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Hautkrankheiten werden in Deutschland stationär vorwiegend in den 115 Hautkliniken versorgt.Versorgungswissenschaftliche und gesundheitsökonomische Analyse der dermatologischen stationären Versorgung und Prädiktion des zukünftigen Versorgungsbedarfes auf der Basis von Primär- und Sekundärdaten.Die ambulante und stationäre Versorgung der dermatologischen Behandlungsindikationen wird überwiegend durch Fachärzte für Dermatologie getragen. Stationär wurden 2018 833 491 Fälle behandelt, entsprechend 4,21 % aller stationären Fälle (19 808 687). Häufigste Behandlungsfälle waren: epithelialer Hautkrebs (gesamt 87 386, davon dermatologische Kliniken 52 608), gefolgt von Melanom (23 917/17 774), Psoriasis (19 291/13 352), Erysipel (73 337/11 260), sonstige Dermatitis (12 671/10 842), atopisches Ekzem (11 421/9734) und Herpes zoster (26 249/9652). Mit einer durchschnittlichen Verweildauer von 5,69 Tagen befanden sich die dermatologischen Kliniken im unteren Drittel. Der Anteil der in Hautkliniken versorgten stationären Indikationen war am höchsten bei Prurigo (95,2 %), Pemphigus (94,9 %), Parapsoriasis (94,6 %), Pemphigoid (90,3 %), Dermatitiden (85,6 %) und atopischem Ekzem (85,2 %). Während die Gesamtzahl der stationären Behandlungsfälle in Deutschland zwischen 2000 und 2018 um durchschnittlich 17,5 % gestiegen ist, ist dies bei Hautkrankheiten zu 26,6 % der Fall, bei einzelnen zu über 150 %. Die Projektion der heutigen auf die zukünftige stationäre Versorgung lässt einen weiterhin hohen Bedarf an stationärer Versorgung durch die Hautkliniken erwarten.Die stationäre dermatologische Versorgung ist auch zukünftig ein unerlässlicher Bestandteil der qualifizierten, sozialrechtlich notwendigen Versorgung in Deutschland.

Background In Germany, skin diseases are mainly treated in the 115 dermatological hospitals. Methods Health care and health economic analysis of dermatological inpatient care and prediction of future care needs based on primary and secondary data. Results Outpatient and inpatient care for dermatologic treatment indications is predominantly provided by dermatology specialists. Inpatient treatment was provided for 833,491 cases in 2018, corresponding to 4.21 % of all inpatient cases (19,808,687). Most common treatment cases were: epithelial skin cancer (total 87,386, of which dermatology clinics 52,608), followed by melanoma (23,917/17,774), psoriasis (19,291/13,352), erysipelas (73,337/11,260), other dermatitis (12,671/10,842), atopic dermatitis (AD) (11,421/9,734), and herpes zoster (26,249/9,652). With an average length of stay of 5.69 days, dermatology hospitals were in the bottom third. The proportion of inpatient indications cared for in dermatology hospitals was highest for prurigo (95.2 %), pemphigus (94.9 %), parapsoriasis (94.6 %), pemphigoid (90.3 %), eczema other than AD (85.6 %), and AD (85.2 %). While the total number of inpatient treatment cases in Germany has increased by an average of 17.5 % between 2000 and 2018, this is the case for 26.6 % of skin diseases and over 150 % for individual ones. The projection of current to future inpatient care suggests a continued high demand for inpatient care by dermatology hospitals. Conclusion Inpatient dermatological care will continue to be an indispensable component of qualified, socially necessary care in Germany.

Basal cell carcinoma (BCC) is the most common malignant tumor among fair-skinned individuals, and its incidence had been steadily rising in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 2 addresses issues such as proper risk stratification, the various therapeutic approaches, and prevention as well as follow-up of patients with basal cell carcinoma.

Basal cell carcinoma is the most common malignant tumor among fair-skinned individuals, and its incidence has been rising steadily in the past decades. In order to maintain the highest quality of patient care possible, the German S2k guidelines were updated following a systematic literature search and with the participation of all professional societies and associations involved in the management of the disease. Part 1 highlights new developments in genetics in particular as well as aspects regarding epidemiology, diagnosis, and histology.

