Effects of COVID-19 Lockdown on Tumour Burden of Melanoma and Cutaneous Squamous Cell Carcinoma.

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.

Utilización de matrices dérmicas en quemaduras / Use of dermal matrices in burns

INTRODUCCIÓN Y OBJETIVO: El uso de matrices dérmicas ha repercutido muy positivamente en los aspectos funcionales y estéticos del paciente quemado, sobre todo tras la reconstrucción de áreas especiales. Presentamos la experiencia del Servicio de Cirugía Plástica y Quemados del Hospital Universitario Miguel Servet de Zaragoza, España, en el uso de matrices dérmicas tras cirugía de quemaduras agudas o de sus secuelas. MATERIAL Y MÉTODO: Estudio observacional de recopilación de 88 casos, infantiles y adultos, tratados entre septiembre de 1999 y septiembre de 2019. Las matrices utilizadas fueron Integra® bicapa y Matriderm® monocapa, únicos sustitutos dérmicos permanentes disponibles en el ámbito de nuestra sanidad pública durante los años referidos. Recopilamos datos de sexo, edad, porcentaje de superficie corporal quemada, mecanismo de la quemadura, grado de profundidad y localización del área tratada con matrices dérmicas, si es quemadura aguda o secuela, pérdidas totales y parciales, y mostramos nuestro protocolo de actuación. RESULTADOS: Por sexos encontramos 51 varones y 37 mujeres con una media de edad de 37.67 años, con el grupo más numeroso entre 31 y 50 años; 71 casos con quemaduras agudas y en 17 con secuelas. El mecanismo de quemadura más frecuente fue el térmico (81%). La loca-lización de uso más frecuente fue la extremidad superior con 61 casos. En 67 casos utilizamos Matriderm® de 1 mm, en 13 Integra® bicapa y en 8 ambas matrices en el mismo paciente. La SCQ media de los pacientes tratados por quemaduras agudas fue del 11.7%. Constatamos 4 casos de pérdida total (1 Integra® bicapa y 3 de Matriderm® monocapa) y 11 casos de pérdidas parciales. CONCLUSIONES: El uso de matrices dérmicas debe de ser cotidiano en nuestras unidades, tanto para quemaduras agudas como para secuelas, y es necesario familiarizarse con sus indicaciones, manejo y resultados para incluirlas en nuestras escalas reconstructivas

BACKGROUND AND OBJECTIVE: Appearance of dermal matrices has had a very positive impact on the functional and aesthetic aspects in burned patients, specially after reconstruction of special areas. We present our experience in the Department of Plastic and Burns Surgery of the Miguel Servet Universitary Hospital in Zaragoza, Spain, in the use of dermal matrices in surgery of acute burns or sequelae. METHODS: We conduct an observational study on 88 cases, children and adults, treated from September 1999 to September 2019. The matrices used were Integra® bilayer and Matriderm® monolayer, the only permanent dermal substitutes available in our public health system during the referred years. We collected data on sex, age, percentage of burned body surface, burn mechanism, degree of depth and location of the area treated with dermal matrices, whether it is an acute burn or a sequel, as well as total and partial losses, and finally we show our protocol of action. RESULTS: Distribution by sex was 51 men and 37 women, average age 37.67 years being the most numerous group between 31 and 50 years; 71 cases of acute burns and 17 sequels. The most frequent burn mechanism was termal (81%). The most frequent used location was the upper limb with 61 cases. We used Matriderm® 1mm in 67 cases, Integra® bilayer in 13 and in 8 cases we used both in the same patient. The average TBSA percentage of patients treated for acute burns was 11.7%. We found 4 cases of total loss (1 of Integra® bilayer and 3 of Matriderm® monolayer), and 11 partial losses. CONCLUSIONS: Use of dermal matrices must be a daily option in our units, both for acute burns and sequelae, and we all must be familiar with their indications, management and results, to take them into account within our established reconstructive scales

Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia / Evaluation of the treatment of head and neck cutaneous squamous cell carcinoma in the elderly: a survival analysis

