The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Prurito ótico por carcinoma basocelular en conducto auditivo externo / Otic pruritus due to basal cell carcinoma of the external auditory canal

El carcinoma basocelular es el tumor cutáneo más frecuente en el área de cabeza y cuello; la exposición crónica al sol es el factor de riesgo más importante para este tumor. Suele manifestarse clínicamente con síntomas anodinos en estadios iniciales, lo que contribuye a que su diagnóstico sea difícil y tardío. Tiene un comportamiento localmente invasivo, especialmente a nivel del pabellón auricular. Este es el único caso descrito en el conducto auditivo externo no relacionado con la exposición al sol, con características clínicas y terapéuticas que lo hacen peculiar.

Basal cell carcinoma is the most frequent skin tumor in the head and neck area, and chronic sun exposure is the most important risk factor. It usually manifests clinically with anodyne symptoms in the early stages, which contributes to its difficult late diagnosis. It is locally invasive, especially at the level of the pinna. It is the only case described in the external auditory canal not related to sun exposure; it presents clinical and therapeutic characteristics that make it peculiar.

Causa infrecuente de odinofagia: angiolipoma laríngeo / Uncommon cause of odynophagia: laryngeal angiolipoma

Laryngeal angiolipoma is a benign and rare tumor at this level. It is a type of unique lipoma, which is located in aritenoepiglottic retraction, epiglottis, and postcricoid region, and it is usually diagnosed after surgical exeresis. It is usually silent until it reaches a large size, causing dysphagia as the most common symptom; so it should be part of the differential diagnosis of odynophagia. We present a case in a male patient of supraglottic angiolipoma as an unusual cause of odynophagia

El angiolipoma laríngeo es un tumor benigno e infrecuente a este nivel. Es un tipo de lipoma único, que se localiza en el repliegue aritenoepiglótico, la epiglotis y la región poscricoidea, y suele diagnosticarse tras su exéresis quirúrgica. Suele ser silente hasta que alcanza gran tamaño, ocasionado odinofagia como síntoma más frecuente; de ahí que deba formar parte del diagnóstico diferencial de la odinofagia. Presentamos un caso en un paciente varón de angiolipoma supraglótico, como causa inusual de odinofagia

[Solitary fibrous tumour of the smooth palate]. / Tumor fibroso solitario del paladar blando.

The solid fibrous solitary tumour of the oral cavity is an extremely rare entity. It is also of complicated diagnosis because of its extensive morphologic diversity (especially when there is a small amount of biopsied tissue) and because of its similarity to many mesenchymal injuries, mostly with hemangiopericytoma. The prognosis is reserved because of the few cases reported, mainly depending on tumour location and size.

Significado pronóstico de la proteína p16 en el cáncer laríngeo / Prognostic significance of p16 protein levels in laryngeal cancer

Introducción: El tabaco y el alcohol son los dos principales factores etiológicos del cáncer laríngeo, y el VPH es un coadyuvante de los anteriores. La positividad del p16 y, por tanto, la detección del VPH, se localiza preferentemente en la orofaringe. En los pacientes con carcinoma orofaríngeo uniformemente tratados con quimio-radioterapia, la presencia del VPH es un indicador pronóstico favorable con respecto a la recurrencia y la supervivencia global. El objetivo consiste en extrapolar estos resultados al cáncer de laringe, tras ver similitudes del mismo con el VPH. Método: Se estudian varias variables clinicopatológicas: edad, tabaquismo, alcoholismo, histología, estadios de la afección y localización en 95 pacientes con cáncer de laringe. Estas variables se correlacionaron con la tinción inmunohistoquímica de p16. Resultados: El VPH es positivo en el 20% de cáncer laríngeo, sobre todo en los estadios III y IV, y a nivel supraglótico y transglótico, pero no pueden obtenerse resultados significativos, pues el test exacto de F para ambas variables, estadio y localización, es 0,482 y 1,073. Conclusiones: El VPH está presente en el 20% del cáncer epidermoide laríngeo, sin mostrar preferencia a nivel de localización ni estadio, en pacientes fumadores, susceptibles de aplicar protocolos de preservación de órgano...

Introduction: Tobacco and alcohol are the two major etiological factors for laryngeal cancer, and HPV is an adjunct of both of them. P16 positivity and therefore HPV detection is preferably located at the oropharynx. In patients with oropharyngeal carcinoma uniformly treated with chemo-radiotherapy, the presence of HPV is a favourable prognostic indicator regarding recurrence and overall survival. Our aim is to extrapolate these results to cancer of the larynx after seeing similarities with HPV. Method: We study several clinical and pathological variables: age, smoker, drinker, histology, staging and localization, in 95 patients with laryngeal cancer. These variables were correlated with immunohistochemical staining of p16. Results: HPV is positive in 20% of epidermoid laryngeal carcinoma. There are no statistically significant differences regarding level (supraglottic or transglottic level) or stages (III and IV). F exact test for both variables, stage and location, are 0,482 and 1,073 respectively. Conclusions: HPV is present in 20% of squamous laryngeal cancer. It shows no preference to level, location or stage in smokers susceptible of being applied organ preservation protocols...

Lepra orofaríngea / Oropharyngeal leprosy

La lepra lepromatosa es una enfermedad infecciosa transmisible, casi erradicada en la actualidad, y crónica, que puede simular un cáncer. Las lesiones más precoces y frecuentes se localizan en piel, cavidades nasal y oral. Su diagnóstico y tratamiento oportuno evitan lesiones irreversibles…

The leprosy lepromatosa is an infectious transmissible disease, almost eradicated at present, and chronicle that can simulate a cancer. The most early and frequent injuries are located in skin, nasal and oral cavity. Its diagnosis and early treatment avoids irreversible injuries…

Schwannoma cervical de la cadena del simpático / Cervical schwannoma of the sympathetic chain

Los schwannomas de la cadena cervical del simpático (SC) son tumores benignos e infrecuentes, que se presentan como una masa cervical unilateral de lento crecimiento, y cuyo diagnóstico preoperatorio definitivo suele ser difícil. A pesar de las pruebas disponibles (TAC, RM, eco y angiografía), solo se obtiene en el momento de la cirugía. El tratamiento de elección es la cirugía, y rara vez se produce recidiva o malignización, aunque sí puede variar hastapresentarse el síndrome de Horner…

Schwannomas of the sympatic cervical chain are infrequent and benign tumors, presented as unilateral cervical mass of slow growth, and whose definitive preoperative diagnosis usually is difficult, in spite of the available tests (CAT, MR, ecography and angiography), obtaining it at the moment of the surgery. Surgical extirpation constitutes the election treatment, being rare the tumor recidive and the malignization, not so the Horner syndrome…

Pseudosarcoma laríngeo / Laryngeal pseudosarcoma

El pseudosarcoma de laringe es un tumor poco frecuente, sobre el cual hay gran controversia a causa de su histogénesis y comportamiento biológico, de ahí la variada nomenclatura que ha recibido. Es un tumor maligno, considerado de buen pronóstico por su evolución favorable tras tratamiento, su alta supervivencia y buena calidad de vida. Se expone un caso, en el que aparece la radioterapia como factor de riesgo …

The pseudosarcoma of larynx is an infrequent tumor, who presents a great controversy in its histogenesis and biological behaviour, which explains the varied nomenclature that it has received. It is a malignant tumor, considered of good prognosis because of its favourable evolution after treatment, its high survival and good life quality. We expose a case in which the radiotherapy seems to be risk factor…