RESUMO
BACKGROUND: Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons. OBJECTIVE: Our study was designed to assess the public's perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physician's specialty biases people when they assess the cosmetic appearance of a surgical scar. MATERIALS AND METHODS: We administered an institutional review board-approved survey to individuals at the Emory Student Center and the Emory Dermatology Clinic. Participants rated the perceived skills and training of the different medical specialties and scored the cosmetic appearance of 16 surgical scars created by a fellowship-trained Mohs surgeon labeled as the work of different specialists. RESULTS: Results from 467 participants were overwhelmingly in favor of plastic surgeons (p<.001). The physician's specialty did not bias participants in assessing the cosmetic appearance of surgical scars. CONCLUSION: The study population had greater confidence in the surgical skills of plastic surgeons than in those of dermatologists, although participants were objective in rating the cosmesis of surgical scars, regardless of the purported surgeon's specialty. Although dermatologic surgeons must continually refine our surgical expertise, we must also educate the public about the breadth and depth of our work. The authors have indicated no significant interest with commercial supporters.
Assuntos
Atitude Frente a Saúde , Procedimentos Cirúrgicos Dermatológicos , Dermatologia , Opinião Pública , Adolescente , Adulto , Cicatriz , Feminino , Cirurgia Geral , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Plástica , Adulto JovemRESUMO
The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non-surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non-surgical treatment options, indications and efficacies for non-melanoma primary eyelid malignancies.
Assuntos
Adenocarcinoma Sebáceo/terapia , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias Palpebrais/terapia , Neoplasias Cutâneas/terapia , Adenocarcinoma Sebáceo/patologia , Antineoplásicos/uso terapêutico , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Criocirurgia , Eletrocoagulação , Neoplasias Palpebrais/patologia , Humanos , Imunoterapia , Terapia a Laser , Fotoquimioterapia , Radioterapia , Neoplasias Cutâneas/patologiaRESUMO
OBJECTIVE: To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes. DESIGN: We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control. SETTING: University of Connecticut dermatology clinic, a tertiary care referral center. PARTICIPANTS: Input data were derived from results of a consecutive sample of 98 patients with nonmelanoma skin cancer on the face and ears, estimates in the literature on 5-year recurrence rates, and a query of healthy focus-group participants. INTERVENTION: We considered Mohs and traditional excision strategies. MAIN OUTCOME MEASURES: Outcomes were measured in quality-adjusted life years, cost, and cost-effectiveness. RESULTS: The Mohs strategy was $292 less expensive than the traditional surgical strategy and was more effective by an incremental quality-adjusted life year of 0.056 (translating to approximately 3 weeks of optimal quality of life). Results were robust to subgroup and sensitivity analyses. CONCLUSIONS: Mohs may be more cost-effective than traditional excision in eradicating nonmelanoma skin cancer. Further investigation of costs from various geographic payment localities and assessment of quality-of-life outcomes from a population-based sample are needed.
Assuntos
Neoplasias da Orelha/economia , Neoplasias da Orelha/cirurgia , Neoplasias Faciais/economia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs/economia , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/cirurgia , Idoso , Análise Custo-Benefício , Feminino , Humanos , Masculino , Método de Monte Carlo , Recidiva Local de Neoplasia , Anos de Vida Ajustados por Qualidade de VidaRESUMO
BACKGROUND: Patients with thick (Breslow>4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offers
Assuntos
Antineoplásicos/administração & dosagem , Interferon-alfa/administração & dosagem , Melanoma/psicologia , Melanoma/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/terapia , Adulto , Antineoplásicos/efeitos adversos , Quimioterapia Adjuvante , Tomada de Decisões , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Proteínas Recombinantes , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: Although patients with one to two dermatofibromas are common, cases of "multiple" dermatofibromas (more than 15 lesions) are rare and may occur in the context of altered or normal immune function. Patients with multiple dermatofibromas clustered in one anatomic area, by contrast, are strikingly rare. OBJECTIVE: The aim of our study was to present an additional case of multiple, clustered dermatofibroma (MCDF) and to summarize the literature concerning this entity. METHODS: We performed a MEDLINE (1960-2001) database search using keywords "dermatofibroma" AND "clustered" OR "agminated" OR "grouped." RESULTS: Five case reports were identified using this search strategy. These cases demonstrated substantial similarity in clinical features and behavior, specifically, the presence of pruritic symptoms, no clear inciting incident, an early active growth phase followed by stabilization, predilection for the lower extremity, and no report of sarcomatous transformation. CONCLUSION: Despite an active early growth phase, MCDF appears to follow a benign clinical course, with no report of sarcomatous transformation at up to 20 years followup.
Assuntos
Histiocitoma Fibroso Benigno/patologia , Neoplasias Cutâneas/patologia , Adulto , Feminino , HumanosRESUMO
BACKGROUND: Keloids are a major cause of morbidity, and arise after operation, injury, or cutaneous infection. Clinically, keloids differ from hypertrophic scars in that they grow beyond the original borders of the injury. Keloids occur most commonly for patients of African and Asian descent, and treatment options are multiple, indicating that there is no entirely satisfactory treatment for keloids. Angiogenesis inhibition has been shown to be effective in treatment of malignancy in both animal models and human beings. OBJECTIVE: We sought to determine whether keloids produce the potent angiogenic factor vascular endothelial growth factor (VEGF). METHODS: We performed in situ hybridization for VEGF on keloid tissue and normal skin. RESULTS: Our study demonstrated abundant production of VEGF in keloids and, surprisingly, the major source of VEGF was the overlying epidermis. CONCLUSIONS: Our results suggest that the overlying epidermis is the major source of keloid angiogenesis. These findings demonstrate that keloids are angiogenic lesions. Topical antiangiogenic therapy, directed at either down-regulating epidermal VEGF or inhibiting keratinocyte-derived VEGF activity on its endothelial receptors, may be useful in the treatment of keloids.
Assuntos
Epiderme/metabolismo , Queloide/metabolismo , Fator A de Crescimento do Endotélio Vascular/biossíntese , Humanos , Hibridização In Situ , Neovascularização Patológica/fisiopatologiaRESUMO
BACKGROUND: Plantar and subungual melanoma exhibits a higher misdiagnosis rate relative to other anatomic sites. Misdiagnosis and delay in diagnosis are statistically associated with poorer patient outcome. Awareness of atypical presentations of acral melanoma may, thus, be important to decrease misdiagnosis rates and improve patient outcome. METHODS: We conducted a retrospective case review of plantar or lower-extremity subungual melanoma performed at Winship Cancer Center, a tertiary care, referral center affiliated with Emory University, between 1985 and 2001. RESULTS: A total of 53 cases of plantar or lower-extremity subungual melanoma were identified. Of 53 cases with a final diagnosis of melanoma, 18 were initially misdiagnosed. Misdiagnoses included wart, callous, fungal disorder, foreign body, crusty lesion, sweat gland condition, blister, nonhealing wound, mole, keratoacanthoma, subungual hematoma, onychomycosis, ingrown toenail, and defective/infected toenail. Of the 18 misdiagnosed cases, 9 were clinically amelanotic. CONCLUSION: Awareness that amelanotic variants of acral melanoma may assume the morphology of benign hyperkeratotic dermatoses may increase the rate of correct diagnosis and improve patient outcome.