ABSTRACT
Introducción: Desde el año 2011 a la fecha se han realizado grandes avances en el diagnóstico y el tratamiento del melanoma cutáneo. Las diferentes sociedades dermatológicas internacionales han actualizado sus recomendaciones y guías de manejo, tomando en consideración los nuevos avances científicos y resultados de ensayos clínicos. Objetivo: El objetivo de la presente revisión es proponer recomendaciones basadas en la evidencia sobre del rol del dermatólogo en el manejo del melanoma cutáneo en el sistema de salud de Chile. Diseño: Revisión sistemática de la literatura en cinco bases de datos: Pubmed/Medline, Embase, Web of Science, Lilacs/SciELO y Cochrane Library; desde julio del 2016 a julio del 2021. Resultados: 1306 registros fueron identificados y 153 cumplieron los criterios de inclusión. Se exponen recomendaciones actualizadas con respecto al diagnóstico y manejo del melanoma cutáneo en Chile. El panel de expertos presenta un diagrama de flujo del proceso de atención de una lesión sospechosa de melanoma, la participación global del equipo médico encargado del cuidado paciente y el rol del dermatólogo. Conclusión: El rol del dermatólogo es central e indispensable en todas las etapas de atención del melanoma cutáneo.
Introduction: Since 2011 great advances have been made in the diagnosis and treatment of cutaneous melanoma. The different international dermatological societies have updated their recommendations and clinical guidelines taking into account new scientific advances and the results of clinical trials. Objective: The aim of this review is to propose evidence-based recommendations on the role of the dermatologist in the diagnosis and management of cutaneous melanoma in the Chilean healthcare system. Design. Systematic review of the literature in five databases: Pubmed/Medline, Embase, Web of Science, Lilacs/SciELO and Cochrane Library; from July 2016 to July 2021. Results: 1306 records were identified and 153 met the inclusion criteria. Updated recommendations regarding the diagnosis and management of cutaneous melanoma in Chile are presented. The expert panel presents a flowchart of the process of care of a suspected melanoma lesion, the overall involvement of the medical team in charge of patient care, and the role of the dermatologist. Conclusion: The role of the dermatologist is central and critical in all stages of cutaneous melanoma care
Subject(s)
Humans , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Melanoma/diagnosis , Melanoma/therapy , Chile , Dermatology/standardsABSTRACT
Abstract: Melanoma Guidelines of the Brazilian Dermatology Society recommend histologic review by pathologists trained in melanocytic lesions whenever possible. Out of 145 melanoma cases identified at a private clinic in São Paulo/Brazil, 31 that had been submited to histologic review were studied to evaluate whether revision had led to change in therapeutic approach.. Differences in original/reviewed reports were found in 58.1% (n=18) of the reports, leading to changes in therapeutic approach in 41.9% (n=13). Change in diagnosis was observed in 6 out of 31 (19,3%) cases. These findings suggest that second opinion by pathologists trained in melanocytic lesions is likely to show significant differences from the original report.
Subject(s)
Humans , Pathology, Clinical/standards , Pathologists , Melanocytes/pathology , Melanoma/pathology , Referral and Consultation , Brazil , Observer Variation , Retrospective Studies , Histological Techniques/methods , Histological Techniques/standards , Dermatology/standards , Dermatologists , Melanoma/diagnosis , Melanoma/therapy , Neoplasm Staging/classificationABSTRACT
BACKGROUND: Telemedicine refers to the use of technology as improvement of healthcare delivery to places where distance becomes an obstacle. Its use represents a great potential for dermatology, a specialty whose visual analysis phase is essential in diagnosis. OBJECTIVES: To analyze the compatibility index of skin cancer diagnoses between primary care and teledermatology, and to validate a protocol for standardization of digital imaging to obtain the reports in teledermatology. METHODS: An observational cross-sectional study developed through the census of 333 examination requests, received between January/2012 and July/2012, in the Center for Telemedicine and Telehealth of SES-SC. We used a protocol for photographic lesion standardization, consisting of three steps (panoramic photo, close-up with ruler and dermoscopy). After collection, the data were sent to a virtual site on the Internet, and recorded with the use of an electronic health record containing the images, the skin phototype and demographic characteristics. RESULTS: The level of compatibility between the diagnosis of skin cancer in Santa Catarina's primary care and the diagnosis proposed by teledermatology was 19.02%. Proportionally, it was 21.21% for BCC, 44.44% for SCC and 6.98% for MM. The protocol was statistically significant (p <0.05), with an OR of 38.77. CONCLUSION: The rate of diagnostic compatibility of skin cancer was low and the use of the protocol optimized the chance of validating requests for examination. .
