RESUMEN
Actinic keratoses (AK) occur frequently; however, real-life clinical data on personalized treatment choice and costs are scarce. This multicentre one-year observational study investigated patient-characteristics, cost and effectiveness of methylaminolaevulinate photodynamic therapy (MAL-PDT), imiquimod (IMI) and 5-fluorour-acil (5-FU) in patients with AKs on the face/scalp. A total of 104 patients preferred MAL-PDT, 106 preferred IMI and 110 preferred 5-FU. At baseline, significant differences between treatment groups were found; most patients were severely affected (mean 32.5 AK in PDT-group, 20.2 in IMI-group, 22.8 in 5-FU-group). A mean reduction in lesions of 81% after MAL-PDT, 82% after IMI and 88% after 5-FU was found after one year. Annual costs were 1,950 for MAL-PDT, 877 for IMI and 738 for 5-FU. These results show that, compared with clinical trials, in the real-life clinical setting AK patients are usually more severely affected and treatment costs are much higher. Furthermore, patient characteristics are important factors in treatment choice.
Asunto(s)
Ácido Aminolevulínico/análogos & derivados , Aminoquinolinas/economía , Aminoquinolinas/uso terapéutico , Fármacos Dermatológicos/economía , Fármacos Dermatológicos/uso terapéutico , Costos de los Medicamentos , Fluorouracilo/economía , Fluorouracilo/uso terapéutico , Queratosis Actínica/tratamiento farmacológico , Queratosis Actínica/economía , Fotoquimioterapia/economía , Fármacos Fotosensibilizantes/economía , Fármacos Fotosensibilizantes/uso terapéutico , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/economía , Ácido Aminolevulínico/uso terapéutico , Análisis Costo-Beneficio , Femenino , Humanos , Imiquimod , Masculino , Persona de Mediana Edad , Países Bajos , Prioridad del Paciente , Fotoquimioterapia/métodos , Inducción de Remisión , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Skin cancer incidence is rising, placing a burden on healthcare systems worldwide. This problem may even be more extensive than expected, since registration of (pre)malignancies of the skin is poor. OBJECTIVE: To provide insight into the numbers of (pre)malignancies in patients with actinic keratosis (AK) or basal cell carcinoma (BCC) in 2 university and 2 general hospitals. METHODS: The types and numbers of previous tumours and of tumours during a two-year follow-up were collected from 574 patients. RESULTS: Mean time between the first diagnosed (pre)malignancy and time of inclusion was 6.6 years. Overall, 60% had multiple types of (pre)malignancies. In BCC patients, 61% had multiple BCCs, in patients with squamous cell carcinoma (SCC), 40% had multiple SCCs. The combination 'BCC and SCC' occurred in 10%, 'BCC and AK' in 47%, 'SCC and AK' in 14%. CONCLUSION: High numbers of patients with multiple (pre)malignancies were found in this patient population in university and general hospitals, which may well reflect the Dutch hospital population. We conclude that skin cancer patients are more extensively affected than was expected up till now. Consequently, the management of skin cancer may be in need of adaptation in near future and the question arises whether dermatologists have the capacity for providing care for all these patients.
Asunto(s)
Carcinoma Basocelular/epidemiología , Queratosis Actínica/epidemiología , Neoplasias Cutáneas/epidemiología , Anciano , Carcinoma Basocelular/patología , Femenino , Humanos , Incidencia , Queratosis Actínica/patología , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/epidemiología , Países Bajos/epidemiología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. OBJECTIVES: To assess surgical procedures used by GPs in skin tumour management. METHODS: We performed a retrospective study of 1,898 pathology reports of skin tumours excised by GPs in 2009. RESULTS: In 22.9% no diagnosis was provided on the application form. Mostly, once-off excisions (no preceding biopsy) were performed, 7% of the excised lesions were malignant, and 35% of incisions were incomplete. Excisions in the face and neck region were incomplete in 65.4%; 22% of melanomas were biopsied or shaved. CONCLUSION: This study underlines the difficulties in skin tumour management in primary care. To stimulate adequate resource use, the number of excisions of benign lesions could be lowered, and pretreatment biopsy in non-melanoma skin cancer management should be encouraged. GPs should be aware of their limitations and consider referral of high-risk malignancies.
Asunto(s)
Enfermedad de Bowen/cirugía , Carcinoma Basocelular/cirugía , Procedimientos Quirúrgicos Dermatologicos/normas , Neoplasias Faciales/cirugía , Medicina General/normas , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Biopsia/métodos , Biopsia/normas , Enfermedad de Bowen/patología , Carcinoma Basocelular/patología , Competencia Clínica , Extremidades , Neoplasias Faciales/patología , Humanos , Queratosis Actínica/patología , Queratosis Actínica/cirugía , Melanoma/patología , Neoplasia Residual , Atención Primaria de Salud/normas , Estudios Retrospectivos , Piel/patología , Neoplasias Cutáneas/patología , TorsoRESUMEN
Skin cancer is common among white populations and rapid increases in incidence are being observed in many countries, leading to a large burden on healthcare systems. Unnecessary referrals from general practitioners (GPs) may contribute to this burden. The aim of this study was to analyse the quality of referrals from GPs of patients with skin tumours. Referral letters for 734 patients were collected. The proposed diagnoses were compared with definitive diagnosis made by dermatologists. In 44.5%, lesions appeared to be benign. Malignant skin tumours were poorly recognised by GPs and seborrheic keratoses were often mistaken for naevi (33.6%). Furthermore, with total body examination, dermatologists found 111 additional malignant lesions. We discussed several recommendations to minimise unnecessary referrals as well as the future role of GPs in skin cancer care.
Asunto(s)
Errores Diagnósticos/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Neoplasias Cutáneas/diagnóstico , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Dermatología , Diagnóstico Diferencial , Femenino , Médicos Generales/educación , Humanos , Queratosis Seborreica/diagnóstico , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Países Bajos , Nevo/diagnóstico , Lesiones Precancerosas/diagnóstico , Valor Predictivo de las Pruebas , Terminología como AsuntoRESUMEN
Bullous pemphigoid (BP) is an autoimmune blistering skin disease. Autoantibodies to BP180 and BP230 can be detected by indirect immunofluorescence (IIF) on different substrates (oesophagus, salt-split-skin, BP180-antigen dots, BP230-transfected cells) and ELISA. Here, we compared test characteristics of these test systems. We analysed sera from BP patients (n=60) in whom the clinical diagnosis had been confirmed histopathologically. The control cohort comprised sera from patients with other autoimmune-associated (n=22) or inflammatory (n=35) skin diseases. All samples were tested by IIF (EUROIMMUN™ Dermatology Mosaic) and ELISA (EUROIMMUN and MBL). Anti-BP180 is best detected with BP180-antigen dots by IIF (sensitivity: 88%; specificity: 97%). As compared to IIF, the differences with both BP180 ELISA techniques are small though. Likelihood ratios (LRs) for positive and negative test results are >10 and between 0.1 and 0.2, respectively, for all test systems. Detection of anti-BP230 is highly variable (sensitivity range 38-60%; specificity range 83-98%). Only the IIF test reveals a LR for positive test results >10. Since the LRs for a negative test are all ~0.5, negative test results for anti-BP230 antibodies do not help to exclude BP. In conclusion, the multi-parameter IIF test reveals a good diagnostic performance in BP. Since this test simultaneously allows for the detection of anti-Dsg1 and anti-Dsg3 antibodies, involved in pemphigus foliaceus and vulgaris, a single test-incubation may be sufficient to differentiate between the most frequent autoimmune blistering diseases.