RESUMEN
BACKGROUND: Exosomes and other secretory membrane vesicles, collectively referred to as extracellular vesicles (EVs), have garnered increasing attention in research due to their biological characteristics. Notably, studies have shown promising results regarding the role of stem cell-derived extracellular vesicles (SC-EVs) in skin and plastic surgery applications. This study aims to elucidate current trends in SC-EVs within the context of skin and plastic surgery and offer insights for future research directions in advancing this critical field. METHODS: A comprehensive search was conducted for relevant studies on SC-EVs in skin and plastic surgery spanning from 2003 to 2023, utilizing the Web of Science database. Subsequently, data analysis was performed using VOSviewer and CiteSpace. RESULTS: A total of 1089 studies were identified, with a noticeable annual increase in publications on SC-EVs' application in skin and plastic surgery. China emerged as the leading contributor to this field, with Shanghai Jiao Tong University being a notable institution. Stem Cell Research & Therapy and the International Journal of Molecular Sciences were the top journals publishing relevant articles. Author Fu Xiaobing from the Chinese People's Liberation Army General Hospital had the highest publication count in this area. Keyword co-occurrence analysis revealed six distinct clusters, with "exosomes" being the most prevalent keyword in recent years. Wound healing and skin rejuvenation emerged as primary research focuses and hotspots in this field. CONCLUSION: This comprehensive review offers insights into global trends surrounding SC-EVs in skin and plastic surgery. Analysis of journals, institutions, references, and keywords provides valuable guidance for researchers in determining future research directions.
Asunto(s)
Bibliometría , Vesículas Extracelulares , Humanos , Vesículas Extracelulares/metabolismo , Cirugía Plástica/estadística & datos numéricos , Células Madre , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , PielRESUMEN
Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad médico-quirúrgica de los servicios de dermatología españoles. El objetivo de esta investigación es conocer la situación y actividad de dichos servicios durante el año 2019. Material y métodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatología de hospitales públicos españoles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participación del 36,4% (59/162). Se observó un déficit de personal generalizado, especialmente de dermatólogos en hospitales de complejidad media-baja. La principal causa del déficit de dermatólogos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atención mixta presencial-telemática estuvo presente en más de la mitad de los centros. En el ámbito de las consultas monográficas, la de psoriasis fue la más implementada. Aproximadamente el 75% de los centros contaron con quirófanos con anestesista. Procedimientos quirúrgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugía de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalización de pacientes y la presencia de dermatólogos residentes de guardia fueron igualmente más habituales en estos hospitales. La actividad docente e investigadora también se relacionó con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situación de los servicios de dermatología españoles justo antes de la pandemia por COVID-19, y pueden ser útiles para la gestión clínica y para definir líneas de trabajo y áreas de mejora (AU)
Background and objective: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methods:Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. Results: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. Conclusions: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement (AU)
Asunto(s)
Humanos , Hospitales Públicos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Encuestas de Atención de la Salud , Infecciones por Coronavirus , Pandemias , Estudios Transversales , EspañaRESUMEN
Background and objective: No recent data on health care resources and medical and surgical activity in Spanish dermatology departments are available in the literature. The aim of this study was to compile this information for 2019. Material and methods:Cross-sectional study based on an online survey sent to the heads of dermatology departments at public hospitals in Spain. Results: Of the 162 department heads contacted, 59 answered the survey (participation rate, 36.4%). General findings included a shortage of staff, especially dermatologists, in hospitals of low and medium complexity. The main reason given for the shortage of dermatologists was a lack of interested applicants. Large hospital complexes had more infrastructure and equipment. Over 50% of the departments surveyed used a combination of in-person and virtual visits. Psoriasis units were the most common specialized care units. Approximately 75% of the hospitals had operating rooms with an anesthetist. More complex procedures such as sentinel lymph node biopsy and Mohs micrographic surgery were performed more often in large hospital complexes. Hospitalization and the presence of dermatology residents working call shifts were also more common in these hospitals. Teaching and research activity differed according to hospital complexity. Conclusions: We have mapped health care resource availability and medical and surgical activity in Spanish dermatology departments prior to the COVID-19 pandemic. Our findings could be useful for improving clinical management and defining future actions and areas for improvement (AU)
Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad médico-quirúrgica de los servicios de dermatología españoles. El objetivo de esta investigación es conocer la situación y actividad de dichos servicios durante el año 2019. Material y métodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatología de hospitales públicos españoles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participación del 36,4% (59/162). Se observó un déficit de personal generalizado, especialmente de dermatólogos en hospitales de complejidad media-baja. La principal causa del déficit de dermatólogos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atención mixta presencial-telemática estuvo presente en más de la mitad de los centros. En el ámbito de las consultas monográficas, la de psoriasis fue la más implementada. Aproximadamente el 75% de los centros contaron con quirófanos con anestesista. Procedimientos quirúrgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugía de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalización de pacientes y la presencia de dermatólogos residentes de guardia fueron igualmente más habituales en estos hospitales. La actividad docente e investigadora también se relacionó con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situación de los servicios de dermatología españoles justo antes de la pandemia por COVID-19, y pueden ser útiles para la gestión clínica y para definir líneas de trabajo y áreas de mejora (AU)
Asunto(s)
Humanos , Hospitales Públicos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Encuestas de Atención de la Salud , Infecciones por Coronavirus , Pandemias , Estudios Transversales , EspañaRESUMEN
Aim: There is a need to evaluate current treatments for stages I-III of Merkel cell carcinoma (MCC). Materials & methods: A systematic literature review was conducted to understand how patients with stage I-III MCC are treated and assess efficacy, safety, health-related quality of life and economic impact of current therapies. Embase was searched using the following inclusion criteria: publications from 2014 to 2019, in English, with adult patients (≥18 years) with early-stage MCC (i.e., stages I-III) and any interventions/comparators. Publications were excluded if they included only patients with stage IV MCC, had no distinction between early and advanced or metastatic MCC or had no extractable data. Results: A total of 18 retrospective studies were included. Few studies had evidence that surgery plus adjuvant radiotherapy significantly increased survival versus surgery alone in early MCC. Limited safety data were reported in three studies. None of the studies reported data on health-related quality of life or economic impact of treatment in patients with early-stage MCC. Conclusion: Although surgery plus adjuvant radiotherapy was a common treatment, no clear standard of care exists for stages I-III MCC and treatment outcomes need to be improved. All studies were retrospective with a high variability in sample sizes; hence, findings should be interpreted with caution.
Asunto(s)
Carcinoma de Células de Merkel/terapia , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Recurrencia Local de Neoplasia/epidemiología , Neoplasias Cutáneas/terapia , Carcinoma de Células de Merkel/diagnóstico , Carcinoma de Células de Merkel/mortalidad , Carcinoma de Células de Merkel/patología , Supervivencia sin Enfermedad , Humanos , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Calidad de Vida , Radioterapia Adyuvante/estadística & datos numéricos , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Piel/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma with a high rate of local recurrence. Recent studies have indicated a potential benefit in local control with the addition of adjuvant radiotherapy (RT). OBJECTIVE: This study sought to evaluate the outcomes of adjuvant RT for patients with DM. MATERIALS AND METHODS: The National Cancer Database was queried (2004-2015) for patients with newly diagnosed, nonmetastatic DM. Patients were divided into 2 groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS. RESULTS: There was no difference in median OS between patients treated with RT when compared with patients observed (111.4 months vs 133.9 months, p = .1312). On multivariable analysis, older age, T stage ≥2, N stage ≥1, and no receipt of immunotherapy were associated with worse OS. CONCLUSION: In this large study evaluating efficacy of adjuvant RT in DM, no overall survival benefit was observed among patients receiving adjuvant RT.
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Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Melanoma/terapia , Radioterapia Adyuvante/estadística & datos numéricos , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Humanos , Inmunoterapia/estadística & datos numéricos , Estimación de Kaplan-Meier , Márgenes de Escisión , Melanoma/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Resultado del TratamientoAsunto(s)
COVID-19 , Técnicas Cosméticas/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Becas , Cuidados Posteriores/estadística & datos numéricos , COVID-19/epidemiología , Ensayos Clínicos como Asunto/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/educación , Dermatología/educación , Educación a Distancia , Empleo/estadística & datos numéricos , Becas/normas , Humanos , SARS-CoV-2 , Sociedades Médicas , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: Dermatologists have the opportunity to provide medically necessary procedures, including laser hair removal, to transgender patients for gender affirmation. Further research is required to better assess the unique dermatologic needs of this population. OBJECTIVE: To examine the prevalence of dermatologic procedures among transgender people in the context of gender-affirming treatment. METHODS: This cross-sectional study examined survey responses from 696 transgender persons enrolled in the Study of Transition, Outcomes, and Gender cohort. Prevalence of self-reported dermatologic procedures was examined and compared across participant subgroups. RESULTS: Electrolysis was the most commonly reported procedure (32.9%). Transfeminine patients were more likely to use dermatologic procedures compared with transmasculine patients. Only 19 participants (2.8%) reported the use of dermal filler injections. CONCLUSION: Differences in utilization of dermatologic procedures were noted in transgender populations. Motivations, barriers, and optimal timing for gender-affirming dermatologic procedures among transgender persons should be examined in future studies.