Hintergrund In der 1994 erschienen Erstpublikation zur frontal fibrosierenden Alopezie (FFA) fasste Steven Kossard sechs Patientinnen, die sich allesamt in der Postmenopause befanden, zusammen. Bei der FFA handelt es sich um eine vernarbende Alopezie, die durch die klinischen Kriterien der frontotemporalen Haarlinienregression und den Verlust der Augenbrauen gekennzeichnet ist. In letzten Jahren wurden zunehmend Fallberichte zur Manifestation in der Pramenopause und bei mannlichen Patienten publiziert. Ziel der arbeit Zusammenfassung und Analyse der verfugbaren Literatur in Pubmed zur FFA bezuglich der Epidemiologie, der Begleiterkrankungen, der Krankheitsprasentation, Diagnostik und Therapie. Material und methoden Die Datenbank Pubmed wurde nach Fallberichten und Fallserien zur FFA durchsucht. Insgesamt wurden 68 Artikel mit insgesamt 932 Patientenfallen eingeschlossen, analysiert und die patientengebundenen Daten ausgewertet. Neben den epidemiologischen Haufigkeiten wie Alter, Geschlecht oder Ethnie wurden zusatzliche Aspekte zu Pradilektionsstellen, assoziierten Hautveranderungen, Begleiterkrankungen, Medikationen und Therapieansprechen sowie die diagnostische Relevanz von Autoantikorpern erfasst. Ergebnisse Teilweise konnten die in Fallserien und Einzelfallberichten publizierten Erkenntnisse bestatigt und besser differenziert werden, wohingegen einzelne Annahmen nicht reproduziert werden konnten. Von besonderer Relevanz ist die in unserer Analyse ermittelte hohe Koinzidenz der FFA mit Schilddrusenerkrankungen. Schlussfolgerungen Die vorliegende Arbeit prasentiert, die bislang umfangreichste Zusammenfassung der in der Literatur zur FFA publizierten Patientenfalle.

When using procedures that enable complete examination of surgical margins (3D histology), microscopically controlled surgery (MCS) represents a safe and proven method to confirm R0 resection of infiltrating tumors, especially at problematic sites, while preserving the adjacent tissue. This allows for excellent or good aesthetic results that are superior (cryosurgery, short-range irradiation) or equivalent (PDT) to nonsurgical and less safe procedures (PDT).

Zusammenfassung Hintergrund Im Kontext der DRG-basierten Krankenhausfinanzierung ist die Analyse des Leistungsspektrums der stationaren Dermatologie von dauerhaft hohem Interesse. Im Rahmen eines Benchmarking-Projekts sollten Leistungsstrukturen und -unterschiede anhand von Kennzahlen vergleichend untersucht werden. Methodik Fur die multizentrische Querschnittsstudie wurden Routinedaten von 46 deutschen dermatologischen Kliniken und Abteilungen erhoben, bearbeitet und analysiert. Fur die Auswertung standen 95 257 Datensatze aus dem Jahr 2011 zur Verfugung, die nach der Systematik des G-DRG-Systems Version 2013 gruppiert wurden. Ergebnisse Die durchschnittliche Verweildauer aller Falle liegt bei 6,3 Tagen (Normallieger: 5,7 Tage) bei einem durchschnittlichen Patientenalter von 52 Jahren. Insgesamt werden 55 % aller Falle medizinischen, 45 % operativen DRGs zugeordnet. Einundsiebzig Prozent der Einrichtungen liegen innerhalb dieses Mittelwertes (± 10 %). Es konnte fur die Stichprobe kein Zusammenhang zwischen der Bettenzahl der Einrichtung und dem angebotenen Leistungsspektrum nachgewiesen werden. Grose Unterschiede zwischen den Einrichtungen zeigten Kennzahlen der Kodierqualitat. Schlussfolgerungen Die Ergebnisse spiegeln die heterogene Behandlungswirklichkeit der stationaren Dermatologie in Deutschland wider. Die Unterschiede in der Leistungserstellung machen deutlich, dass sie neben patientenbezogenen Einflussfaktoren insbesondere auch von den infrastrukturellen Bedingungen und den verfugbaren Ressourcen an den jeweiligen Standorten gepragt sind.

Summary Background In the context of DRG-based hospital funding, the analysis of services provided in dermatologic inpatient care is highly relevant. We analyzed and compared clinical service structures and varieties in dermatologic hospitals through a benchmarking technique. Methods For this multicenter cross-sectional study, routine data from 46 German dermatologic clinics and departments were collected, processed, and analyzed. In total, 95 257 data sets from 2011 were available. The data were grouped according to the G-DRG-system 2013 version. Results The average length of stay for all cases was 6.3 days (DRG “inliers”: 5.7 days), and average patient age was 52 years. In total, 55 % of all cases were grouped to medical, 45 % to surgical DRGs. 71 % of all hospitals provide services within or close to this average value (± 10 %). No association was found between the number of hospital beds and the variety of clinical services provided in our sample. We found huge varieties in several parameters assessing the coding quality. Conclusions The results reflect the heterogeneous reality in German inpatient dermatology. The varieties in dermatologic service range still depend on patient-related factors as well as infrastructural conditions and the resources available at each site.

Excision and reexcision of melanomas of the lower extremities and especially the toe area, the sole, or the top of the foot, frequently result in defects that, due to their location, can only be covered by complex local or free flap techniques. Split or full-thickness skin grafts are also a good option for wound coverage. For this purpose, one frequently waits for granulation tissue to form, which requires another operation at a later date. In melanomas with a thickness of ≥ 1mm, along with reexcision, a sentinel lymph node biopsy is performed for diagnostic reasons, with the sentinel lymph node typically located in the inguinal area. Using a patient with acral lentiginous melanoma as an example, we describe the use of the single-stage Junod’s procedure (inguinal crossectomy with simultaneous harvesting of a skin spindle for coverage of a leg ulcer) [1] in the above-mentioned scenario.

