Nuria Blázquez-Sánchez

Estudio temporal de los diferentes patrones metastásicos en la progresión del melanoma cutáneo

Resumen Introduccion El melanoma es uno de los tumores que mas ha aumentado en las ultimas decadas y posee un elevado potencial de diseminacion. Cuando metastatiza, hasta en dos tercios de las ocasiones lo hace a los ganglios linfaticos regionales y aproximadamente en un tercio de los casos a nivel sistemico. Existen, sin embargo, pocos estudios en la literatura que hayan analizado los diferentes patrones metastasicos en el contexto de la historia natural del melanoma. El objetivo principal del presente estudio es analizar las diferentes vias y patrones metastasicos y el tiempo de evolucion en el desarrollo de metastasis en el melanoma cutaneo. Material y metodos Se realizo un estudio retrospectivo en una serie de 575 pacientes con melanoma primario como primera presentacion entre los anos 1990 y 2004. En el seguimiento, 67 pacientes desarrollaron metastasis. Se establecieron y evaluaron diferentes vias de diseminacion. Tambien se establecieron cuatro rutas de diseminacion dependiendo del patron de diseminacion en la progresion del melanoma. Se evaluo el curso temporal de las metastasis. Por ultimo, se analizaron aquellos melanomas con recurrencia locorregional comparando los melanomas con y sin progresion sistemica. Resultados Las metastasis linfaticas regionales constituyen la primera via de diseminacion de los melanomas (55,2 %). Las metastasis sistemicas aparecieron como primera via metastasica en el 14,9 % de los casos. La localizacion anatomica y el grosor tumoral influyen en las diferentes vias metastasicas. Las metastasis a distancia aparecieron con una media de 25 meses, independientemente de la ruta de diseminacion. Conclusiones La aparicion de metastasis a distancia es un evento con un curso temporal constante. Surgen al mismo tiempo independientemente de la ruta metastasica del melanoma. Esto podria explicar el beneficio limitado de la biopsia del ganglio centinela sobre la supervivencia global de los pacientes con melanoma.

Validación de un cuestionario en español sobre comportamientos, actitudes y conocimientos relacionados con la exposición solar: «Cuestionario a pie de playa»*

Resumen Introduccion Los cuestionarios son el metodo habitual de investigacion de las conductas relacionadas con la exposicion solar. Sin embargo, para que un instrumento sea valido debe acreditar sus propiedades de medicion. El objetivo del presente trabajo fue evaluar la validez y la fiabilidad de un cuestionario en espanol sobre comportamientos, actitudes y conocimientos relacionados con la exposicion solar en la playa. Pacientes y metodo Se realizo un estudio de corte transversal administrandose el cuestionario a una muestra de 422 participantes a pie de playa. Para la prueba del test-retest se encuesto a 70 participantes del medio hospitalario en dos ocasiones diferentes. Se analizaron la validez, la consistencia interna y la reproducibilidad de los items del instrumento. Resultados El analisis factorial de los componentes principales mostro valores de comunalidades y saturaciones factoriales > 0,50, y revelo la presencia de multiples dimensiones que presentaron valores de coeficiente alfa de Cronbach > 0,70. Los items de comportamientos y conocimientos evidenciaron coeficientes de correlacion intraclase y delta > 0,70. Los items del apartado de actitudes mostraron valores moderados de estabilidad (0,50-0,80). Conclusiones Se presenta el primer cuestionario sobre comportamientos, actitudes y conocimientos relacionados con la exposicion solar, elaborado en espanol, con garantias de validez y fiabilidad. Este instrumento constituira una herramienta de utilidad en la investigacion epidemiologica y del ambito de la prevencion primaria del cancer de piel en Espana.

Estudio dermoscópico del melanoma maligno cutáneo: análisis descriptivo de 45 casos

Resumen Introduccion La dermatoscopia o microscopia de epiluminiscencia es una novedosa tecnica de microscopia in vivo util para el diagnostico de las lesiones pigmentadas cutaneas. El objetivo del presente trabajo es analizar los patrones dermoscopicos de una serie consecutiva de melanomas cutaneos primarios. Material y metodos Se trata de un estudio de corte transversal, en el que se analizan las caracteristicas clinicas, histologicas y dermoscopicas de 45 melanomas primarios. Resultados Las dos terceras partes de la serie eran melanomas de espesor fino y el 50% melanomas in situ . Clinicamente, el 72 % de las lesiones eran sospechosas de melanoma (regla ABCD). Dermoscopicamente, el 93% presentaron patrones dermoscopicos especificos. El patron global mas frecuente fue el multicomponente (71 %). El 7% de las lesiones mostraron un patron inespecifico. Los hallazgos locales mas destacables fueron las manchas de pigmento irregulares (80 %), el reticulo pigmentado atipico (57 %), los puntos y globulos irregulares (68 y 62 %), las proyecciones radiales/pseudopodos (20 %) y el velo azul-gris (42 %). Ademas, destaco la presencia de areas hipopigmentadas (86 %), estructuras de regresion (80 %) y vascularizacion atipica (73 %). Las lesiones acras mostraron patrones caracteristicos de estas localizaciones. Conclusion El analisis de patrones dermoscopicos facilita el diagnostico de certeza del melanoma en estadios precoces, y es particularmente util en lesiones poco expresivas clinicamente. La identificacion de hallazgos dermoscopicos ofrece informacion complementaria al estudio histologico convencional.

Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo

INTRODUCTION Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost. OBJECTIVES To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS. MATERIAL AND METHODS Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence. RESULTS Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534). CONCLUSIONS MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Longitudinal Study of Different Metastatic Patterns in the Progression of Cutaneous Melanoma

INTRODUCTION Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. MATERIAL AND METHODS A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. RESULTS Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed CONCLUSIONS The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients.

A Spanish version of the skin cancer index: a questionnaire for measuring quality of life in patients with cervicofacial nonmelanoma skin cancer

The Skin Cancer Index (SCI) is the first specific patient‐reported outcome measure for patients with cervicofacial nonmelanoma skin cancer. To date, only the original English version has been published.

Oral oxybutynin for the treatment of hyperhidrosis: outcomes after one-year follow-up.

Although many treatments are available to address hyperhidrosis, the results are not always satisfactory. The aim of the study was to assess the effectiveness, optimal dosage regimen and long‐term safety of oral oxybutynin in the treatment of hyperhidrosis.

[Cost analysis of Mohs micrographic surgery in high-risk facial basal cell carcinoma].

INTRODUCTION Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost. OBJECTIVES To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS. MATERIAL AND METHODS Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence. RESULTS Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was e106,129.07 and e1325.80, respectively (compared to e97 700 and e1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=0.534). CONCLUSIONS MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Validation of a Spanish Questionnaire to Evaluate Habits, Attitudes, and Understanding of Exposure to Sunlight: "The Beach Questionnaire"*

BACKGROUND Questionnaires are the usual method for investigating sun-related behavior. However,such tools must be validated through evaluation of their measurement properties.The aim of the present study was to assess the validity and reliability of a Spanish questionnaire evaluating habits, attitudes, and understanding of exposure to sunlight. PATIENTS AND METHODS In a cross-sectional study, the questionnaire was administered to a sample of 422 participants found on beaches. For the test-retest analysis, 70 hospital-based health professionals were interviewed on 2 separate occasions.The construct validity, internal consistency, and reproducibility were analyzed. RESULTS Factorial analysis of the principal components confirmed the construct validity with commonalities and factor saturations > 0.50, and revealed multiple dimensions with Cronbach a values > 0.70.The items on habits and understanding showed intraclass correlation and d coefficient values > 0.70, but those on attitude had lower stability values (0.50-0.80). CONCLUSIONS This is the first Spanish questionnaire with demonstrated validity and reliability for evaluating habits, attitudes, and understanding of exposure to sunlight. It will be a useful instrument for future epidemiologic studies and research into the prevention of skin cancer in Spain.

Behaviour, attitudes and awareness concerning sun exposure in adolescents on the Costa del sol

A history of sunburn and cumulative sun exposure during adolescence are the most important risk factors for the development of skin cancer. Skin cancer can be prevented by reducing sun exposure, particularly during adolescence, which is precisely the age group that could best benefit from primary prevention campaigns.ObjectiveTo determine the behaviour, attitudes and understanding of adolescents concerning sun exposure.MethodsThis cross-sectional descriptive study undertaken during 2011 included secondary school adolescents from randomly selected schools on the Costa del Sol, southern Spain. A validated beachside questionnaire was used to record data on demographics, skin colour, phototype, sun exposure habits, sunburns, practices, attitudes and knowledge about the sun.ResultsThe study involved 270 students, aged 14–17 years, from 11 schools; 50.4% were female, 43.7% were aged 14 years, and 85.9% were Spanish. Most had a light skin colour (49.3%) and phototypes III (42.2%) or IV (34.8%). Most (71%) went to the beach on more than 16 days and 74.4% had had sunburn the previous summer. Sun cream was used by 47.8% and 1.1% wore long sleeves or trousers. Concerning attitudes, 60.7% stated they felt better when they were tanned, and concerning understanding, most were aware of the harmful effects of the sun on the skin.ConclusionAdolescents comprise a special risk group with a positive attitude towards tanning. Further studies are required to assess educational stategies in order to reduce the desire to have a suntan, and improve sun protection practices and habits targeted at this age group.