THERAPEUTISCHE UMSCHAU最新文献

Introduction:

Introduction: The number of cancer survivors - people who have overcome cancer or are living with the disease - is steadily increasing thanks to improved diagnostics and treatment. Studies indicate that many cancer survivors show good functional and quality of life scores in the long term, but comparisons with reference data show that cancer survivors still experience significant physical, psychological, and social impairments compared to the general population, even years after treatment. Cancer survivorship care focuses on developing care services for this issue, which has not been sufficiently addressed to date. Integrative oncology can offer a substantial contribution in the improvement the situation, particularly in light of the combination of evidence-based complementary therapies with conventional treatments, with the goal of enhancing well-being and quality of life, as well as active self-management (including nutrition and exercise in secondary prevention). Common problems experienced by cancer survivors, such as cancer-related fatigue, sleep disorders associated with cancer, and chemotherapy-induced polyneuropathy, can be reduced and the quality of life (QoL) of cancer survivors improved by integrating IO therapy concepts. Interventions from all core disciplines of IO can be used in many areas of survivorship care in a complementary, collaborative, and transparent manner alongside conventional medical treatments.

Introduction: Integrative oncology (IO) combines conventional cancer medicine with evidence-based complementary procedures, thereby placing special demands on the concept of evidence, research methodology, and the evaluation of care quality. This article highlights key theoretical, methodological, and practical principles. The classic concept of evidence is examined in detail through the three pillars of evidence-based medicine. Complementary research designs such as mixed methods, pragmatic studies, whole-systems approaches, and preference-based designs, are discussed as they offer new perspectives for generating valid and patient-centered evidence. In addition, regulation and practice-oriented quality criteria are presented as well as the current consensus process within the newly founded "Swiss Network for Integrative Oncology" (SNIO), which defines common standards, training structures, and research strategies. These efforts lay the foundation for the ongoing development of the field - toward an IO that is safe, effective, and truly patient-centered.

Introduction: Oral lichen planus (OLP) is a chronic inflammatory, T cell-mediated autoimmune disease of the oral mucosa that primarily affects middle-aged women. A typical clinical feature is a network of white lines (Wickham's striae) on the buccal mucosa. In addition to asymptomatic forms, painful erosive-atrophic variants also occur, which require treatment. Diagnosis is usually clinical, but a biopsy may be needed if the presentation is atypical. In terms of differential diagnosis, drug reactions and contact hypersensitivities must be considered. The exact pathogenesis remains unclear, though immunologic, genetic, and viral factors (especially hepatitis C) are discussed. Topical corticosteroids are the first-line treatment. In therapy-resistant cases, options include tacrolimus, methotrexate (MTX), apremilast, or systemic corticosteroids. Maintaining good oral hygiene, eliminating potential triggers (e. g., amalgam), and tailoring therapy to individual symptoms are essential components of effective management. Due to the risk of malignant transformation to squamous cell carcinoma, regular follow-up is essential.

Introduction: For a long time, advanced melanoma was a difficult-to-treat disease with no effective survival strategies. With the development of checkpoint inhibitors and kinase inhibitors in the 21st century, treatment options have improved considerably. Recent studies indicate that adjuvant therapy with anti-PD1-antibodies significantly improves the recurrence-free survival in stage IIB/C patients without lymph node involvement. However, the challenge is to identify the right patients for long-term treatment, as many could be cured by surgery alone. Neoadjuvant therapy, in which systemic treatment is administered before the surgical removal of the macroscopic lymph node metastases, has proven to be promising. Neoadjuvant approaches, particularly with anti-PD1-antibodies, can significantly reduce the recurrence rate. Additionally, histological analysis of tumor tissue after neoadjuvant therapy could help identify patients who do not require further adjuvant treatment, thereby reducing side effects and costs. However, the implementation of neoadjuvant therapy in clinical practice faces challenges, such as the lack of approval in Switzerland and the need for specialized histopathological assessments. Future research efforts should focus on developing criteria for patient selection and validating the role of histopathological examinations in prognosis. A de-escalation of therapeutic approaches could lead to more patient-centered, resource-efficient medicine.

Introduction:

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus, eczema, and impaired skin barrier. In recent years we have seen significant advances in the treatment of AD, with the introduction of new topical and systemic therapies. In addition to basic therapy and classic topical steroids and calcineurin inhibitors other topical substances and for severe forms systemic biologics and Janus kinase inhibitors are now available. Therapy selection is individualized, level-based considering disease severity, and regarding comorbidities and patient preferences. This article provides an up-to-date overview of evidence-based therapeutic options, discusses their efficacy and safety, and offers an outlook on future developments.

Introduction: The classic Spitz nevus is a benign, biologically stable melanocytic lesion in children and should not be equated with melanoma or its precursors. In contrast, Spitz tumors as a group represent a heterogeneous spectrum of melanocytic neoplasms, ranging from benign nevi to intermediate lesions with uncertain biological behavior and, rarely, malignant Spitz melanomas. Accurate classification relies on an integrative assessment of clinical, histological, and immunohistochemical features, complemented by molecular analyses in selected cases. Age-related risk stratification, growth behavior, architectural symmetry, and markers of maturation and proliferation are key determinants. The primary objective is not semantic categorization but rather a precise estimation of biological potential. This diagnostic approach helps to avoid overtreatment of stable lesions while enabling early detection of rare progressive cases. A structured, age-appropriate, and interdisciplinary diagnostic strategy is essential for informed and responsible clinical decision-making.

Introduction: Cutaneous T-cell lymphomas (CTCL) are rare skin-predominant lymphomas, with Mycosis fungoides being the most common subtype. In Europe, the incidence is about 0.3 per 100 000 patient years. The majority of patients are suffering from limited disease with a 5-year survival of 90 %. Clinically, skin lesions can mimic eczema or psoriasis, leading to delayed diagnosis. CTCL diagnosis requires a combination of clinical examination, skin biopsy with histopathological analysis and blood tests to assess systemic involvement. CTCL treatment is stage-dependent. Depending on the stage of the disease, local or systemic therapies can be used. Individually optimised combinations are common. Novel targeted therapies such as brentuximab vedotin and mogamulizumab have expanded the treatment landscape, offering more effective and personalized options. Allogeneic stem cell transplantation is the only curative approach. In CTCL, quality of life is often impaired due to chronic itching, fatigue, and stigmatizing skin lesions. Psychodermatologic care plays a key role in comprehensive patient support.

Introduction: Correct and precise dermatohistopathologic diagnosis requires excellent histopathologic knowledge on the one hand, and on the other hand often a close correlation between clinical findings and histopathologic results. Clinicopathologic correlation (CPC) is essential to further improve the quality of histopathologic diagnosis and reduce the risk of misdiagnosis. This article describes the importance of CPC using examples of typical dermatoses that would be difficult to diagnose histologically alone and highlights the forms and chances of CPC.