{"id":382265,"global_id":"medizinonline.com\/es\/?id=382265","global_id_lineage":["medizinonline.com\/es\/?id=382265"],"author":"17458","status":"publish","date":"2023-11-08 20:31:38","date_utc":"2023-11-08 19:31:38","modified":"2023-11-08 20:31:38","modified_utc":"2023-11-08 19:31:38","url":"https:\/\/medizinonline.com\/es\/event\/nationaler-palliative-care-kongress-2023\/","rest_url":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/events\/382265","title":"Nationaler Palliative Care Kongress 2023","description":"","excerpt":"","slug":"nationaler-palliative-care-kongress-2023","image":false,"all_day":true,"start_date":"2024-11-22 00:00:00","start_date_details":{"year":"2024","month":"11","day":"22","hour":"00","minutes":"00","seconds":"00"},"end_date":"2024-11-23 23:59:59","end_date_details":{"year":"2024","month":"11","day":"23","hour":"23","minutes":"59","seconds":"59"},"utc_start_date":"2024-11-21 23:00:00","utc_start_date_details":{"year":"2024","month":"11","day":"21","hour":"23","minutes":"00","seconds":"00"},"utc_end_date":"2024-11-23 22:59:59","utc_end_date_details":{"year":"2024","month":"11","day":"23","hour":"22","minutes":"59","seconds":"59"},"timezone":"Europe\/Zurich","timezone_abbr":"CET","cost":"","cost_details":{"currency_symbol":"","currency_code":"","currency_position":"prefix","values":[]},"website":"https:\/\/www.palliative-kongresse.ch\/2023\/de","show_map":true,"show_map_link":true,"hide_from_listings":false,"sticky":true,"featured":false,"categories":[{"name":"General practice","slug":"general-practice","term_group":0,"term_taxonomy_id":90,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":748,"filter":"raw","id":90,"urls":{"self":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories\/90","collection":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Oncology","slug":"oncology","term_group":0,"term_taxonomy_id":108,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":166,"filter":"raw","id":108,"urls":{"self":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories\/108","collection":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Pain","slug":"pain","term_group":0,"term_taxonomy_id":118,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":162,"filter":"raw","id":118,"urls":{"self":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories\/118","collection":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Palliativ","slug":"palliativ","term_group":0,"term_taxonomy_id":77251,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":45,"filter":"raw","id":77251,"urls":{"self":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories\/77251","collection":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Pharmacology","slug":"pharmacology","term_group":0,"term_taxonomy_id":110,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":614,"filter":"raw","id":110,"urls":{"self":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories\/110","collection":"https:\/\/medizinonline.com\/es\/wp-json\/tribe\/events\/v1\/categories"}}],"tags":[],"venue":{"id":34322,"author":"16797","status":"inherit","date":"2013-09-19 00:00:00","date_utc":"2013-09-18 22:00:00","modified":"2013-09-19 00:00:00","modified_utc":"2013-09-18 22:00:00","url":"https:\/\/medizinonline.com\/es\/attachment-x2-png-49564f_663-2\/","venue":"x2.png-49564f_663","slug":"attachment-x2-png-49564f_663-2","show_map":true,"show_map_link":true,"global_id":"medizinonline.com\/es\/?id=34322","global_id_lineage":["medizinonline.com\/es\/?id=34322"]},"organizer":[{"id":347377,"author":"4","status":"publish","date":"2013-09-18 00:00:00","date_utc":"2013-09-17 22:00:00","modified":"2013-09-18 00:00:00","modified_utc":"2013-09-17 22:00:00","url":"https:\/\/medizinonline.com\/es\/entre-el-15-y-el-20-de-las-lesiones-pueden-evolucionar-a-carcinoma\/","organizer":"“Entre el 15% y el 20% de las lesiones pueden evolucionar a carcinoma”.","description":"

El Prof. Dr. med. Stephan Lautenschlager, jefe de dermatolog\u00eda del Stadtspital Triemli, informa en una entrevista sobre la epidemiolog\u00eda, los m\u00e9todos de diagn\u00f3stico y la terapia de la queratosis act\u00ednica. Adem\u00e1s, entra en m\u00e1s detalles sobre lo peligrosa que es esta enfermedad y cu\u00e1l es el riesgo de convertirse en un espinalioma maligno.<\/strong><\/p>\n

<\/p>\n

Prof. Lautenschlager, la queratosis act\u00ednica a\u00fan no se considera un c\u00e1ncer de piel, \u00bfhasta qu\u00e9 punto es peligrosa la enfermedad?<\/strong><\/p>\n


