The evolving field of Dermato-oncology and the role of dermatologists: Position Paper of the EADO, EADV and Task Forces, EDF, IDS, EBDV-UEMS and EORTC Cutaneous Lymphoma Task Force.

BACKGROUND The incidence of skin cancers has been increasing steadily over the last decades. Although there have been significant breakthroughs in the management of skin cancers with the introduction of novel diagnostic tools and innovative therapies, skin cancer mortality, morbidity and costs heavily burden the society. OBJECTIVE Members of the European Association of Dermato-Oncology, European Academy of Dermatology and Venereology, International Dermoscopy Society, European Dermatology Forum, European Board of Dermatovenereology of the European Union of Medical Specialists and EORTC Cutaneous Lymphoma Task Force have joined this effort to emphasize the fundamental role that the specialist in Dermatology-Venereology has in the diagnosis and management of different types of skin cancer. We review the role of dermatologists in the prevention, diagnosis, treatment and follow-up of patients with melanoma, non-melanoma skin cancers and cutaneous lymphomas, and discuss approaches to optimize their involvement in effectively addressing the current needs and priorities of dermato-oncology. DISCUSSION Dermatologists play a crucial role in virtually all aspects of skin cancer management including the implementation of primary and secondary prevention, the formation of standardized pathways of care for patients, the establishment of specialized skin cancer treatment centres, the coordination of an efficient multidisciplinary team and the setting up of specific follow-up plans for patients. CONCLUSION Skin cancers represent an important health issue for modern societies. The role of dermatologists is central to improving patient care and outcomes. In view of the emerging diagnostic methods and treatments for early and advanced skin cancer, and considering the increasingly diverse skills, knowledge and expertise needed for managing this heterogeneous group of diseases, dermato-oncology should be considered as a specific subspecialty of Dermatology-Venereology

Increased Prevalence of Metabolic Syndrome in Patients with Acne Inversa

BACKGROUND: Acne inversa (AI; also designated as Hidradenitis suppurativa) is a common chronic inflammatory skin disease, localized in the axillary, inguinal and perianal skin areas that causes painful, fistulating sinuses with malodorous purulence and scars. Several chronic inflammatory diseases are associated with the metabolic syndrome and its consequences including arteriosclerosis, coronary heart disease, myocardial infraction, and stroke. So far, the association of AI with systemic metabolic alterations is largely unexplored. METHODS AND FINDINGS: A hospital-based case-control study in 80 AI patients and 100 age- and sex-matched control participants was carried out. The prevalence of central obesity (odds ratio 5.88), hypertriglyceridemia (odds ratio 2.24), hypo-HDL-cholesterolemia (odds ratio 4.56), and hyperglycemia (odds ratio 4.09) in AI patients was significantly higher than in controls. Furthermore, the metabolic syndrome, previously defined as the presence of at least three of the five alterations listed above, was more common in those patients compared to controls (40.0% versus 13.0%; odds ratio 4.46, 95% confidence interval 2.02 to 9.96; P<0.001). AI patients with metabolic syndrome also had more pronounced metabolic alterations than controls with metabolic syndrome. Interestingly, there was no correlation between the severity or duration of the disease and the levels of respective parameters or the number of criteria defining the metabolic syndrome. Rather, the metabolic syndrome was observed in a disproportionately high percentage of young AI patients. CONCLUSIONS: This study shows for the first time that AI patients have a high prevalence of the metabolic syndrome and all of its criteria. It further suggests that the inflammation present in AI patients does not have a major impact on the development of metabolic alterations. Instead, evidence is given for a role of metabolic alterations in the development of AI. We recommend monitoring of AI patients in order to correct their modifiable cardiovascular risk factors

Klinische Ergebnisse zur Anwendung eines Hämoglobin-Sprays zur Förderung der Heilung chronischer Wunden

A new technological approach for supplying hypoxic chronic wounds with oxygen is a moist wound treatment with aqueous solutions containing tissue compatible oxygen binders. This facilitates diffusion of oxygen, necessary for the healing process, from the surroundings (room air through an open-porous wound padding) into the ulcerous tissue. A product that is still in development is a spray which contains hemoglobin obtained from domestic pigs. Clinical investigations (a clinical trial, treatment observations and single patient uses) are presented, which were performed to create clinical data regarding efficiency and safety of this product. All data have shown that the application of the hemoglobin spray promoted wound healing in all analyzed cases.Data from a clinical study in Mexico and subsequent therapy observations revealed that in 39 out of 42 patients (93%) the treated wounds were healed. 9 patients from a series of therapy observations in Monterrey (Mexico) showed similar observations. All treated wounds were closed. Single patient uses carried out in Witten (Germany; 6 wounds from 8 (75%)) and Prague (Czech Republic; 5 wounds from 5 (100%) were healed) further support these results: The application of hemoglobin spray can promote healing of chronic wounds. Within the framework of the clinical investigation, the treatment observations, and the individual healing experiments the hemoglobin spray was applied more than 2,000 times onto chronic wounds of 82 patients. In all cases, the spray was well tolerated and there were no adverse event that might have been an adverse reaction to the hemoglobin spray.Ein neuer technologischer Ansatz zur Versorgung hypoxischer chronischer Wunden mit dem zur Heilung benötigten Sauerstoff ist eine feuchte Wundbehandlung mit wässrigen Lösungen, in denen gut gewebeverträgliche Sauerstoff-Binder eine erleichterte Diffusion von Sauerstoff aus der Umgebung (Raumluft aus einer offenporigen Wundauflage) zum Ulcus-Gewebe ermöglichen. Ein Produkt in Entwicklung enthält als Sauerstoff-Binder Hämoglobin vom Hausschwein (Hämoglobin-Spray).Klinische Untersuchungen (eine klinische Studie, Therapiebeobachtungen und individuelle Heilversuche) werden präsentiert, aus denen sich klinische Daten zur Wirksamkeit und Unbedenklichkeit ergeben.Alle durchgeführten Anwendungen des Hämoglobin-Spray ergaben, dass die Wundheilung gefördert wurde. In einer klinischen Studie und einer unmittelbar nachfolgenden Serie von Therapiebeobachtungen konnten bei 39 von 42 Patienten (93%) die behandelten Wunden komplett geheilt werden. In gleicher Weise wurden die Wunden von 9 Patienten einer weiteren Serie von Therapiebeobachtungen in Monterrey (Mexiko) bis zur Abheilung behandelt. Individuelle Heilversuche in Witten (Deutschland; 6 von 8 Wunden (75%) abgeheilt) und in Prag (Tschechische Republik; 5 von 5 Wunden (100%) geheilt) bestätigen diese Ergebnisse: Anwendungen des Hämoglobin-Sprays können die Heilung chronischer Wunden fördern.Dabei wurden die Anwendungen des Hämoglobin-Spray ausnahmslos gut vertragen, sämtliche beobachteten unerwünschten Ereignisse während der Anwendungen hatten andere Ursachen. Im Rahmen der klinischen Studie, der Therapiebeobachtungen und der individuellen Heilversuche wurde das Hämoglobin-Spray über 2.000-mal in den chronischen Wunden von 82 Patienten angewendet. Es wurde durchgehend gut vertragen, und es gab keine unerwünschten Ereignisse, die verdächtig waren, möglicherweise unerwünschte Reaktionen auf das Hämoglobin-Spray zu sein