O CBCc é responsável por morbilidade individual e coletiva importante, acarretando carga assistencial e económica não desprezível para os sistemas de saúde e para a sociedade.
Assim, pretende-se que este estudo tenha impacto clínico na abordagem diagnóstica e terapêutica destes doentes no CHTMAD e na região por ele servida, contribuindo para a melhor caracterização do CBCc da C&P nestas populações.
Apesar dos conhecimentos sobre o CBCc ao nível da etiopatogénese, diagnóstico e tratamento terem progredido nas últimas décadas, há questões ainda não elucidadas, como a ausência de biomarcadores associados ao prognóstico. Apesar de ser o tumor cutâneo maligno mais frequentemente diagnosticado na população mundial, até à data as mutações do TERTp não têm sido reportadas como fator prognóstico, em contraste com o CECc.
As dificuldades encontradas na realização deste estudo, nomeadamente ao nível da investigação clínica, evidenciam a necessidade de algumas recomendações. Todos os registos clínicos deviam incluir dados básicos mínimos, tais como o tamanho da lesão, características da lesão, localização anatómica exata, se é primária ou recidivante, assim como a evolução. O diagnóstico histológico por biópsia, prévio a qualquer tipo de tratamento, deveria ser obrigatório. Uma vez realizado o diagnóstico, o paciente deveria ser apresentado numa Consulta de Grupo Multidisciplinar, o caso devia ser discutido, e elaborado um plano de tratamento. Para esta consulta, além dos dados já referidos, é essencial registar dados epidemiológicos e clínicos essenciais, como os antecedentes patológicos e as características clínicas e histológicas de agressividade do CBCc.
Este estudo pode servir para introduzir um novo paradigma na gama de preocupações dos sistemas de saúde, particularmente na região em foco, podendo contribuir para uma maior sensibilização em investir na prevenção primária, colaborando na redução da incidência do CBCc e reduzindo a carga assistencial e económica num futuro próximo. Adicionalmente pretende-se contribuir para a informação, análise e elaboração de medidas por parte das autoridades em saúde, regionais e mesmo nacionais, no sentido de criar diferentes linhas de atuação com prioridades diferenciadas. Concretamente: campanhas a nível municipal e regional no sentido de alertar, educar e formar as populações quanto aos riscos da exposição solar inadequada, riscos individuais e coletivos intrínsecos, e os cuidados de autoexame;
desenvolvimento e implementação ao nível dos Cuidados de Saúde Primários e Hospitalares de programas de rastreio de cancro cutâneo, de forma regular e sistemática e, acima de tudo, que
esses programas sejam consequentes; contribuir para campanhas nacionais, já existentes, de prevenção do cancro cutâneo, enfatizando a região.
Penso que o nosso trabalho poderá aumentar o alerta para um diagnóstico mais atempado e preciso do CBCc na região de TMAD e, dessa forma, contribuir para uma prevenção secundária e terciária. Por outro lado, a nossa série pode constituir uma base para estudos posteriores mais robustos, que possam mesmo incluir mais casos de CBCc tratados fora da região, como nos Hospitais Polivalentes do Porto e Hospitais e Clínicas privados. Assim, poderão ser encontrados biomarcadores para o CBCc que permitam, baseando-nos numa maior robustez dos resultados, a saber: a estratificação do risco e a configuração de grupos de risco nas populações alvo, a fim de uma abordagem diagnóstica precoce e terapêutica adequada do CBCc nestas populações; o planeamento do tratamento do CBCc baseado no comportamento biológico e na presença desses mesmos biomarcadores.
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