\n Prof. Lautenschlager:<\/strong>
\n<\/em> Hoy en d\u00eda se asume que las queratosis act\u00ednicas forman parte de un continuo de enfermedades iniciadas por la exposici\u00f3n a los rayos UV. La causa principal es el da\u00f1o inducido por la luz UV, seguido de la formaci\u00f3n de queratosis act\u00ednicas, que a su vez pueden convertirse en carcinoma de c\u00e9lulas escamosas. Debido a los cambios citol\u00f3gicos que se limitan al epitelio, las queratosis act\u00ednicas se clasifican como carcinomas in situ seg\u00fan la doctrina actual. <\/p>\n

\u00bfCu\u00e1l es la prevalencia de la queratosis act\u00ednica y qu\u00e9 grupos de poblaci\u00f3n se ven m\u00e1s afectados?<\/strong><\/p>\n

Es bien sabido que los individuos de tez clara tienden a desarrollar queratosis act\u00ednicas en zonas con alta exposici\u00f3n a los rayos UV. Por ejemplo, se encuentran en cerca del 50% de los adultos en Australia, y en cerca del 10-25% en nuestras latitudes. Parece que la prevalencia es a\u00fan mayor en las personas mayores de 70 a\u00f1os. En el pasado, los hombres se ve\u00edan afectados con m\u00e1s frecuencia que las mujeres como resultado de la exposici\u00f3n ocupacional. Sin embargo, esta proporci\u00f3n se ha igualado en los \u00faltimos 10-20 a\u00f1os debido al aumento de la exposici\u00f3n recreativa a los rayos UV.<\/p>\n

\u00bfCu\u00e1l es el riesgo de desarrollar un carcinoma maligno (espinoma) si ya tiene queratosis act\u00ednica? Las cifras de la investigaci\u00f3n parecen variar mucho aqu\u00ed….<\/strong><\/p>\n

Las queratosis act\u00ednicas pueden permanecer estables durante a\u00f1os, desaparecer espont\u00e1neamente o convertirse en carcinomas espinocelulares. Por desgracia, no se puede predecir ni el momento de la transformaci\u00f3n en carcinoma invasivo ni las formas propensas a ello. Se supone que en un plazo de diez a\u00f1os, entre el 15 y el 20% de las lesiones se convierten en carcinoma.<\/p>\n

\u00bfQu\u00e9 m\u00e9todos deben utilizar los m\u00e9dicos para diagnosticar la queratosis act\u00ednica?<\/strong><\/p>\n

B\u00e1sicamente, el diagn\u00f3stico debe hacerse cl\u00ednicamente, pudiendo existir distintas formas, que luego tambi\u00e9n se presentan histol\u00f3gicamente de distintas maneras, por ejemplo, queratosis hipertr\u00f3ficas liquenoides, bowenoides, pigmentadas y atr\u00f3ficas hasta similares al cornu cutaneum. Especialmente en el caso de queratosis engrosadas – llamadas infiltradas -, la biopsia debe excluir que se haya producido una invasi\u00f3n y, por tanto, un carcinoma espinocelular. En manos de expertos, puede ser \u00fatil una evaluaci\u00f3n adicional con el microscopio de luz reflejada.<\/p>\n

\u00bfEs posible una distinci\u00f3n diagn\u00f3stica clara entre la queratosis act\u00ednica y el espinalioma?<\/strong><\/p>\n

S\u00f3lo un engrosamiento indica un posible carcinoma espinocelular.
\nPor ello, en caso de duda, debe realizarse siempre una evaluaci\u00f3n histol\u00f3gica. Adem\u00e1s, debe tenerse en cuenta que histol\u00f3gicamente en la epidermis una queratosis act\u00ednica no puede distinguirse de un carcinoma espinocelular, por lo que tambi\u00e9n debe biopsiarse a suficiente profundidad.<\/p>\n

\u00bfA qu\u00e9 otras enfermedades debe prestarse especial atenci\u00f3n en el diagn\u00f3stico diferencial?<\/strong><\/p>\n

Si, en raras ocasiones, hay que diferenciar un solo cambio, se distinguir\u00e1n las queratosis seborreicas planas ligeramente pigmentadas o, como mucho, los cambios inducidos por virus, el carcinoma basocelular superficial o la enfermedad de Bowen. Con menor frecuencia, deben diferenciarse los cambios puramente inflamatorios, como el lupus eritematoso discoide.<\/p>\n

Existe la posibilidad de una regresi\u00f3n espont\u00e1nea. \u00bfHay que recomendar medidas terap\u00e9uticas?<\/strong><\/p>\n

Por un lado, suele haber m\u00faltiples queratosis act\u00ednicas, que indican una denominada carcinizaci\u00f3n de campo. Esto multiplica el riesgo de transformaci\u00f3n en un carcinoma espinocelular. Por otro lado, las lesiones progresivas no pueden distinguirse de las regresivas, por lo que existe consenso entre los expertos para tratar las queratosis act\u00ednicas. Sin embargo, a\u00fan no hay consenso sobre qu\u00e9 medida terap\u00e9utica lograr\u00e1 el mejor resultado en cada situaci\u00f3n.<\/p>\n

