Evolución de la incidencia del cáncer de piel y labio durante el periodo 1978-2007 / Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007

Introducción: El objetivo del estudio es analizar la tendencia temporal en la incidencia del cáncer de piel a nivel mundial, europeo y español durante el período comprendido entre 1978-2007. Material y métodos: Se estudiaron la incidencia y la tendencia del cáncer de piel en el período 1978-2007 a través de la publicación Cancer Incidence in Five Continents usando las tasas estandarizadas por edad y sexo por 100.000 habitantes. Resultados: La incidencia del melanoma cutáneo ha aumentado desde 1978 a 2002, pero en el último periodo 2003-2007 disminuye a nivel mundial. Las incidencias máximas se registraron en Australia y en la población de raza blanca de Hawaii. En España la incidencia de melanoma se triplicó en ambos sexos al final del período. La incidencia del cáncer cutáneo no melanoma aumentó durante el período de estudio (1978-2007), con tasas más elevadas en varones. Las incidencias máximas se registraron en Australia, Brasil y en la población europea de Zimbabue. En España la incidencia de cáncer cutáneo no melanoma llegó a duplicarse o triplicarse en ambos sexos al final del período. Limitaciones: No se ha podido analizar el período más actual 2008-2012 debido a un retraso de 5 años en la publicación de los datos por parte del IARC. Conclusiones: El aumento de la incidencia del cáncer de piel ajustando por los cambios en el envejecimiento de la población sugiere que las medidas de prevención primaria son insuficientes o inadecuadas. La disminución de la incidencia de melanoma en Australia en el último período apoya la eficacia de medidas de prevención iniciadas hace varias décadas (AU)

Introduction: The aim of this study was to analyze trends in the incidence of skin cancer worldwide, in Europe, and in Spain between 1978 and 2007. Material and methods: Skin cancer incidence and trends for the period 1978 to 2007 were investigated using the age- and sex-standardized rates (per 100,000 population) published in the Cancer Incidence in Five Continents series. Results: The incidence of cutaneous melanoma increased progressively from 1978 to 2002 but decreased in the last period analyzed (2003-2007). The highest rates were reported for Australia and the white population in Hawaii. In Spain, the incidence of melanoma tripled in both sexes over the study period. The incidence of nonmelanoma skin cancer also increased between 1978 and 2007, and higher rates were detected in men. The highest incidence rates were recorded in Australia, Brazil, and among the European inhabitants of Zimbabwe. In Spain, the incidence of nonmelanoma skin cancer had doubled or tripled in both sexes by the end of the study period. Limitations: We were unable to analyze data for the period 2008 to 2012 due to a 5-year delay in the publication of data by the International Agency for Research on Cancer. Conclusions: The rise in the incidence of skin cancer, assessed using age-standardized rates, suggests that primary prevention measures are insufficient or inappropriate. The reduction in the incidence of cutaneous melanoma in Australia between 2003 and 2007 suggests that the preventive strategies initiated several decades earlier in that country have been effective (AU)

Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007. / Evolución de la incidencia del cáncer de piel y labio durante el periodo 1978-2007.

INTRODUCTION: The aim of this study was to analyze trends in the incidence of skin cancer worldwide, in Europe, and in Spain between 1978 and 2007. MATERIAL AND METHODS: Skin cancer incidence and trends for the period 1978 to 2007 were investigated using the age- and sex-standardized rates (per 100,000 population) published in the Cancer Incidence in Five Continents series. RESULTS: The incidence of cutaneous melanoma increased progressively from 1978 to 2002 but decreased in the last period analyzed (2003-2007). The highest rates were reported for Australia and the white population in Hawaii. In Spain, the incidence of melanoma tripled in both sexes over the study period. The incidence of nonmelanoma skin cancer also increased between 1978 and 2007, and higher rates were detected in men. The highest incidence rates were recorded in Australia, Brazil, and among the European inhabitants of Zimbabwe. In Spain, the incidence of nonmelanoma skin cancer had doubled or tripled in both sexes by the end of the study period. LIMITATIONS: We were unable to analyze data for the period 2008 to 2012 due to a 5-year delay in the publication of data by the International Agency for Research on Cancer. CONCLUSIONS: The rise in the incidence of skin cancer, assessed using age-standardized rates, suggests that primary prevention measures are insufficient or inappropriate. The reduction in the incidence of cutaneous melanoma in Australia between 2003 and 2007 suggests that the preventive strategies initiated several decades earlier in that country have been effective.

