ABSTRACT
Introduction/Aims: During the COVID-19 pandemic, our unit converted to a see and treat model for the treatment of non-melanoma skin cancers (NMSCs), aiming to undertake complete excision at the first review. The intention was to reduce patient contact, to reduce the risk of virus transmission, whilst keeping waiting times to a minimum. This audit aimed to assess whether "See and treat" is an effective strategy and to determine whether it should continue following easing of lockdown restrictions. Material(s) and Method(s): 300 patients were seen in 'See and treat' clinics from February to December 2021. Results/Statistics: Initial analysis showed 81.9% of patients were treated during the first visit, with the main reason for treatment delay being anticoagulation. Average time from referral to treatment was 46.8 days. Of the lesions: 46.9% were BCCs, 21.2% were SCCs, 9.8% actinic keratosis, and 22.1% were a mixture of other types. 74.5% of the resultant defects were closed primarily, 12.3% were closed with local flaps, 7.1% left open to granulate, 2.5% grafted with Integra and 2.8% closed with FTSG. The complete excision rate was 98.8%. Conclusions/Clinical Relevance: This audit shows that the "See and treat" model is an effective and safe method for the management of NMSCs in an oral and maxillofacial surgery unit. Based on these results, we recommend that this strategy remains in place post-pandemic to reduce clinic appointments and waiting times. Pre-appointment screening could help to detect high risk patients (such as those on anticoagulation) and address these issues before the first visit, further increasing the efficiency of the system. Copyright © 2022
ABSTRACT
Objective: To integrate evidence and assess the risk factors associated with actinic keratosis (AK). Methods: Unrestricted searches were conducted on five electronic databases, with an end-date parameter of September 2021. We summarized the study characteristics and pooled the results from individual studies by using a random-effects model. The risk of bias was estimated using the Cochrane Risk of Bias Tool, and the quality of evidence was estimated according to the Newcastle-Ottawa Scale. Results: Sixteen studies were included in final analysis, and we assessed the AK risk among a variety of risk factors. Overall, the male sex (odds ratio (OR): 2.51; 95% confidence interval (CI): 1.94-3.25; P < 0.01), age >45 years (OR = 7.65, 95% CI: 2.95-19.86; P < 0.01), light Fitzpatrick skin phototype (OR = 2.32, 95% CI: 1.74-3.10; P < 0.01), light hair color (OR = 2.17, 95% CI: 1.40-3.36; P < 0.01), light eye color (OR = 1.67, 95% CI: 1.03-2.70; P = 0.04), freckles on face/arms (OR = 1.88, 95% CI: 1.37-2.58; P < 0.01), suffered positive history of other types of non-melanoma skin cancer (OR = 4.46, 95% CI: 2.71-7.33; P < 0.01), sunburns in childhood (OR = 2.33, 95% CI: 1.47-3.70; P < 0.01) and adulthood (OR = 1.50, 95% CI: 1.12-2.00; P < 0.01), severe sunburn (OR = 1.94, 95% CI: 1.62-2.31; P < 0.01), and chronic occupational and/or recreational sun exposure (OR = 3.22, 95% CI: 2.16-4.81; P < 0.01) increased the risk of AK. Moreover, sunscreen use (OR = 0.51, 95% CI: 0.34-0.77; P < 0.01) and history of atopy reduced the risk of AK. Sensitivity analysis yielded consistent results. The included studies showed a high risk of bias. Conclusion: We confirm several well-known AK risk factors and their quantitative data, and summarized the uncommon risk factors and protective factors. Our results may inform on the design and implementation of AK screening and educational programs.
ABSTRACT
A method is described for inactivation of pathogens, especially airborne pathogens, using ultraviolet (UV) radiation emitted directly into occupied spaces and exposing occupants to a dose below the accepted actinic exposure limit (EL). This method is referred to as direct irradiation below exposure limits, or DIBEL. It is demonstrated herein that low-intensity UV radiation below exposure limits can achieve high levels of equivalent air changes per hour (ACH(eq)) and can be an effective component of efforts to combat airborne pathogens such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). An ACH(eq) of 4 h(-1) is presently achievable over a continuous 8 h period for the SARS-CoV-2 virus with UV-C light-emitting diodes (LEDs) having peak wavelength at 275 nm, and future improvements in LED technology and optics are anticipated to enable improvements up to 150 h(-)(1) in the coming decade. For example, the actinic EL is 60 J/m(2) at 254 nm, and human coronaviruses, including SARS-CoV-2, have a UV dose required for 90 % inactivation of about 5 J/m(2) at 254 nm. Irradiation by 254 nm UV-C at the EL is expected to provide 90 % inactivation of these organisms in air in about 40 min when the UV-C is delivered at a constant irradiance over 8 h, or in about 5 min if the UV-C is delivered at a constant irradiance over 1 h. Since the irradiation is continuous, the inactivation of initial contaminants accumulates to 99 % and then 99.9 %, and it also immediately begins inactivating any newly introduced (e.g., exhaled) pathogens at the same rate throughout the 8 h period. The efficacy for inactivating airborne pathogens with DIBEL may be expressed in terms of ACH(eq), which may be compared with conventional ventilation-based methods for air disinfection. DIBEL may be applied in addition to other disinfection methods, such as upper room UV germicidal irradiation, and mechanical ventilation and filtration. The ACH(eq) of the separate methods is additive, providing enhanced cumulative disinfection rates. Conventional air disinfection technologies have typical ACH(eq) values of about h(-1) to 5 h(-1) and maximum practical values of about 20 h(-1). UV-C DIBEL currently provides ACH(eq) values that are typically about 1 h(-1) to 10 h(-)(1), thus either complementing, or potentially substituting for, conventional technologies. UV-C DIBEL protocols are forecast herein to evolve to >100 ACH(eq) in a few years, potentially surpassing conventional technologies. UV-A (315 nm to 400 nm) and/or UV-C (100 nm to 280 nm) DIBEL is also efficacious at inactivating pathogens on surfaces. The relatively simple installation, low acquisition and operating costs, and unobtrusive aesthetic of DIBEL using UV LEDs contribute value in a layered, multi-agent disinfection strategy.