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Dermatology/standards , Image Interpretation, Computer-Assisted/standards , Primary Health Care/standards , Skin Neoplasms/diagnosis , Telemedicine/standards , Cross-Sectional Studies , Dermatology/methods , Observer Variation , Predictive Value of Tests , Primary Health Care/methods , Reproducibility of Results , Telemedicine/methods , Telepathology/methods , Telepathology/standardsABSTRACT
Background: Diagnostic accuracy (DA) is an outcome measure to assess the feasibility of teledermatology tools. Despite ample data with variable DA values, no study has examined the aggregate DA value obtained from the available studies and observed its consistency over a period of time. This kind of a longitudinal study about teledermatology will be necessary to check its usefulness and plan for further implementation. Aims: To observe the DA trend over a period of 15 years (1997-2011). Methods: Only those studies (n = 59) using a single tool for general, tertiary, and subspecialty teledermatology practice were included to obtain the DA values. Studies were graded based on the number of subjects and gold standard comparison between teledermatologist and clinical dermatologist (face-to-face examination). Results: This analysis sought to identify the DA trend was carried out by evaluating 17 store and forward teledermatology (SAFT) based and 8 Video conference (VC) tool-based studies with 2385 and 1305 patients respectively, in comparison with the gold-standard assessment. The average DA was 73.35% ± 14.87% for SAFT and 70.37% ± 7.01% for VC. One sample t-test analysis with 100% accuracy as standard value revealed 28% deficiency for SAFT (t = 7.925; P = 0.000) and 30% deficiency for VC (t = 11.955; P = 0.000). Kruskall-Wallis test confirmed the consistency of DA values in the SAFT (χ2 = 1.852, P = 0.763) tool. Conclusion: SAFT and VC were adequately validated on a large number of patients by various feasibility studies with the gold standard (face-to-face) comparison between teledermatologists and clinical dermatologists. The DA of SAFT was good, stable over the 15 years and comparable to VC. Health-care providers need to plan for appropriate utility of SAFT either alone or in combination with VC to implement and deliver teledermatology care in India.
Subject(s)
Adult , Child , Dermatology/standards , Dermatology/trends , Feasibility Studies , Humans , India , Longitudinal Studies , Outpatients , Reference Standards , Reproducibility of Results , Skin Diseases/diagnosis , Telemedicine/standards , Telemedicine/trendsABSTRACT
La psoriasis es una enfermedad crónica que afecta al 1%-2% de la población, produce importante deterioro de la calidad de vida y puede asociarse a complicaciones metabólicas y articulares severas. Existen múltiples agentes sistémicos para el manejo de los casos moderado-severos; sin embargo, la mayoría no puede utilizarse de manera continua o prolongada y los estudios han demostrado que un alto porcentaje de pacientes está disconforme con sus tratamientos. Los agentes biológicos representan una poderosa herramienta en el tratamiento de la psoriasis; no obstante, los riesgos asociados y sus costos hacen necesario restringir su uso. Debido a estas consideraciones, diferentes sociedades dermatológicas en el mundo han desarrollado guías clínicas de consenso para el manejo de estos agentes en psoriasis. El presente artículo resume las recomendaciones de las sociedades Alemana (2007), Americana (2008), Española (2009) y Británica (2009) de Dermatología y los principales ensayos clínicos de cada uno de los agentes biológicos disponibles para el tratamiento de la psoriasis, y pretende entregar algunas directrices para la utilización de estos agentes en el medio nacional.
Psoriasis is a chronic disease that affects 1%-2% of the population, causes serious deterioration in the quality of life and may be associated with severe metabolic and joint complications. There are numerous systemic agents for the management of moderate-severe cases, however, most of them cannot be used in a continuous or prolonged way, and studies have shown a high percentage of dissatisfaction with those treatments. Biologics represent a powerful tool in the treatment of psoriasis, however, associated risks and costs make it necessary to restrict their use. Because of this, different dermatological societies around the world have developed clinical guidelines for the management of these agents in psoriasis. This article summarizes the recommendations of the German (2007), American (2008), Spanish (2009) and British (2009) Dermatology Societies, as well as the main clinical trials of biologics for the treatment of Psoriasis, and attempts to provide some guidelines for the use of these agents in our country.
Subject(s)
Humans , Dermatologic Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Dermatology/standards , Tumor Necrosis Factor-alpha/agonists , Interleukins/agonists , Psoriasis/drug therapy , Consensus , Patient Selection , Practice Guidelines as TopicSubject(s)
Humans , Skin Diseases , Leprosy , Primary Health Care/standards , Dermatology/standards , Basic Health ServicesABSTRACT
It provides the expected requirements of such products and for establishing acceptable levels for reactive ingredients; toxic metals; instruction for and limitations of use; warning; labelling and packaging