El «Hospital de la Tiña»: Una señera institución granadina (1679-1923) / The Tinea Hospital in Granada, 1679–1923: An Institution With a Long History

El Hospital de la Tiña, fundado con fines benéfico-sanitarios en el siglo XVII, ha funcionado desde entonces hasta bien entrado el siglo XX realizando el tratamiento de las tiñas a pacientes de todas procedencias acogidos en la institución. En el presente estudio describimos la fundación del hospital, las características de los pacientes y sus cuidadores, así como lo que se consideraba tiña, sus tipos, la pauta de tratamiento y los cuidados alimenticios e higiénicos. Nos llama la atención que la presencia tan temprana de un hospital «monográfico» no se tradujo en estudios sobre la enfermedad y la aplicación de los conocimientos de la época

The Tinea hospital in Granada, Spain, was a charitable health facility founded in the 17th century and still treating patients well into the 20th century. The hospital accepted patients from anywhere, not only those residing in the surrounding area. We describe the hospital's founding and the characteristics of the patients and caregivers. We also discuss how tinea was considered at the time, including the typology and treatment protocols applied as well as diet and hygiene measures used. It is striking that a hospital so focused on treating a single disease did not produce studies on the condition or on the application of contemporary knowledge to guide treatment

Sutura oblicua subcutánea / Subcutaneous vector-running sutures

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The Tinea Hospital in Granada, 1679-1923: an institution with a long history.

The Tinea hospital in Granada, Spain, was a charitable health facility founded in the 17th century and still treating patients well into the 20th century. The hospital accepted patients from anywhere, not only those residing in the surrounding area. We describe the hospital's founding and the characteristics of the patients and caregivers. We also discuss how tinea was considered at the time, including the typology and treatment protocols applied as well as diet and hygiene measures used. It is striking that a hospital so focused on treating a single disease did not produce studies on the condition or on the application of contemporary knowledge to guide treatment.

Motivos dermatológicos de consulta en atención primaria. Análisis de la demanda derivada / Skin Conditions in Primary Care: An Analysis of Referral Demand

INTRODUCCIÓN: Las enfermedades cutáneas constituyen uno de los principales motivos de consulta en atención primaria (AP), motivo por el que el médico de AP está obligado a conocer su diagnóstico y su importancia e integrar estos conocimientos y aptitudes en su formación. En este estudio realizamos un análisis de los motivos de derivación desde AP a asistencia especializada (demanda derivada) y de la concordancia diagnóstica entre médico de AP y dermatología/anatomía patológica. MATERIAL Y MÉTODOS: Se recogieron datos de 755 pacientes y 882 primeras consultas de Dermatología procedentes de AP, en el periodo comprendido entre el 1 de febrero de 2012 hasta el 30 de abril de 2012, a los que aplicamos un protocolo de recogida de datos (edad, sexo, profesión, motivo de derivación, diagnóstico de AP y de dermatología). Con los datos realizamos un estudio estadístico para conocer frecuencias, motivos de derivación, sensibilidad y especificidad y los valores predictivos positivos (VPP), valores predictivos negativos (VPN) e índices kappa de concordancia diagnóstica. RESULTADOS: Los diagnósticos más frecuentes fueron queratosis seborreicas, nevus melanocíticos, queratosis actínicas y acné. El motivo más frecuente de derivación fue la valoración diagnóstica (52,5%). La sensibilidad (S) y especificidad (E) del diagnóstico en tumores cutáneos fueron de S = 22,4%, E = 94,7%, VPP = 40,7% y VPN = 88,3%, κ = 0,211 y en los diagnósticos más frecuentes la S en general es baja y la E bastante alta. CONCLUSIONES: El médico de AP, de acuerdo con nuestros resultados, está más capacitado para afirmar que el paciente no padece determinada enfermedad cutánea (E alta) que para establecer el verdadero diagnóstico clínico (S baja), lo que nos sugiere la necesidad de planificar acciones formativas que se traduzcan en una aumento de los conocimientos y aptitudes necesarias para el correcto manejo de las enfermedades cutáneas, especialmente por su trascendencia del cáncer de piel. Sin duda redundaría en una mayor agilidad del sistema, menos listas de espera y una mejor atención sanitaria

