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

To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Keywords: Histology; Mohs Surgery; Skin Neoplasms

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

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

The nasal region is a frequent site of keratinocyte carcinomas. Its peculiar anatomy, contour, and three-dimensionality make surgical repair challenging. Eventually, in situations of greater complexity, a single technique may not be sufficient to restore the original anatomy, requiring the association of methods. This article describes a strategy for reconstructing a full-thickness alar defect, including the nasal margin, based on the combination of a nasolabial transposition flap with a hinge flap. It is a safe procedure, dependent on the mobilization of local tissue and performed in a single surgical procedure.

Keywords: Surgical flaps. Nose neoplasms. Skin neoplasms. Mohs surgery. Carcinoma, basal cell