\u00bfCu\u00e1les son las opciones de tratamiento farmacol\u00f3gico? \u00bfCu\u00e1l le parece m\u00e1s eficaz?<\/strong><\/p>\n

Existen numerosas opciones de tratamiento. La decisi\u00f3n debe tomarse en funci\u00f3n del n\u00famero, la localizaci\u00f3n, el tipo de piel y otras caracter\u00edsticas individuales del paciente. Adem\u00e1s de la situaci\u00f3n vital, tambi\u00e9n deben tenerse en cuenta las comorbilidades, el cumplimiento y las preferencias del paciente. Por \u00faltimo, pero no por ello menos importante, la experiencia y la familiaridad de los m\u00e9dicos tratantes tambi\u00e9n desempe\u00f1an un papel decisivo.
\nUn tratamiento com\u00fan y eficaz para las formas m\u00e1s aisladas es la crioterapia. Si el objetivo es tratar la carcinizaci\u00f3n de campo, para tratar los cambios incipientes que a\u00fan no son visibles, se debe dar preferencia a la terapia fotodin\u00e1mica y al tratamiento local con imiquimod, fluorouracilo t\u00f3pico o, en las fases iniciales, diclofenaco como m\u00e1ximo. Recientemente se ha aprobado en Suiza una nueva y prometedora terapia t\u00f3pica con gel de mebutato de ingenol. Dado que la terapia s\u00f3lo es necesaria durante un breve periodo de tiempo, cabe suponer que el cumplimiento por parte del paciente mejora significativamente. Para los casos extensos, especialmente cuando todo el cuero cabelludo est\u00e1 afectado en pacientes de edad avanzada, debe considerarse tambi\u00e9n la posibilidad de un tratamiento con rayos X, que suele conducir a un largo periodo de remisi\u00f3n, pero que suele requerir seis ciclos de tratamiento.<\/p>\n

\u00bfQu\u00e9 consejos deben dar los m\u00e9dicos a sus pacientes en caso de queratosis act\u00ednica?<\/strong><\/p>\n

Adem\u00e1s de la educaci\u00f3n sobre los signos de advertencia de una transformaci\u00f3n incipiente en carcinoma espinocelular, los pacientes deben recibir instrucciones precisas sobre las medidas de protecci\u00f3n solar. Adem\u00e1s de la protecci\u00f3n solar textil, es prioritaria la aplicaci\u00f3n regular de cremas solares con un factor de protecci\u00f3n solar de alto a muy alto. Por supuesto, tambi\u00e9n deben evitarse los solariums.<\/p>\n

Entrevista: Andreas Grossmann<\/strong><\/em><\/p>","slug":"entre-el-15-y-el-20-de-las-lesiones-pueden-evolucionar-a-carcinoma","image":{"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631.jpg","id":33991,"extension":"jpg","width":767,"height":294,"filesize":84660,"sizes":{"thumbnail":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"cnvs-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"cnvs-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"pk-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"pk-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"csco-120":{"width":120,"height":46,"mime-type":"image\/jpeg","filesize":1915,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x46.jpg"},"csco-120-landscape":{"width":120,"height":90,"mime-type":"image\/jpeg","filesize":2611,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x90.jpg"},"csco-120-portrait":{"width":120,"height":160,"mime-type":"image\/jpeg","filesize":3163,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x160.jpg"},"csco-120-square":{"width":120,"height":120,"mime-type":"image\/jpeg","filesize":2809,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x120.jpg"},"csco-90":{"width":90,"height":34,"mime-type":"image\/jpeg","filesize":1567,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x34.jpg"},"csco-90-landscape":{"width":90,"height":68,"mime-type":"image\/jpeg","filesize":2008,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x68.jpg"},"csco-90-portrait":{"width":90,"height":120,"mime-type":"image\/jpeg","filesize":2372,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x120.jpg"},"csco-90-square":{"width":90,"height":90,"mime-type":"image\/jpeg","filesize":2190,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x90.jpg"},"csco-320":{"width":320,"height":123,"mime-type":"image\/jpeg","filesize":6207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x123.jpg"},"csco-320-landscape":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"csco-320-portrait":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-320-square":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-560":{"width":560,"height":215,"mime-type":"image\/jpeg","filesize":12835,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x215.jpg"},"csco-560-landscape":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-portrait":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-square":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"cnvs-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"cnvs-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"pk-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"pk-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"csco-120-2x":{"width":240,"height":92,"mime-type":"image\/jpeg","filesize":4201,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x92.jpg"},"csco-120-landscape-2x":{"width":240,"height":180,"mime-type":"image\/jpeg","filesize":5818,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x180.jpg"},"csco-120-portrait-2x":{"width":240,"height":294,"mime-type":"image\/jpeg","filesize":7176,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x29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