Introduction: Since patients with vitiligo are believed to be more susceptible to developing malignant neoplasias due to the lack of melanin in the affected skin, the use of sunscreens is critically important.
Objective: To evaluate the pattern of sunscreen usage in vitiligo patients.
Methods: A transverse study of vitiligo patients was conducted from August 2009 to April 2010. The following variables were studied using a questionnaire and physical examination: demographic data (gender, age, education level, and phototype); clinical characteristics of the condition (age at diagnosis, affected areas of the body, and clinical type); sunscreen use (frequency, protection factor, and duration of use); and habits of sun exposure.
Results: Of the 121 study subjects, 43 used sunscreen – mainly with sun protection factor 30 – on a daily basis.The variables associated with daily use were female gender (p = 0.001, OR = 4.76, 95% CI = 1.80-12.59) and recommendation by a dermatologist in the first medical visit (p = 0.047, OR=2.28, 95% CI = 1.01-5.28).
Conclusion: A pattern of sunscreen usage was determined for patients with vitiligo. In addition, it was verified that a dermatologist''''''''s recommendation to wear sunscreen had a statistically significant impact (p = 0.047, OR=2.28, 95% CI = 1.01-5.28).
Keywords: vitiligo; evaluation; sunscreening agents.

Keywords: VITILIGO, EVALUATION, SUNSCREENING AGENTS

Introduction: The paramedian forehead flap has been used for centuries in nasal reconstruction. It is a unique flap in terms of restoring complex nasal defects. It can adequately restore contour, texture, projection of the nasal tip and convexity of the ala, especially when combined with cartilage grafting. Objectives: To evaluate the versatility of the paramedian forehead flap in nasal reconstruction following Mohs micrographic surgery, especially in an outpatient setting and under local anesthesia. Furthermore, to discuss traditional approaches versus more recent refinements on its design and execution. Methods: Retrospective study of patients with surgical defects resulting from Mohs micrographic surgery that have been repaired using the paramedian forehead flap. Results: Nineteen patients were included in the study. Restoration or the nasal mucosa was required for full thickness defects in 4 (22%) patients. Structural support provided by auricular cartilage graft was required in 12 (67%) patients. The flap pedicle was designed ipsilaterally to the defect in 14 (74%) patients. Complications were minimal and unusual. Conclusions: The paramedian forehead flap is a valuable technique in the repair of extensive and deep nasal defects following Mohs micrographic surgery. With proper surgical planning, adequate measures for patient comfort, and meticulous technique, the paramedian forehead flap can be safely performed in an outpatient setting, achieving unique results in nasal reconstruction.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: The nasolabial interpolation flap is an essential flap in nasal reconstruction. Its main indications are deep and extensive defects of the nasal ala. Objectives: To evaluate the usefulness of the nasolabial fold interpolation flap for alar reconstruction after Mohs micrographic surgery-especially in an outpatient setting and under local anesthesia-as well as to discuss refinements in its design and execution. Methods: Retrospective study of patients with nasal ala defects resulting from Mohs micrographic surgery repaired with nasolabial interpolation flap. Results: Eighteen patients were included in the study; 7 (39%) had localized defects in the ala only and were reconstructed with an isolated nasolabial interpolation flap; however 11 (61%) had defects involving both the ala and some adjacent anatomical subunit. These patients underwent a combined reconstruction. Resection of the remaining portion of a subunit was performed in 14 (78%) cases. There were no complications or recurrence after an average follow up of 29 months. Excellent functional and aesthetic results were achieved in all patients. Conclusions: The nasolabial interpolation flap is essential in the reconstruction of alar defects after Mohs micrographic surgery. If adjacent subunits are involved-such as the medial cheek or nasal sidewall-the nasolabial interpolation flap must be combined with another method of repair. The flap can be safely performed in an outpatient setting.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: Successful restoration of form and function of the nose after Mohs surgery requires thoughtful reconstructive planning. Nasal defects that are deep and extensive, especially those located on the ala, may require a cartilage graft to help restore nasal function, anatomy, and cosmesis. Objectives: To evaluate the usefulness of auricular cartilage grafts in nasal reconstruction after Mohs micrographic surgery, as well as to describe a cartilage graft harvesting technique. Methods: Retrospective study of patients with nasal defects following Mohs surgery who were submitted to an auricular cartilage graft. Results: Ten patients were included in the study. The cartilage graft was harvested from the scaphoid fossa/antihelix in six (60%) patients, and from the concha in four (40%) patients. All scaphoid fossa/antihelix cartilage grafts were harvested through anterior incision, while conchal grafts were removed through posterior incision. One patient developed a hematoma, which drained spontaneously. Conclusions: auricular cartilage grafts are a versatile, reliable, and predictable method of providing structural support in nasal restoration. It is crucial to identify patients who can benefit from this technique. Through careful planning and adequate execution, ear cartilage grafts help to improve nasal reconstructions results in selected cases.