INTRODUCTION: The prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders. OBJECTIVE: To describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels. MATERIAL AND METHODS: The study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ2 test depending on the type of variable. The independence of the associations was assessed using regression analysis. RESULTS: In total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6 ± 8 kg/m2. The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P = 0.003), skin tags (P = 0.001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels. CONCLUSIONS: AN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients

Skin conditions in primary care: an analysis of referral demand.

INTRODUCTION: Skin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate. MATERIAL AND METHODS: Data were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement. RESULTS: The most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high. CONCLUSIONS: According to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions-especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.

Evaluación del pelo y cuero cabelludo: tricograma / Hair and Scalp Evaluation: The Trichogram

Los métodos de exploración en tricología se pueden clasificar en 3 categorías: métodos no invasivos (historia clínica, exploración general, inspección y palpación del cabello y cuero cabelludo, fotografía, dermoscopia, etc.), métodos semi-invasivos (tricograma) e invasivos (biopsia). En este artículo se repasa de forma práctica el abordaje de los motivos de consulta en tricología en la consulta del dermatólogo (AU)

Hair and scalp evaluation techniques can be classified into 3 categories: noninvasive methods (clinical history, general examination, inspection and palpation of the hair and scalp, photography, dermoscopy, etc.); semi-invasive methods (the trichogram); and invasive methods (biopsy). In this article, we provide a practical guide on how to evaluate hair and scalp conditions in the dermatology office (AU)

Exploración de las uñas con dermoscopia: onicoscopia / Nail digital dermoscopy: onychoscopy

La dermoscopia es un procedimiento diagnóstico que ha demostrado su utilidad en tumores pigmentados. En la actualidad sus aplicaciones se han extendido a otras enfermedades de la piel y de los anejos como el pelo (tricoscopia) y uñas (onicoscopia).La aplicación de la dermoscopia en la exploración de las alteraciones ungueales es una técnica no invasiva que nos permite valorar diferentes características de las uñas: anomalías en la lámina ungueal (pigmentaciones de origen melanocítico y no melanocítico), y el lecho ungueal y nos ayuda adetectar anomalías en el patrón vascular del hiponiquio y del pliegue proximal (en las enfermedades del tejido conectivo).A continuación se exponen los signos más característicos de la exploración con esta técnica y se establecen los patrones de las pigmentacione sungueales de origen melanocítico y no melanocítico, enfermedades ungueales como el psoriasis ungueal y afectación de enfermedades del tejidoconectivo (AU)

Dermoscopy has proven to be a useful diagnostic procedure in pigmented tumours. More recently its application has been extended to other skin diseases, and diseases of the cutaneous annexes such as the hair (trichoscopy) and nails (onichoscopy).The application of dermoscopy in the evaluation of nails disorders is a noninvasive technique that enables the assessment of specific characteristics ofthe nails: dermoscopy permits better visualization of abnormalities in the nail plate (pigmentation produced by melanocytic and non melanocyticlesions) and bed, and aids detection of the vascular abnormalities in the hyponychium and proximal nail fold (in connective tissue diseases).The most characteristic signs observed with this technique are reported below, describing the patterns of nail pigment of melanocytic and nonmelanocycit origin, nail diseases like ungueal psoriasis and connective tissue diseases (AU)