language. Data was extracted using a dual extraction method. Data from studies have shown that the mortality of malignant melanoma is highly predicated on the tumor thickness at the time of diagnosis. Our data review is in support of the implementation of whole-body skin examinations, performed by primary care physicians, for the purpose of early detection of melanoma. A large national population-based, case-control, skin cancer screening trial in Germany has shown a reduction in melanoma-specific mortality. In conclusion, our review of the evidence supports physicians performed whole-body skin examination can lead to the detection of earlier stage melanomas as well as to a reduction in disease-specific mortality. We found a paucity of randomized trials to be a limitation of screening studies for many cancers, including melanoma. To improve screening rates and early detection of malignant melanoma, we propose making skin cancer education part of the curriculum in US primary care residency programs to become the genesis for widespread melanoma screening. Our study had no funding.
Asunto(s)
Detección Precoz del Cáncer/métodos , Tamizaje Masivo/economía , Melanoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Piel/patología , Simulación por Computador , Análisis Costo-Beneficio , Detección Precoz del Cáncer/economía , Alemania/epidemiología , Humanos , Incidencia , Melanoma/epidemiología , Médicos de Atención Primaria/educación , Atención Primaria de Salud , Neoplasias Cutáneas/epidemiología , Estados Unidos/epidemiologíaRESUMEN
A 73-year-old woman came to the casualty ward with symptoms of syncopal attacks, weakness, fever with chills and rigors. A provisional diagnosis of Plasmodium vivax malaria was made after the blood investigations. She had deranged renal function tests, altered sensorium and low platelet count. Repeated tests for P. falciparum (Card test) were negative. Glucose-6-Phosphate dehydrogenise (G6PD) levels were within normal limits. Treatment for P. vivax was started with intravenous quinine initially followed by oral quinine for a period of seven days and patient responded to the treatment and was discharged within 2 weeks of admission. Most of the cases of P. vivax present with typical and predictable features, although atypical cases with characteristics of P. falciparum can occur, especially in the elderly.