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Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Cirugía de Reasignación de Sexo/estadística & datos numéricos , Personas Transgénero/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Procedimientos Quirúrgicos Dermatologicos/métodos , Procedimientos Quirúrgicos Dermatologicos/psicología , Femenino , Humanos , Masculino , Motivación , Autoinforme/estadística & datos numéricos , Cirugía de Reasignación de Sexo/métodos , Cirugía de Reasignación de Sexo/psicología , Tiempo de Tratamiento/estadística & datos numéricos , Personas Transgénero/psicología , Adulto JovenRESUMEN
OBJECTIVES: Literature on dermatology outpatient demographic and clinical data is limited, and the few studies on this topic are mainly conducted overseas, with medical systems and case mix different to Australia. This study presents demographic data relating to dermatology public outpatient referrals to a tertiary hospital in Brisbane, Australia, and determines what additional structured data should be collected to formulate and evaluate initiatives to address service issues such as referral quality, triage process and wait times. METHODS: A four-year retrospective audit was undertaken, summarising all referrals (n = 7140) and clinical dermatology encounters (n = 53 844) between January 2016 and December 2019 at Princess Alexandra Hospital (PAH), the largest hospital in Metro South Health (MSH), serving a population of one million. PAH has one of the two largest public dermatology clinics in Queensland and is the only dermatology service within MSH. RESULTS: Patient demographic data, wait time by triage category, referral rates over time and encounter durations were collected. Structured diagnostic data (e.g. ICD-10 coding) of the provisional diagnosis, comorbidities, medications and the final diagnosis are not collected in a structured format and would be a valuable addition. CONCLUSIONS: The clinical burden of public dermatology is increasing. Both collection and analysis of structured data pertaining to the referrals and encounters are important to help formulate, implement and evaluate initiatives that aim to improve health service provision in this area.
Asunto(s)
Atención Ambulatoria/organización & administración , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Dermatología , Enfermedades de la Piel/epidemiología , Centros de Atención Terciaria , Tiempo de Tratamiento/estadística & datos numéricos , Adulto , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , TriajeAsunto(s)
Anestesia por Inhalación/instrumentación , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Óxido Nitroso/administración & dosificación , Dolor Asociado a Procedimientos Médicos/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anestesia por Inhalación/métodos , Anestesia por Inhalación/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Humanos , Dolor Asociado a Procedimientos Médicos/etiologíaAsunto(s)
Biopsia/instrumentación , Procedimientos Quirúrgicos Dermatologicos/instrumentación , Países en Desarrollo , Accesibilidad a los Servicios de Salud/organización & administración , Equipo Quirúrgico/provisión & distribución , Biopsia/estadística & datos numéricos , Estudios Transversales , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Instituciones de Salud/provisión & distribución , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , HumanosAsunto(s)
COVID-19/epidemiología , Procedimientos Quirúrgicos Dermatologicos , Pandemias , Pautas de la Práctica en Medicina , Neoplasias Cutáneas/cirugía , Anciano , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Humanos , Massachusetts/epidemiología , Cirugía de Mohs/estadística & datos numéricos , SARS-CoV-2 , TriajeRESUMEN
BACKGROUND: Merkel cell carcinoma (MCC) management typically includes surgery with or without adjuvant radiation therapy (aRT). Major challenges include determining surgical margin size and whether aRT is indicated. OBJECTIVE: To assess the association of aRT, surgical margin size, and MCC local recurrence. METHODS: Analysis of 188 MCC cases presenting without clinical nodal involvement. RESULTS: aRT-treated patients tended to have higher-risk tumors (larger diameter, positive microscopic margins, immunosuppression) yet had fewer local recurrences (LRs) than patients treated with surgery only (1% vs 15%; P = .001). For patients who underwent surgery alone, 7 of 35 (20%) treated with narrow margins (defined as ≤1.0 cm) developed LR, whereas 0 of 13 patients treated with surgical margins greater than 1.0 cm developed LR (P = .049). For aRT-treated patients, local control was excellent regardless of surgical margin size; only 1% experienced recurrence in each group (1 of 70 with narrow margins ≤1 cm and 1 of 70 with margins >1 cm; P = .56). LIMITATIONS: This was a retrospective study. CONCLUSIONS: Among patients treated with aRT, local control was superb even if significant risk factors were present and margins were narrow. We propose an algorithm for managing primary MCC that integrates risk factors and optimizes local control while minimizing morbidity.
