Five-year economic evaluation of non-melanoma skin cancer surgery at the Costa del Sol Hospital (2006-2010).

BACKGROUND: The cost associated with treatment of non-melanoma skin cancer is expected to rise considerably over the coming decades. This important public health problem is therefore expected to have an enormous economic impact for the various public health services. OBJECTIVES: To estimate the cost of the surgical-care process of non-melanoma skin cancer at the Costa del Sol Hospital and seek areas to improve its efficiency, using the activity-based costing (ABC) method and the tools designed for decision analysis. SECONDARY OBJECTIVE: To compare the costs for hospitalized patients obtained using the ABC method with the data published by the Spanish Ministry of Health, using the diagnosis-related groups (DRG) classification system. MATERIAL AND METHODS: Retrospective analysis of the cost of non-melanoma skin cancer surgery at the Costa del Sol Hospital. RESULTS: The total estimated cost from 2006 to 2010 was 3 398 540€. Most of the episodes (47.3%) corresponded to minor outpatient surgery. The costs of the episodes varied greatly according to the type of admission: 423€ (minor outpatient surgery), 1267€ (major outpatient surgery), and 1832€ (inpatient surgery). The average cost of an inpatient episode varied significantly depending on the calculation system used (ABC: 2328€ vs. DRG: 5674€). CONCLUSIONS: The ABC cost analysis system favours standardization of the care process for these tumours and the detection of areas to improve efficiency. This would enable more reliable economic studies than those obtained using traditional methods, such as the DRG.

[Erythrodermic lichen planus pemphigoides]. / Liquen plano penfigoide eritrodérmico.

Lichen planus pemphigoides is a clinico-histological subtype of lichen planus in which there are bullous lesions similar to those of bullous pemphigoid. Lichen planus is included among the rare causes of erythroderma. We present a case of erythrodermic lichen planus pemphigoides in a 49-year-old female patient who satisfactorily responded to treatment with cyclosporine. A detailed physical examination and immunofluorescence study are key to the diagnosis of lichen planus pemphigoides.

[Tetracaine-induced systemic contact-type dermatitis]. / Dermatitis sistémica de contacto por tetracaínas.

We report the case of a 71-year-old-man with dermatitis in the groin area. Forty-eight hours previously, he had undergone transurethral resection for benign prostatic hyperplasia. During the prostatectomy, the probe was lubricated with a urological ointment containing the topical anesthetic, tetracaine. The patient had previously experienced severe pruritus and fissures in the perianal area after using antihemorrhoidal ointments. Biopsy and patch testing with the standard series and lubricant ointment showed positive reactions to this lubricant, called "urological lubricant" (UL) (+ + +) with caine mix (+ + +). The patient was diagnosed with systemic contact-type dermatitis due to caine mix. The dermatitis improved with topical steroids and oral antihistamine agents.

Liquen plano penfigoide eritrodérmico / Erythrodermic lichen planus pemphigoides

El liquen plano penfigoide es un subtipo clínico-histológico de liquen plano en el que aparecen lesiones ampollosas similares a las del penfigoide ampolloso. El liquen plano se incluye entre las causas excepcionales de eritrodermia. Presentamos un caso de liquen plano penfigoide eritrodérmico en una paciente de 49 años que respondió satisfactoriamente al tratamiento con ciclosporina. Una minuciosa exploración física y el estudio mediante inmunofluorescencia son claves en el diagnóstico del liquen plano penfigoide

Lichen planus pemphigoides is a clinico-histological subtype of lichen planus in which there are bullous lesions similar to those of bullous pemphigoid. Lichen planus is included among the rare causes of erythroderma. We present a case of erythrodermic lichen planus pemphigoides in a 49-year-old female patient who satisfactorily responded to treatment with cyclosporine. A detailed physical examination and immunofluorescence study are key to the diagnosis of lichen planus pemphigoides

Dermatitis sistémica de contacto por tetracaínas / Tetracaine-induced systemic contact-type dermatitis

Varón de 71 años que presenta lesiones eccemato-purpúricas en zona inguinal, de un día de evolución. 48 horas antes se le había practicado una resección transuretral por hipertrofia benigna de próstata. Durante la intervención se le aplicó el anestésico tópico tetracaína, base del denominado “lubricante urológico” (LU), exclusivamente en la sonda uretral y glande. El paciente refería que en anteriores ocasiones había tenido fisuras perianales tras la aplicación de cremas antihemorroidales. Se le realizó biopsia y pruebas alérgicas de contacto que incluyeron la batería estándar de alergenos y los propios del LU. A las 24 y a las 48 horas se confirmó resultado positivo a la mezcla de caínas (+ + +) y LU (+ + +). El LU tópico fue testado en 20 pacientes control, resultando negativo en todos ellos. El diagnóstico fue de eccema sistémico de contacto por caínas. El proceso se resolvió en 7-10 días tras aplicación tópica de corticosteroides, y la toma de antihistamínicos orales

We report the case of a 71-year-old-man with dermatitis in the groin area. Forty-eight hours previously, he had undergone transurethral resection for benign prostatic hyperplasia. During the prostatectomy, the probe was lubricated with a urological ointment containing the topical anesthetic, tetracaine. The patient had previously experienced severe pruritus and fissures in the perianal area after using antihemorrhoidal ointments. Biopsy and patch testing with the standard series and lubricant ointment showed positive reactions to this lubricant, called “urological lubricant” (UL) (+ + +) with caine mix (+ + +). The patient was diagnosed with systemic contact-type dermatitis due to caine mix. The dermatitis improved with topical steroids and oral antihistamine agents

Hiperplasia epitelial focal o enfermedad de Heck / Focal epithelial hyperplasia or Heck disease

La hiperplasia epitelial focal o enfermedad de Heck es un cuadro benigno causado por la infección provocada por determinados subtipos del virus del papiloma humano (VPH). Cursa con lesiones papulosas blanquecinas aplanadas en la mucosa oral, especialmente en los sitios de roce o trauma. Es excepcional en la raza caucásica y muy prevalente en Sudamérica y Centroamérica. Presentamos un caso epidemiológicamente típico de esta enfermedad que, debido a los movimientos migratorios, se verá cada vez con mayor frecuencia en nuestro medio

Focal epithelial hyperplasia or Heck disease is a benign disorder caused by infection by certain subtypes of human papilloma virus (HPV). It presents with flat whitish papules in the oral mucosa, especially where the latter is subjected to abrasion or at the sites of lesions. It is uncommon among Caucasians, but very prevalent in South and Central America. We present an epidemiologically typical case of this disease which, owing to immigration, will be encountered with increasing frequency among our patient population

Alopecia inducida por presión / Pressure-induced alopecia

La alopecia inducida por presión o alopecia postoperatoria se puede incluir en el grupo de Ias alopecias traumáticas. Resulta de la aplicación de una presión mantenida y localizada sobre el cuero cabelludo, que provoca una hipoxia tisular. Se presenta en forma de una o varias placas de alopecia en la zona occipital. En la mayoría de los casos, es una alopecia temporal que se resuelve en pocos meses, aunque en algunos casos graves puede ser definitiva. No precisa tratamiento. Las medidas preventivas son las únicas eficaces (AU)