Assuntos
Melanoma , População Rural , Programa de SEER , Neoplasias Cutâneas , Humanos , Melanoma/mortalidade , Melanoma/epidemiologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/epidemiologia , Programa de SEER/estatística & dados numéricos , População Rural/estatística & dados numéricos , Masculino , Feminino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Idoso , Adulto , Medição de Risco/estatística & dados numéricosRESUMO
BACKGROUND: Dermatology practice has recently seen multiple changes. A better understanding of trends pertaining to dermatology practice setups is necessary. OBJECTIVE: To analyze the recent changes in dermatology practice in terms of geography, practice size, and gender distribution as well as to analyze the availability of dermatologists based on zip codes' income levels. METHODS: This was a cross-sectional study. We extracted data on the sex and billing addresses of dermatologists from Medicare provider utilization and payment data for 2012 and 2017. We used 2017 tax returns data to calculate the poverty level for each zip code. RESULTS: Between 2012 and 2017, the number of solo practitioners decreased, while that of dermatologists working in large groups increased. The southern region experienced the largest changes. The male-to-female ratio decreased. Dermatology practices mainly comprised mixed genders, with a higher proportion of all-male groups versus that of all-female groups, but this difference decreased over time. In the northeastern and western regions, more than one third of dermatologists were located in the wealthiest zip codes. LIMITATIONS: The Medicare data may not be exhaustively representative of the dermatology workforce, and the zip codes of 489 dermatologists' billing addresses were missing in the tax return dataset. CONCLUSIONS: These findings provide an understanding of the recent changes pertaining to dermatology practice setups and of the substantial health care disparities based on geographic distribution.
Assuntos
Informação de Saúde ao Consumidor/estatística & dados numéricos , Transplante de Órgãos/efeitos adversos , Educação de Pacientes como Assunto , Neoplasias Cutâneas/etiologia , Compreensão , Humanos , Internet/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , LeituraAssuntos
COVID-19/economia , Dermatologia/economia , Financiamento Governamental/estatística & dados numéricos , Programas Governamentais/economia , Pandemias/economia , SARS-CoV-2 , Empresa de Pequeno Porte/economia , Programas Governamentais/estatística & dados numéricos , Humanos , Estados UnidosAssuntos
COVID-19 , Dermatologia , Telemedicina , Humanos , Pandemias , Avaliação de Resultados da Assistência ao Paciente , SARS-CoV-2RESUMO
BACKGROUND: Immunosuppressed patients have worse outcomes from cutaneous squamous cell carcinomas (cSCCs), although unclear whether it is due to the development of more high-stage tumors or worse outcomes for a given stage. OBJECTIVE: Analyze the impact of immunosuppression on the development of cSCCs and tumor stage-dependent outcomes. MATERIALS AND METHODS: Single-institution 1:2 case-control study of primary invasive cSCCs from 2005 to 2015 in 106 mixed-cause immunosuppressed patients and 212 control subjects matched to age, gender, and race. RESULTS: Four hundred twelve cSCCs from 106 immunosuppressed patients and 291 tumors from 212 matched immunocompetent patients were included. Both cohorts had similar T-stage distribution, with <5% high-stage tumors, that is, AJCC-7 T2, AJCC-8 T3, and BWH T2b/T3. Immunosuppression significantly increased the likelihood of poor outcomes (POs) (aggregate of local recurrence (LR), nodal and distant metastasis, and squamous cell carcinoma-related deaths) for low-stage tumors, that is, AJCC-7 T1 (odds ratio [OR], 4.29), AJCC-8 T1 (OR, 3.45), AJCC-8 T2 (OR, 3.75), BWH T1 (OR, 3.53), and BWH T2a (OR, 3.41) tumors. There was no significant difference in the treatment: most tumors were treated with Mohs (71% vs 75%) or excision (21% vs 20%) in both cohorts. CONCLUSION: Immunosuppressed patients have an increased risk of POs, specifically LRs, from low-stage cSCCs. Definitive treatment of cSCCs is recommended.
Assuntos
Carcinoma de Células Escamosas/mortalidade , Hospedeiro Imunocomprometido/imunologia , Terapia de Imunossupressão/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Cutâneas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Estudos de Casos e Controles , Feminino , Humanos , Metástase Linfática/imunologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/imunologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Análise de SobrevidaAssuntos
Carcinoma de Células Escamosas/epidemiologia , Imunocompetência , Hospedeiro Imunocomprometido , Neoplasias Cutâneas/epidemiologia , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/patologia , Estudos de Casos e Controles , Humanos , Incidência , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologiaAssuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Fatores Etários , Idoso , Carcinoma Basocelular/fisiopatologia , Carcinoma de Células Escamosas/fisiopatologia , Estudos de Coortes , Dermatologia , Escolaridade , Feminino , Humanos , Masculino , Melanoma/fisiopatologia , Pessoa de Meia-Idade , Avaliação das Necessidades , Prevalência , Medição de Risco , Fatores Sexuais , Neoplasias Cutâneas/fisiopatologia , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: The reported efficacy of imiquimod for lentigo maligna varies widely, without consensus on tumor or treatment factors that can impact tumor clearance. OBJECTIVE: We sought to provide a more precise estimate of clearance rates in patients with lentigo maligna who are treated with imiquimod and to analyze factors that can impact tumor clearance. METHODS: We performed a literature search for biopsy-proven lentigo maligna treated with imiquimod monotherapy, linked treatment and outcome data to individual tumors, calculated histologic and clinical clearance rates with 95% confidence intervals (CIs), and analyzed the impact of tumor and treatment factors on tumor clearance using logistic regression. RESULTS: Based on 347 tumors from 45 studies, histologic and clinical clearance rates were 76.2% (95% CI, 71.4-81.0%) and 78.3% (95% CI, 73.6-82.9%), respectively. The incidence of clinical recurrence was 2.3% (95% CI, 0.5-4.2%), with a mean follow-up of 34.2 ± 11.8 months. Treatment with >60 total applications, or with >5 applications per week was associated with a higher likelihood of histologic clearance (odds ratio, 8.4 [95% CI, 2.9-24.1] and odds ratio, 6.0 [95% CI, 2.4-14.7], respectively). LIMITATIONS: Our limitations included the accuracy and scope of published data, variable follow-up times, potential patient selection, and publication bias related to case series/cohort designs of previous studies. CONCLUSION: Imiquimod offers a 76% histologic and 78% clinical clearance rate for lentigo maligna. Both cumulative dose and treatment intensity affect tumor clearance.