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Carcinoma de Células de Merkel/terapia , Vías Clínicas/normas , Procedimientos Quirúrgicos Dermatologicos/métodos , Recurrencia Local de Neoplasia/epidemiología , Neoplasias Cutáneas/terapia , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/diagnóstico , Carcinoma de Células de Merkel/mortalidad , Carcinoma de Células de Merkel/patología , Procedimientos Quirúrgicos Dermatologicos/normas , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Guías de Práctica Clínica como Asunto , Radioterapia Adyuvante/normas , Radioterapia Adyuvante/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
BACKGROUND: Surgery is the best treatment for basal cell carcinoma (BCC); however, incomplete excisions are possible. OBJECTIVE: Assessment of the accurateness of dermoscopy and clinical evaluation in the detection of borders of BCC and description of dermoscopic findings in clinically healthy tissue surrounding BCC. MATERIALS AND METHODS: Eighty-eight lesions with clinical dermoscopic diagnosis of BCC were examined clinically and dermoscopically, to delineate the correct site of surgical incision, demarcating the respective margins with colred dermographic pencils. Specific dermoscopic features were searched in the skin adjacent to the demarcated clinical margin. RESULTS: In 29 of 88 lesions, clinical and dermoscopic margins of the tumor coincided. In the remaining 59 (67%), 10 (16.9%) presented, in the lesion area identified under dermoscopy, classical criteria for BCC and 57 (96.6%) nonclassical criteria. Differences between clinical and dermoscopic margins were significantly more frequent in superficial BCCs (p = .006). The frequency was not significantly different (p = .85) in relation to body sites. CONCLUSION: Dermoscopy improves the identification of margins for surgical excision in BCC. The observation of nontraditional dermoscopic criteria of BCC, mainly pink-white areas and short telangiectasias in the area between clinically and dermoscopically detected margins, helps to define the actual tumoral margins and to achieve a really radical excision.
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Carcinoma Basocelular/diagnóstico , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Dermoscopía/estadística & datos numéricos , Neoplasias Cutáneas/diagnóstico , Piel/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/patología , Carcinoma Basocelular/cirugía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Estudios Prospectivos , Piel/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
BACKGROUND: Second-opinion review is linked to error reduction and treatment changes in anatomic pathology. OBJECTIVE: We sought to establish the rate of diagnostic discrepancy identified by second-opinion dermatopathologic review and the effect on surgical treatment. METHODS: Cases referred for treatment of a malignant neoplasm diagnosed by an outside pathologist were reviewed. The external and internal second-opinion dermatopathologic reports were compared. Discordance in diagnosis, subtype, and treatment change owing to second-opinion review was recorded. The referring pathologist's level of dermatopathologic training was also documented. RESULTS: A total of 358 cases were included. Dermatopathologic second-opinion diagnosis was discordant with the outside diagnosis in 37 of 358 cases (10.3%). In 32 of 358 cases (8.9%), second-opinion review resulted in a change in treatment, with 28 of 32 (87.5%) of these changes resulting in cancelled surgery. Dermatologists without dermatopathologic fellowship training had the highest rate of discordant diagnoses compared with pathologists and dermatopathologists. LIMITATIONS: This was a retrospective study at a tertiary care facility. CONCLUSION: Second-opinion dermatopathologic review is associated with identification of discordant diagnoses and a substantial influence on treatment, with both cancellation of surgery and augmented management. Secondary pathologic review should be considered in high-volume surgical practices.
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Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Errores Diagnósticos/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Neoplasias Cutáneas/diagnóstico , Piel/patología , Biopsia/estadística & datos numéricos , Humanos , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Procedimientos Innecesarios/estadística & datos numéricosRESUMEN
BACKGROUND: Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis. OBJECTIVE: To identify risk factors for SSI after minor dermatologic surgery. METHODS: Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI. MAIN RESULTS: A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8-9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001-1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76-5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93-8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79-5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection. CONCLUSIONS: This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis.
