Guía de atención integral con evaluación económica para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma basocelular

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Artículo de investigación
Rev Asoc Colomb Dermatol. 2015; 23: 4 (Octubre-Diciembre), 258-296

Guía de atención integral con evaluación económica para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma basocelular

Comprehensive Guide, with economic assessment, for the prevention, diagnosis, treatment and monitoring of non melanoma skin cancer: basal cell carcinoma.
Autor(es): 
Alvaro Acosta
aeacostam@unal.edu.co
Dermatólogo oncólogo; coordinador, Dermatología Oncológica, Instituto Nacional de Cancerología; profesor titular, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Jhon Nova
Especialista en Dermatología, magíster en Epidemiología Clínica, Centro Dermatológico Federico Lleras Acosta Bogotá, D.C., Colombia.
Guillermo Sánchez
Especialista en Epidemiología General, magíster en Epidemiología Clínica, doctor en Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
Andrea Rodríguez
Especialista en Estadística Aplicada, magíster en Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
Xavier Rueda
Dermatólogo oncólogo, Instituto Nacional de Cancerología Bogotá, D.C., Colombia.
Martha Valbuena
Especialista en Dermatología y Fotodermatología, Centro Dermatológico Federico Lleras Acosta, Bogotá, D.C., Colombia.
Magda Cepeda
Magíster en Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
Ana Francisca Ramirez
Especialista en Dermatología y Dermatología Oncológica, Asociación Colombiana de Dermatología y Cirugía Dermatológica, Bogotá, D.C., Colombia.
Guillermo Jimenez
Especialista en Dermatología, Dermatología Oncológica y Cirugía Dermatológica, Asociación Colombiana de Dermatología y Cirugía Dermatológica, Bogotá, D.C., Colombia.
Hugo Herrera
Especialista en Dermatología, Asociación Colombiana de Dermatología y Cirugía Dermatológica y Universidad El Bosque Bogotá, D.C., Colombia.
Ingrid Arévalo
Magíster en Epidemiología Clínica y PhD (c) en Medicina Preventiva y Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
Omar Segura
Magíster en Epidemiología Clínica, Epidemiólogo de Campo, PhD (c) en Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
Resumen: 

Objetivo: Generar recomendaciones para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma basocelular, con el fin de apoyar al personal de salud en los diferentes servicios encargados de la atención, buscando garantizar una atención integral, homogénea, con calidad, equidad y eficiencia, para los pacientes con esta enfermedad; además, generar indicadores de seguimiento a las recomendaciones de la guía, acordes con el contexto nacional. Materiales y métodos: Se conformó el Grupo Desarrollador de la Guía con un grupo interdisciplinario de profesionales y representantes de pacientes. Se establecieron el alcance, los objetivos, las preguntas y los resultados de la guía. Se hizo una búsqueda de guías sobre manejo del carcinoma basocelular, pero ninguna de las encontradas podía adaptarse, por lo que se decidió elaborar una nueva guía. Se hizo una búsqueda bibliográfica de revisiones sistemáticas o metaanálisis, ensayos clínicos, estudios de cohorte y estudios de casos y controles, en las bases de datos Medline (vía Pubmed y Ovid), Embase y Central (vía Ovid). Se evaluó la calidad metodológica de los artículos seleccionados. Posteriormente, se elaboraron las tablas de evidencia por medio del software GRADEpro® 3.6 y se generaron las recomendaciones bajo la metodología GRADE por medio de consensos de expertos. Resultados: Se presentan las recomendaciones de prevención primaria y secundaria, tratamiento (quirúrgico y no quirúrgico) y seguimiento del carcinoma basocelular. Además, se presentan varias preguntas generales que sirven al lector para contextualizarse en el tema de la guía de práctica clínica, pero que no generan recomendaciones. Conclusiones: Se considera que las recomendaciones relacionadas con prevención son prioritarias en el proceso de implementación de la guía. Se presentan cuatro indicadores de auditoría para la guía de práctica clínica relacionados con prevención, diagnóstico y tratamiento.

Palabras clave: 
guía de práctica clínica, neoplasias cutáneas, carcinoma basocelular.

Summary: 

Objective: To generate recommendations for the prevention, diagnosis, treatment and follow-up for the non-melanoma skin cancer basal cell carcinoma, with the aim of providing support for the health professionals in the different services in charge of its attention, looking to guarantee integral, homogeneous attention, with quality, equity and efficiency for the patients with this pathology; as well as generating follow-up indicators to the guide’s recommendation in accordance with the national context. Materials and methods: The Guide Development Group was formed by an interdisciplinary group of professionals and patient representatives. Reach, objectives, questions, and outcomes for the guide were defined. A guide search about handling basal cell carcinoma was performed, but none of the guides found was found to be adaptable, therefore writing a guide de novo was decided. A literature search was performed, including systematic reviews-meta-analyses, clinical trials, cohort studies, and case-control studies in the Medline (via Pubmed and Ovid), Embase and Central (via Ovid) databases. The methodological quality of the selected articles was evaluated. Subsequently, evidence tables were made through the GRADEpro® 3.6 software and recommendations were generated under the GRADE technology through experts’ consensus. Results: Primary prevention, secondary prevention, treatment (surgical and non-surgical) as well as basal cell carcinoma follow-up recommendations are presented. Additionally, several general questions are presented which serve the reader to be contextualized in the subject of clinical practice guides, but which do not generate recommendations. Conclusions: It is considered that the recommendations relating to prevention are a priority in the guide’s implementation process. Four auditing indicators for the clinical practice guide are presented relating to prevention, diagnosis, and treatment.

Key words: 
Clinical practice guide, skin neoplasia, basal cell carcinoma.
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