Asunto(s)
Neoplasias Faciales , Inmunosupresores/administración & dosificación , Trasplante de Riñón/inmunología , Melanoma , Neoplasias Cutáneas , Adulto , Neoplasias Faciales/diagnóstico , Neoplasias Faciales/cirugía , Femenino , Humanos , Melanoma/diagnóstico , Melanoma/cirugía , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , Factores de TiempoAsunto(s)
Carcinoma de Células Escamosas/secundario , Herpes Zóster/diagnóstico , Neoplasias Cutáneas/secundario , Neoplasias de la Vulva/patología , Pared Abdominal , Anciano de 80 o más Años , Biopsia con Aguja , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Inmunohistoquímica , Radioterapia Adyuvante , Enfermedades Raras , Neoplasias Cutáneas/patología , Neoplasias de la Vulva/radioterapia , Neoplasias de la Vulva/cirugíaRESUMEN
A 62-year-old woman with a pre-existing psoriasis was treated with oral imatinib (400 mg/day) for a metastatic gastrointestinal stromal tumour. Within 4 weeks of starting therapy, she developed a guttate psoriasis flare. The eruption markedly improved within 2 weeks following cessation of imatinib. However, it recurred when imatinib was recommenced. She has been able to continue on imatinib (400 mg/day) with low-dose oral methotrexate (12.5 mg/week) controlling the psoriasis.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/patología , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Piperazinas/efectos adversos , Psoriasis/tratamiento farmacológico , Pirimidinas/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Benzamidas , Erupciones por Medicamentos/etiología , Femenino , Tumores del Estroma Gastrointestinal/complicaciones , Humanos , Mesilato de Imatinib , Metotrexato/administración & dosificación , Persona de Mediana Edad , Neoplasias Peritoneales/complicaciones , Piperazinas/administración & dosificación , Psoriasis/complicaciones , Pirimidinas/administración & dosificación , Resultado del TratamientoRESUMEN
BACKGROUND: Perineural invasion (PNI) by cutaneous squamous cell carcinoma (CSCC) and basal cell carcinoma (BCC) is an infrequent but not rare complication of traditionally low-morbidity skin cancers that can lead to catastrophic sequelae; 2.5% to 14% of CSCC and approximately 3% of BCC exhibit PNI. Tumors with PNI tend to be larger, have greater subclinical extension, have a higher rate of recurrence, and have a greater risk of metastases. Tumors with PNI may result in major neurologic deficits. OBJECTIVE: To review current recommendations for the management of PNI and to evaluate a treatment strategy involving excision using Mohs micrographic surgery (MMS) followed by adjunctive radiotherapy. MATERIALS AND METHODS: Cases of PNI treated with MMS and radiotherapy were reviewed for recurrence, disease-free follow-up, and adverse events. RESULTS: Twelve patients with incidental PNI treated with MMS and adjunctive radiotherapy are presented. After 3 to 32 months of follow-up, there had been no recurrences. Adverse events from radiotherapy were minor and self-limited. CONCLUSIONS: The use of adjunctive radiotherapy in these patients remains controversial. When managing superficial skin tumors with PNI, a multidisciplinary team including a cutaneous surgeon and a radiation oncologist familiar with PNI is recommended.
Asunto(s)
Parálisis de Bell/etiología , Carcinoma Basocelular/complicaciones , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/terapia , Neoplasias Primarias Múltiples/complicaciones , Neoplasias Primarias Múltiples/terapia , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/terapia , Adulto , Carcinoma Basocelular/patología , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Femenino , Humanos , Cirugía de Mohs , Invasividad Neoplásica , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/radioterapia , Nervios Periféricos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/radioterapiaRESUMEN
Published reports indicate that physicians sometimes use deceptive tactics with third-party payers. Many physicians appear to be willing to deceive to secure care that they perceive as necessary, particularly when illnesses are severe and appeals procedures for care denials are burdensome. Physicians whose practices include larger numbers of Medicaid or managed care patients seem more willing to deceive third-party payers than are other physicians. The use of deception has important implications for physician professionalism, patient trust, and rational health policy development. If deception is as widespread as these studies suggest, there may be serious problems in the medical profession and the health care financing systems at the interface between physicians and third-party payers. Deception may be a symptom of a flawed system, in which physicians are asked to implement financing policies that conflict with their primary obligation to the patient.