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Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Infección de la Herida Quirúrgica/etiología , Anciano , Antibacterianos/uso terapéutico , Procedimientos Quirúrgicos Dermatologicos/métodos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de RiesgoAsunto(s)
COVID-19 , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , COVID-19/epidemiología , Utilización de Instalaciones y Servicios , Humanos , Pandemias , Equipo de Protección Personal/estadística & datos numéricos , SARS-CoV-2 , Telemedicina/estadística & datos numéricos , Triaje , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Coronavirus 2019 (COVID-19) disease has rapidly spread worldwide with a multitude effects on daily life. Since the transmission risk increases with close contact, some cosmetic procedures are considered high risk and majority of them had to be postponed or canceled in private dermatocosmetology clinics especially during the heavy period of the outbreak. AIMS: We aimed to document the medical and socioeconomic problems emerged in dermatocosmetology clinics in Turkey caused by COVID-19 pandemic and to discuss the management strategies taken by dermatologists. PATIENTS/METHODS: This survey research was conducted with 100 dermatologists who work in private dermatocosmetology clinics. The survey included 38 questions about office re-arrangements including patient admission and office environment, safety precautions taken for cosmetic procedures, management of clinic staff, and financial impact of the pandemic. RESULTS: A remarkable decrease in major cosmetic interest was reported in private clinics; meanwhile, there was an increase in applicants for noncosmetic dermatological complaints. The most avoided cosmetic procedures were application of skin care devices, lasers, chemical peeling, and thread lifting, while botulinum toxin injection was the most performed procedure. Nearly half of the participants had severe financial damage. Of the participants, 55% reported that they worked anxiously during this period and 60% believed that they managed the early period of the pandemic successfully. CONCLUSION: Private dermatocosmetology clinics have to work in a totally different period that they have never experienced before. The pandemic has had serious impacts on both medical and socioeconomic issues which had to be managed carefully.
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Instituciones de Atención Ambulatoria/organización & administración , COVID-19/prevención & control , Técnicas Cosméticas/economía , Procedimientos Quirúrgicos Dermatologicos/economía , Control de Infecciones/métodos , Adulto , Anciano , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/normas , COVID-19/epidemiología , COVID-19/transmisión , Prueba de COVID-19 , Técnicas Cosméticas/estadística & datos numéricos , Estudios Transversales , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Administración de Consultorio , Pandemias/economía , SARS-CoV-2 , Factores Socioeconómicos , Turquía/epidemiologíaAsunto(s)
COVID-19/prevención & control , Instituciones Oncológicas/organización & administración , Procedimientos Quirúrgicos Dermatologicos , Oncología Médica/organización & administración , Pandemias , SARS-CoV-2 , Neoplasias Cutáneas/cirugía , Distribución por Edad , Biopsia/estadística & datos numéricos , COVID-19/diagnóstico , COVID-19/epidemiología , Prueba de COVID-19 , Comorbilidad , Infección Hospitalaria/prevención & control , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Humanos , Oncología Médica/métodos , Complicaciones Posoperatorias/epidemiología , Utilización de Procedimientos y Técnicas , Neoplasias Cutáneas/patología , Evaluación de SíntomasAsunto(s)
Centros Médicos Académicos/estadística & datos numéricos , Investigación Biomédica/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Dermatología/estadística & datos numéricos , Práctica Privada/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/educación , Dermatólogos/educación , Dermatólogos/estadística & datos numéricos , Dermatología/educación , Becas/organización & administración , Becas/estadística & datos numéricos , Humanos , Publicaciones/estadística & datos numéricos , Sociedades Médicas/organización & administración , Sociedades Médicas/estadística & datos numéricosRESUMEN
BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer. While Mohs micrographic surgery is commonly accepted for BCC treatment, surgical excision with free margins is widely considered the best treatment modality for BCCs in Japan. However, little is known about the predictors of the invasion levels of BCCs. OBJECTIVE: To investigate the optimization of deep surgical margins by identifying factors significantly influencing the invasion levels of facial BCCs. METHODS: The tumor invasion level was defined as the deepest part of a tumor. Tumor thickness was measured from the top of the granular layer to the deepest extension of the tumor or from the ulcer base overlying the deepest point of invasion in ulcerated lesions. Factors independently associated with tumor thickness and invasion level were identified by multivariate analysis. Six variables were tested: age, sex, anatomical region (nose, orbit, others), histologic pattern (aggressive, non-aggressive), presence of pigmentation, and diameter. RESULTS: We included 718 cases of facial BCCs involving 705 Japanese patients. The most frequent anatomical region and histologic pattern were the nose and nodular pattern, respectively. Only tumor diameter showed a correlation with tumor thickness (ß = 0.377, P < 0.001). Tumor diameter (AOR = 71.189, 95 % CI: 11.420-430.931, P = 0.01) and the following anatomical regions showed correlations with the invasion level: nose/others: AOR=2.769, 95 % CI: 1.235-6.493, P = 0.01; orbit/others: AOR=6.369, 95 % CI: 2.728-15.429, P < 0.001; orbit/nose: AOR=2.300, 95 % CI: 1.056-4.984, P = 0.04. CONCLUSIONS: This study serves as a guide for optimizing deep surgical margins and planning surgery for facial BCCs considering independently associated factors.