RESUMO
BACKGROUND: In Mohs surgery, the histologic verification of tumor removal results in a lower rate of cancer recurrence compared with simple excision. Factors associated with the increased use of Mohs surgery are not well characterized. OBJECTIVE: To investigate trends in the utilization of Mohs surgery. METHODS AND MATERIALS: The authors performed a retrospective analysis of the National Ambulatory Medical Care Survey for patient visits associated with Mohs surgery from 1995 to 2010. The authors assessed percentage of skin cancers managed with Mohs surgery, the most common locations of skin cancer managed with Mohs surgery, and patient demographics associated with Mohs surgery. RESULTS: Although there was an upward trend in the use of Mohs surgery (p = .004), a low percentage of skin cancers (average of 10.0%) were managed with this technique. When the surgical location was specified, Mohs surgery was most commonly used for the head and neck region. Demographic groups receiving Mohs surgery at higher rates included African Americans (44.2%) and patients aged 75 to 84 years (12.4%). CONCLUSION: There has been an upward trend in the use of Mohs surgery, particularly in the head and neck region where tissue preservation is essential.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Cirurgia de Mohs/estatística & dados numéricos , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/tendências , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto JovemAssuntos
Gota/diagnóstico , Adulto , Derme/patologia , Gota/sangue , Gota/patologia , Humanos , Masculino , Ácido Úrico/sangueAssuntos
Pérnio/patologia , Lúpus Eritematoso Cutâneo/patologia , Dermatopatias Vesiculobolhosas/patologia , Administração Tópica , Pérnio/diagnóstico , Pérnio/tratamento farmacológico , Clobetasol/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Doenças Raras , Medição de Risco , Dermatopatias Vesiculobolhosas/diagnóstico , Dedos do Pé , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Many factors, including patients' methods of payment, may influence psoriasis treatment decisions. OBJECTIVE: To characterize psoriasis treatments by patients' types of payment in the US outpatient office setting. METHODS: Using the National Ambulatory Medical Care Survey (NAMCS), a large survey that samples outpatient office visits to US non-federally funded physicians, visits linked with sole diagnoses for psoriasis (ICD-9-CM: 696.1) were identified. There were 545 unweighted records. The types and number of treatments prescribed at these visits were categorized by expected major payment type to be used for the visit. RESULTS: Mainstay psoriasis therapies such as vitamin D analogs and clobetasol were prescribed regardless of payment type. Retinoids were also within the most frequently prescribed psoriasis medications for all payment types, however they were less frequently prescribed than vitamin D analogs. Payment type did not have a significant effect on the number of medications prescribed at psoriasis visits. LIMITATIONS: Data on treatment adherence and filling of prescriptions are not included in the NAMCS database. CONCLUSION: Prescribing patterns for psoriasis medications are similar across payment type. Additional factors appear to modulate therapy choice for patients with psoriasis.