INTRODUCCIÓN: Se desconoce si la linfadenectomía cervical para el tratamiento del carcinoma espinocelular cutáneo de cabeza y cuello (CECccyc) aumenta la supervivencia en el paciente de avanzada edad. El objetivo de este estudio es determinar si esta terapia influye en la supervivencia de estos pacientes, y conocer si el índice abreviado de Charlson (ICa) puede utilizarse como alternativa a la edad en la estimación de la supervivencia. MÉTODOS: La población a estudio la componen todos los pacientes a quienes se diagnosticó CECccyc intervenidos consecutivamente entre 2006 y 2011. Se excluyeron los carcinomas no invasivos, no cutáneos. Se realiza una agrupación de los pacientes en función de la edad (<70, 70-79, 80-89, >90), ICa (<3, ≥3) y presencia (N1) o ausencia (N0) de metástasis cervicales. La variable dependiente es la realización o no de linfadenectomía cervical. Se efectúa un análisis de la supervivencia univariante según la presencia de metástasis; bivariante para cada una de las variables independientes según el tratamiento recibido; y multivariante. RESULTADOS: Se incluyen 416 casos. El tiempo medio de supervivencia es mayor en el grupo N0. Para cada uno de los grupos según la presencia de metástasis, las diferencias en el tiempo medio de supervivencia según la edad y el ICa no son significativas, independientemente del tratamiento recibido. El análisis multivariante muestra la influencia de la edad (p = 0,0001, OR = 1,488, IC95% = (1,318; 1,679)) y del ICa (p = 0,001, OR = 1,817, IC95% = (1,257; 2,627)) sobre los pacientes N0. Respecto a los pacientes N1, solo la variable tratamiento regional tiene una influencia positiva sobre la supervivencia (p = 0,048, OR = 0,15, IC95% = (0,023; 0,981)). CONCLUSIONES: El ICa y la edad son buenos indicadores de la mortalidad en pacientes CECccyc N0. No es así en pacientes CECccyc N1. En pacientes CECccyc N1 el tratamiento regional tiene una influencia positiva sobre la supervivencia. No se puede afirmar que existan diferencias en el tiempo medio de supervivencia de los pacientes con CECccyc en función de si han desarrollado metástasis o no y según el tratamiento recibido. Serán necesarios nuevos estudios

INTRODUCTION: It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (CCI-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality. METHODS: The study population included all patients diagnosed with cSCCh&n consecutively treated between 2006 and 2011. Non-invasive, non-cutaneous carcinomas were excluded. Patients were grouped according to their age (< 70, 70-79, 80-89, > 90), CCI-SF (< 3, ≥ 3) and presence (N1) or absence (N0) of cervical metastases. The dependent variable was the performance or not of cervical lymphadenectomy. A univariate survival analysis was performed according to the presence of metastases, a bivariate analysis for each of the independent variables according to the received treatment and a multivariate analysis. RESULTS: 416 cases were included. The mean survival time was greater in the N0 group. For each of the groups based on the presence of metastasis, the differences in the mean survival time according to age and CCI-SF were not significant, regardless of the treatment received. The multivariate analysis showed the influence of age (p = 0.0001, OR = 1.488, 95%CI = (1.318; 1.679)) and CCI-SF (p = 0.001, OR = 1.817, 95%CI = (1.257; 2.627)) in the N0 group. In the N1 group only regional treatment has a positive influence on survival (p = 0.048, OR = 0.15, 95%CI = (0.023; 0.981)). CONCLUSIONS: CCI-SF and age are good mortality indicators in cSCCh&n N0 patients, but not so in cSCCh&n N1 patients. In cSCCh&n N1 patients, regional treatment has a positive influence on survival. Differences cannot be affirmed in the mean survival time of patients with cSCCh&n, based on the development of metastases and the treatment given. New studies will be necessary

Evaluation of the treatment of head and neck cutaneous squamous cell carcinoma in the elderly: a survival analysis. / Evaluación del tratamiento del carcinoma epidermoide cutáneo de cabeza y cuello en la edad avanzada. Análisis de la supervivencia.

INTRODUCTION: It is unknown whether cervical lymphadenectomy as a treatment for cutaneous squamous cell carcinoma of the head and neck (cSCCh&n) increases survival in elderly patients. The aim of this study is to determine whether this procedure has an influence on the survival of these patients, and whether the Short-Form Charlson Comorbidity Index (CCI-SF) can be used as an alternative to age in the surgeon's estimation of elderly patient mortality. METHODS: The study population included all patients diagnosed with cSCCh&n consecutively treated between 2006 and 2011. Non-invasive, non-cutaneous carcinomas were excluded. Patients were grouped according to their age (<70, 70-79, 80-89, >90), CCI-SF (<3, ≥3) and presence (N1) or absence (N0) of cervical metastases. The dependent variable was the performance or not of cervical lymphadenectomy. A univariate survival analysis was performed according to the presence of metastases, a bivariate analysis for each of the independent variables according to the received treatment and a multivariate analysis. RESULTS: 416 cases were included. The mean survival time was greater in the N0 group. For each of the groups based on the presence of metastasis, the differences in the mean survival time according to age and CCI-SF were not significant, regardless of the treatment received. The multivariate analysis showed the influence of age (p=0.0001, OR=1.488, 95%CI=[1.318; 1.679]) and CCI-SF (p=0.001, OR=1.817, 95%CI=[1.257; 2.627]) in the N0 group. In the N1 group only regional treatment has a positive influence on survival (p=0.048, OR=0.15, 95%CI=[0.023; 0.981]). CONCLUSIONS: CCI-SF and age are good mortality indicators in cSCCh&n N0 patients, but not so in cSCCh&n N1 patients. In cSCCh&n N1 patients, regional treatment has a positive influence on survival. Differences cannot be affirmed in the mean survival time of patients with cSCCh&n, based on the development of metastases and the treatment given. New studies will be necessary.