There is a vast number of potential wound closure techniques in dermatosurgery. Taking various factors into account, such as anatomic site, defect size and depth, skin elasticity as well as other aspects (for example creases and hairline), surgeons are often required to tailor individual closure procedures, in order to achieve optimal results. Due to poor elasticity and frequent actinic damage, closure of scalp defects has proven to be particularly difficult and thus poses a challenge in ever -yday clinical practice.The double hatchet procedure – characterized by an advancement rotation component involving two opposite hatchet flaps – first described by Emmet in 1977 represents a simple and readily feasible plastic reconstruction technique for such defects [1]. It is particularly useful in the frontal and temporal region and marked by easy mobilization due to its relatively narrow base. However, this latter feature also entails a slightly increased risk for flap necrosis.

Axel Hauschild*, Helmut Breuninger*, Roland Kaufmann, Rolf-Dieter Kortmann, Martin Klein, Jochen Werner, Julia Reifenberger, Thomas Dirschka, Claus Garbe (1) Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Germany (2) Department of Dermatology, Tubingen University Hospital, Germany (3) Department of Dermatology, Frankfurt University Hospital, Germany (4) Department of Radiation Therapy and Radio-oncology, Leipzig, Germany (5) Fachklinik Hornheide, Division of Oral and Maxillofacial Surgery, Plastic and Aesthetic Surgery, Munster, Germany (6) Department of Otolaryngology, Marburg University Hospital, Germany (7) Department of Dermatology, Dusseldorf University Hospital, Germany (8) Dermatology Practice, Dusseldorf, Germany (9) Department of Dermatology, Tubingen University Hospital, Germany

Summary Background: German university medical centers are important institutions for scientific research, academic teaching and patient care representing crucial components of academic education, medical specialist training and health services research. The aim was to analyze the structure and performance of the dermatology departments at German university medical centers. Patients and methods: Nationwide survey of the heads of the dermatology departments at German university medical centers (n = 35) using a standardized questionnaire on the departmentis performance profiles in inpatient and outpatient care, financial remuneration, research output and the anticipated development of the department. Results: Data from 2010 on 33 of 35 (94.3%) dermatology departments at German university medical centers were analyzed. The mean number of inpatient beds of the departments was 57 (range 24–133) with a utilization of bed capacity of 86% on average. The mean case mix of the 2,494 inpatient cases per year was 1,748, the reported mean case mix index was 0.83. On average, 21,973 cases (range 5,284–92,547) were treated at university outpatient clinics. Of the 33 participating departments of dermatology 22 were placed within the top third of their faculty regarding research funding. The most important components of patient care included surgical dermatology (31.4%), dermato-oncology (16.9%) and general dermatology (32.1%). Conclusions: Covering the whole spectrum of dermatology, the dermatology departments of German university medical centers show extraordinary performances in both patient care and scientific research. They considerably contribute to the overall performance and the economic outcome of the German university medical centers and are an integral part of these institutions.

Summary Fumaric acid esters have been used successfully in the therapy of psoriasis vulgaris since 1959. In the last 17 years, many of the underlying mechanisms of anti-psoriatic action, such as a Th1/Th2 shift, a suppression of important leukocyte adhesion molecules, the induction of pro-apoptotic pathways in T-cells and recently anti-angiogenic action, have been discovered. Based on the knowledge of these immunomodulatory characteristics, fumaric acid esters have been shown to be effective or potentially effective in a multitude of dermatological as well as non-dermatological diseases. The range of new therapeutic targets reaches from multiple sclerosis to illnesses such as necrobiosis lipoidica, granuloma annulare and sarcoidosis. Experimental approaches offer promising, although preliminary, results on the treatment of cancer, malaria, chronic inflammatory lung diseases, and Huntington disease, to name but a few. This valued and well-known drug mainly prescribed by dermatologists is now experiencing a renaissance far beyond dermatologic applications.

To confirm a local R0 resection of tumors with infiltrative growth at problem sites and for sparing of tissue, microscopically controlled surgery represents a safe and proven method, particularly when there are no gaps between the tissue taken at the incision margins.

Background: The increasing use of lasers for the removal of pigmented skin lesions has led to a growing risk of erroneously treated malignant melanocytic tumours. Patients and methods: In two patients, both of whom developed a melanoma, the lesions were initially misdiagnosed clinically as a benign naevus and treated with laser vaporisation. Results: On recurrence of the tumours, the diagnosis of melanoma was finally established by histological examination of the excised tumours in which differentiation from pseudomelanoma remained difficult. Conclusions: In such cases of initially misdiagnosed melanomas, laser removal not only complicates and delays the correct diagnosis but might also worsen the prognosis after recurrence of an incompletely removed tumour.