The evolution in surgical techniques for treatment of vitiligo has been producing extremely satisfying results in patients with stable vitiligo, without Köebner phenomenon and resistants to other types of treatment. Many techniques are available and should be used accordingly to the patient and to the dermatologist experience to optimize the results.

Keywords: VITILIGO, SURGERY, TRANSPLANTATION, DERMATOLOGIC SURGICAL PROCEDURES

Complete surgical removal of lentigo maligna is challenging due to the difficulty in determining margins, subclinical spread and frequent facial location. In this article, we report the surgical approach of an extensive facial lentigo maligna with the "spaghetti" technique, with free margins in the third surgical step. This technique consists in the resection of a circular margin surrounding the clinical boundaries of the tumor, with histological evaluation, without removing the lesion. New steps include widening of the affected margins until the whole area is free, when tumor resection and reconstruction of the surgical defect take place simultaneously. The aim is to reach the free margins, preserving tissue in aesthetic and functional areas.

Keywords: Bloodless medical and surgical procedures; Melanoma; Skin neoplasms

The Keystone flap is a versatile and reliable option for the reconstruction of major defects, especially those located in the lower limbs. With its use, there is  a low risk of necrosis, being a way to avoid the use of a graft. We report the case of a 92-year-old female patient who was submitted to the Keystone flap after Mohs surgery for pre-tibial Bowen's disease treatment, with good evolution. The Keystone flap is based on musculocutaneous and fasciocutaneous perforators, has high flap survival rates, low risk of complications, reduced pain and morbidity of the donor site, in addition to rapid patient recovery

Keywords: Perforator flap; Mohs surgery; Lower extremity

INTRODUCTION: Lentigo maligna is a subtype of melanoma in situ, which affects sun-exposed areas. On the face, it can have a clinical and dermoscopic appearance similar to several benign pigmented lesions. Differential diagnosis between them is fundamental for the appropriate therapeutic and should be made by histopathological analysis. Excisional biopsy is the gold standard, but in large, unresectable lesions or in difficult anatomical sites, it can have aesthetic or functional implications. In these cases, shave biopsy appears to be a safe and reliable alternative.
OBJECTIVE: To describe an appropriate shave biopsy technique, discuss its results and indications in the outpatient routine of the dermatologist.
METHODS: Sixteen patients with suspected : Lentigo maligna on the face and scalp were selected. Inclusion criteria were older than 18 years, lack of diagnosis and previous treatment, flat lesions larger than 8 mm and suggestive clinical and dermatoscopic signs. The approach performed was shave biopsy.
RESULTS: The diagnosis of : Lentigo maligna was confirmed in 25% of the cases, and a widening of margins presented compatible results in 100% of them.
CONCLUSIONS: Shave biopsy seems to be a suitable alternative for flat lesions without clinical and dermoscopic criteria of vertical growth.

Keywords: Acne Vulgaris; Diclofenac; Inflammation; Hyperpigmentation

The ear is one of the regions with the highest prevalence of cutaneous tumors. The reconstruction of auricular defects resulting from its excision tends to be complicated, especially when extensive and of the total thickness. We report two cases of reconstruction of surgical defects due to the resection of auricular basal cell carcinomas by Mohs micrographic surgery. One case was reconstructed through an interpolated island flap mobilized from the retroauricular region through the primary defect itself, and the other by retroauricular skin flap with anterior rotation through the primary defect. Both presented satisfactory aesthetic and functional results.

Keywords: Mohs Surgery; Skin Neoplasms; Surgical Flaps

The trilobate flap can be used for the reconstruction of mid-size defects of the lower nasal portion. The third lobe determines the rotational arch’s increase, reducing the flap tension and improving the final aesthetics. We report the case of a patient submitted to the procedure with good aesthetic and functional results.

Keywords: Dermatologic Surgical Procedures; Mohs Surgery; Surgical Flaps

Although several techniques have been described for upper lip reconstruction, functional reconstruction of total upper lip defects remains a challenge. We report a case of a significant size squamous cell carcinoma excised in the upper lip region using the double-advancement technique, with positive functional and aesthetic results.

Keywords: Carcinoma, Squamous Cell; Lip Neoplasms; Surgical Flaps

INTRODUCTION: Mohs micrographic surgery (MMS) can achieve high cure rates in skin cancer treatment and remove as little healthy tissue as possible.
OBJECTIVE: This study aims to characterize patients undergoing Mohs micrographic surgery and to assess predictive factors for a higher number of surgical phases.
METHODS: Observational, cross-sectional, retrospective, and descriptive study conducted in a reference service for micrographic surgery from 2013 to 2019. The medical records of 230 patients (256 lesions) were reviewed.
RESULTS: Injuries with recurrence had significantly more stages than injuries without recurrence (1.69 stages versus 1.31 stages). Tumors greater than 2 cm had a greater number of phases than those smaller than 1 cm and between 1.1 and 2.2 cm (2.0 versus 1.08 and 1.22, respectively). When comparing the locations of the lesions with the number of phases, there was no significant difference. There was a considerable difference regarding the preoperative histological subtypes: aggressive basal cell carcinomas (BCC) required a higher number of phases than non-aggressive BCCs.
CONCLUSIONS: Our study demonstrates, corroborating data from the literature, that the risk factors described are directly related to a greater number of stages of Mohs micrographic surgery.

Keywords: Mohs Surgery; Skin Neoplasms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell Surg Cosmet

Introduction: Facial skin cancer can be very challenging to surgical treatment. Reconstruction with cervicofacial flap is an adequate option when extensive damage is present. We describe a surgical procedure for complex lesions with high morbidity potential. Case study: 69-year-old woman with a large, recurring sclerodermiform basal cell carcinoma (BCC) in the left zygomatic area. Due to the lesion characteristics, we opt to perform Mohs surgery. A cervicofacial flap was used with good aesthetic results and no relapse. Discussion: The cervicofacial flap is ideal for extensively damaged areas and can be used as an alternative to skin graft.

Keywords: Carcinoma, Basal Cell; Mohs Surgery; Surgical Flaps

INTRODUCTION: Seborrheic keratosis (SK) has the typical pigmented dermoscopy features such as fissures and ridges, fat fingers, and cerebriform patterns. Here we describe a case where pigmented columns (PC) were visualized on SK’s dermoscopy associated with a squamous cell carcinoma (SCC). Case presentation: We report a case of a lesion whose dermoscopy showed PC. Histopathological report showed well-differentiated SCC and associated SK. Discussion: The PC was visualized in an area of dendritic melanocytes in the epidermis, correlating with the pigmented SK component of the lesion. To our knowledge, this is the first time PC is described in SK´s dermoscopy.

Keywords: Carcinoma squamous cell; Dermoscopy; Skin neoplasms.