The patient journey : a report of skin cancer care across Europe

Summary - Background: There are poorly documented variations in the journey a skin cancer patient will follow from diagnosis to treatment in the European Union. Objectives: To investigate the possible difficulties or obstacles that a person with a skin malignancy in the European Union may have to overcome in order to receive adequate medical screening and care for his/her condition. In addition, we wished to explore differences in European health systems, which may lead to health inequalities and health inequities within Europe. Methods: Ten European countries took part in this investigation (in alphabetical order): Finland, Germany, Greece, Italy, Malta, Poland, Romania, Spain, the Netherlands and the U.K. The individual participants undertook local and national enquiries within their own country and completed a questionnaire. Results This exercise has identified important differences in the management of a skin cancer patient, reflecting major disparities in health care between European countries. Conclusions: Further investigation of health disparities and efforts to address health inequalities should lead to improvements in European health care quality and reduction in morbidity from skin cancer.This publication arises from the EPIDERM project, which was funded by the European Commission’s Executive Agency for Health and Consumers (EPIDERM project: PHEA 2007- A ⁄100994 HI). Funding for publication of this supplement was provided by the European Skin Cancer Foundation (ESCF).peer-reviewe

Surgery

The chapter introduces dermatologists to dermatologic surgery. The basic concepts, stitches, and techniques are explained; this allows a correct approach to the milestone of the dermatologic surgeon: the fusiform excision. The proper planning and orientation is done considering the concept of relaxed skin tension lines and cosmetic units. There are several variations of the classic ellipse such as crescentic ellipse, S-plasty, M-plasty, relaxing incision, serial excision, and wedge excision repair. The prevention of surgical complications depends on correct preoperative evaluation, proper surgical technique, postoperative care, and follow-up care. If primary approximation is not possible, flaps, grafts, and secondary healing have to be considered.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Cryotherapy

Cryotherapy, or better said, cryosurgery is the destruction of tissue using subzero temperatures. It stands as one of the most commonly used surgical techniques among dermatologists and family physicians, as it is relatively simple to perform, versatile, and inexpensive when compared to other surgical alternatives.1 It is a surgical option for treating benign nonmelanocytic skin lesions such as lentigo solaris, ephelides, and seborrheic keratosis (SK), and premalignant and malignant nonmelanocytic skin lesions such as pigmented actinic keratosis and pigmented basal cell carcinomas (BCCs).SCOPUS: ch.binfo:eu-repo/semantics/publishe

Skin biopsies in DC vaccines for stage III-IV melanoma patients: role of neutrophils ?

Dendritic cell (DC) vaccines are used for the induction of anti-tumor T cell reaction in melanoma patients. DC are generated in vitro, pulsed with antigen and matured prior to injection. They are supposed to migrate to lymph nodes and to present the processed antigen to naive T cells allowing activation of tumor-specific lymphocytes. It has been suggested that intradermal injection allows a superior migration to the lymph node. Eight HLA-A2 positive patients with stage III or IV melanomas expressing NA 17 antigen were collected. They were included in a pilot trial of vaccination in which they received IL3/INFb DC presenting the NA17 A2 antigen. In each patient, a skin biopsy was performed at the injection site, 24 h after inoculation. The striking features of the biopsies were the presence of a perivascular CD3+/CD8+ T cell infiltrate with a slight population of CD4+ cells and the presence of a massive neutrophilic infiltrate associated with the injected DC still present, realizing a suppurative granuloma. The persistence of DC 24 h after the injection suggests that migration in the lymph node is not necessary for the induction of the immune response. The skin itself could be the location of a reaction starting with a massive recruitment of neutrophils. © 2007 Springer-Verlag.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Chemical peels

Hyperpigmentation is one of the most common cosmetic causes for consultation in dermatology for all skin types but especially for those with dark skin or mixture of ethnicities. It is the result of an increase in cutaneous melanin deposition either by increased melanin synthesis or, less commonly, by a greater number of melanocytes.1 Whether the melanin is deposited in the epidermis or dermis is important therapeutically because dermal hyperpigmentation is much more challenging to treat.SCOPUS: ch.binfo:eu-repo/semantics/publishe

The programme of Community action in the field of health (2007-2013)

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Skin cancer prevention

Core Messages: Primary prevention Skin Cancer is one of the most preventable cancers and there is strong evidence that UV radiation is the main environmental factor. The best interventional target for primary prevention is children. Adequate photoprotection may be achieved by wearing protective clothes and by using a broad-spectrum sunscreen. Actinic keratosis and squamous cell carcinoma have shown a direct protective effect on sunscreen use in human beings. More time will be needed to prove the efficiency of the preventive effect on melanoma and basal cell carcinoma. Sunbeds use is a major concern since it has been confirmed a positive association between melanoma and sunbed use. Secondary prevention Skin cancers are perfect targets for secondary prevention since it is visible on the skin's surface and can be detected at an early, curable stage. Early detection can be enhanced by different educational procedures. Early detection requires skin inspection which can be done by dermatologists, primary care physicians, nurses, patients and their family. The self skin examination's effectiveness in reducing mortality has been demonstrated. High-risk groups for developing melanoma are middle-aged or older men, family members of melanoma patients, lower socio-economic strata of the population, many moles/atypical moles, fair skin and blue/green eyes or blond-red hair. High-risk groups for NMSC are fair skin, longstanding sun exposure, advanced age and immunosuppression. © 2010 Springer-Verlag Berlin Heidelberg.SCOPUS: ch.binfo:eu-repo/semantics/publishe

The effect of Q-Switched Nd:YAG 1064 nm/532 nm laser in the treatment of onychomycosis in vivo

In this prospective clinical study, the Q-Switched Nd:YAG 1064 nm/532 nm laser (Light Age, Inc. Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14 J/cm2 were applied at 9 billionths of a second pulse duration and at 5 Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed "self-evaluation questionnaires" rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064 nm/532 nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time. © 2013 Kostas Kalokasidis et al.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Prise en charge des cancers cutanés non-mélanome par le médecin généraliste

The incidence of skin cancer cases has increased significantly during the last decades. Non melanoma skin cancer (NMSC) is the most common cancer in Caucasian populations. This term refers to 2 major types of skin cancer :basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mortality from BCC and SCC is low but there may be substantial morbidity from disfigurement as these lesions tend to be located on the skin of the head and neck. Actinic keratosis is a premalignant condition that may evolve into SCC. Fortunately, skin cancer is amenable to early detection and potential cure. General practitioners may play a very important role in the timely diagnosis and management of these tumors. They are on the front line to detect NMSC :opportune examination coupled with good observation skills allow a high detection rate of suspicious lesions. It is essential to identify the high-risk patient as well as the clinical signs of suspicious lesions. This article outlines the clinical features of common NMSC and highlights which lesions should be best referred to a dermatologist.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Epidemiology of nonmelanoma skin cancer (NMSC) in Europe: Accurate and comparable data are needed for effective public health monitoring and interventions

SCOPUS: re.jFLWINinfo:eu-repo/semantics/publishe