RESUMO
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Assuntos
Dermatologia , Humanos , Espanha , Estudos TransversaisRESUMO
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Assuntos
Dermatologia , Humanos , Espanha , Estudos TransversaisRESUMO
OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.
Assuntos
Carcinoma Basocelular , Carcinoma de Células Escamosas , Melanoma , Neoplasia de Células Basais , Neoplasias Cutâneas , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Melanoma/complicações , Cirurgia de Mohs , Estudos Prospectivos , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery (MMS). The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single-centre studies without a comparison group. OBJECTIVE: To compare the characteristics of patients, tumours, MMS and 1-year follow-up in patients younger than 80 years, with patients older than 80 years at the time of surgery. METHODS: Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour and surgery were recorded. Follow-up data were collected from two visits; the first within 1 month postsurgery and the second within the first year. RESULTS: From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75.4%) were aged <80 years and 633 (24.6%) were ≥80 years old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma. Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects and requiring more time in the operating room. Despite this, the incidence of postoperative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first-year follow-up. CONCLUSION: The risk of short-term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly.
Assuntos
Cirurgia de Mohs , Recidiva Local de Neoplasia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/efeitos adversos , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Sistema de Registros , Carga TumoralRESUMO
INTRODUCTION: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS: Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION: The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.
Assuntos
Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anestesia/métodos , Anestesia/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Sistema de Registros , Gestão de Riscos , Neoplasias Cutâneas/terapia , Espanha , Retalhos CirúrgicosAssuntos
COVID-19/mortalidade , Imunossupressores/uso terapêutico , Idoso , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , EspanhaRESUMO
INTRODUCTION: The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS: This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS: Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION: The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.
Assuntos
Carcinoma Basocelular/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Sistema de Registros , Neoplasias Cutâneas/cirurgia , Carcinoma/epidemiologia , Carcinoma/cirurgia , Carcinoma Basocelular/epidemiologia , Terapia Combinada , Bases de Dados Factuais , Dermatofibrossarcoma/epidemiologia , Dermatofibrossarcoma/cirurgia , Neoplasias Faciais/epidemiologia , Neoplasias Faciais/cirurgia , Humanos , Hospedeiro Imunocomprometido , Melanoma/epidemiologia , Melanoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Fatores de Risco , Terapia de Salvação , Neoplasias Cutâneas/epidemiologia , Espanha/epidemiologia , Resultado do TratamentoAssuntos
Dermatologia/organização & administração , Fundações/organização & administração , Acessibilidade aos Serviços de Saúde , Cirurgia de Mohs , Sistema de Registros , Sociedades Médicas , Venereologia/organização & administração , Estudos de Viabilidade , Humanos , Cirurgia de Mohs/estatística & dados numéricos , EspanhaAssuntos
Certolizumab Pegol/uso terapêutico , Imunossupressores/uso terapêutico , Nocardiose/microbiologia , Dermatopatias Bacterianas/microbiologia , Artrite Psoriásica/tratamento farmacológico , Humanos , Leflunomida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardia/isolamento & purificação , Nocardiose/patologia , Dermatopatias Bacterianas/patologia , PunhoAssuntos
Hemorragia/patologia , Líquen Escleroso e Atrófico/diagnóstico , Dermatopatias Vesiculobolhosas/patologia , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Feminino , Hemorragia/enzimologia , Humanos , Líquen Escleroso e Atrófico/enzimologia , Pessoa de Meia-Idade , Pele/patologia , Dermatopatias Vesiculobolhosas/enzimologiaRESUMO
Palmar involvement in lichen nitidus is infrequent. In such cases, the histopathologic findings of palmar lesions are usually identical to those of extrapalmar ones. We report on the case of a patient with multiple tiny papules located on the palms and elbows. A biopsy specimen from the elbow showed the typical features of lichen nitidus, but a biopsy from the palm disclosed an inflammatory infiltrate mostly disposed around the bases of rete ridges and composed of lymphocytes and histiocytes with some giant cells both in the dermis and in the epidermis. This location of the infiltrate is similar to that found in hypertrophic lichen planus, a combination of lichen planus and lichen simplex chronicus. We conclude that this histopathologic feature in palmar lichen nitidus could be the result of the superimposition of lichen nitidus on normal palmar skin, resulting in a picture resembling hypertrophic lichen planus.
Assuntos
Dermatoses da Mão/patologia , Líquen Nítido/patologia , Adulto , Feminino , Humanos , Pele/patologiaRESUMO
Erythema gyratum repens (EGR) is an uncommon but distinctive dermatosis characterized by marble-like swirls of erythema and a thin covering scale over the trunk, axillae and groins which has been associated with malignancy. Bronchial carcinoma has been the most frequent neoplasm associated. A case of EGR in a 50-year-old man with carcinoma of the lung is reported. The onset of dermatosis preceded the discovery of the neoplasm by 9 months. Oral corticosteroids induced the disappearance of the skin lesions. No recurrence was observed after discontinuation of the treatment. The patient died 1 year after the onset of dermatosis.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Eritema/etiologia , Neoplasias Pulmonares/diagnóstico , Síndromes Paraneoplásicas/etiologia , Carcinoma Pulmonar de Células não Pequenas/complicações , Eritema/fisiopatologia , Evolução Fatal , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/fisiopatologiaRESUMO
Superficial granulomatous pyoderma (SGP) is a form of pyoderma gangrenosum (PG) characterized by superficial ulceration and chronic course. To date it has been described as a condition with specific histopathological findings. We report a new case with clinical characteristics of SGP and describe why we believe that the histological changes previously described are not typical of this entity.