Keywords: MOHS SURGERY; EAR CARTILAGE; SURGICAL FLAPS; NOSE NEOPLASMS; BASAL CELL CARCINOMA

Introduction: The cutaneous upper lip is often affected by malignant skin neoplasms. Surgical treatment is preferred for most lesions in this site. Whenever available, tumors in the perioral area should be managed with Mohs micrographic surgery.
Case report: The author of the present article describes the implementation of a rotation flap in the cutaneous upper lip of a patient who underwent Mohs micrographic surgery.
Discussion: There are a number of options for repairing surgical defects in the cutaneous upper lip. When primary closure is not possible, rotation flaps are considered because they allow camouflaging of the rotation arc in the nasolabial fold, and the other incisions in the perioral rhytids.

Keywords: LIP NEOPLASMS; MOHS SURGERY; SURGICAL FLAPS

The purse-string suture is one of the several repair options in dermatologic surgery. Its main indications are round or oval wounds on the trunk and limbs.
The authors describe the combination of purse string suture and second intention healing for a surgical defect after removal of a basal cell carcinoma on the temple.
The purse-string suture is an important closure method that may yield good results in selected cases. Although it is more often indicated on the trunk and limbs, it may be performed on the temple to avoid more complex repair.

Keywords: Suture techniques; Wound closure techniques; Wounds and injuries

INTRODUCTION: Interpolation flaps are well-established techniques for nasal reconstruction after the removal of skin cancers. Ideally, they should be performed after complete analysis of the surgical margins using Mohs micrographic surgery.
OBJECTIVE: To compare the paramedian forehead flap with the nasolabial interpolation flap for nasal reconstruction after Mohs surgery.
METHODS: Retrospective descriptive study of a consecutive sample of patients submitted to interpolation flaps for nasal reconstruction after Mohs surgery.
RESULTS: Twenty patients were included in the study, with 10 individuals undergoing each flap modality. Eighteen (90%) patients had defects involving multiple nasal anatomic subunits. The nasal tip (n = 10) and dorsum (n = 7) were the most affected areas in patients who underwent paramedian forehead flap, while the nasal ala (n = 10) and sidewall (n = 7) were the most affected in patients who underwent nasolabial interpolation flap. The removal of an additional portion of a subunit was performed in 15 (75%) patients. Complications were minimal and uncommon.
CONCLUSIONS: The paramedian forehead flap is more indicated for defects affecting the nasal tip and dorsum, while the nasolabial interpolation flap is more suitable for the restoration of the nasal ala. The subunit principle allowed incision lines to be camouflaged.

Keywords: Mohs surgery; Nose neoplasms; Surgical flaps

INTRODUCTION: The nose is frequently affected by cutaneous carcinomas. Due to its functional and cosmetic importance, tumors on this location are preferably treated by Mohs micrographic surgery, which provides the highest cure rates. For repairing of surgical defects several options are available, including healing by second intention, primary closure, skin grafts, and flaps. In certain cases, one should consider a combination of methods.
OBJECTIVE: To describe the authors' experience in nasal reconstruction after Mohs surgery and to assess if the number of involved subunits influenced the use of combined repairs.
METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and nasal reconstruction by one of the authors during a 3-year period.
RESULTS: 208 cases were included, and the most common repair method were flaps (n = 82). Combined methods were performed in 44/154 (29%) cases with involvement of only one nasal anatomical subunit and 29/54 (54%) cases with multiple nasal subunits involved.
CONCLUSIONS: The dermatologic surgeon should be familiar with different options for nasal reconstruction. The combination of repair methods was often performed, mainly for wounds that affected more than one nasal subunit.

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

INTRODUCTION: The perioral region is commonly affected by non-melanoma skin cancer. Mohs micrographic surgery is the treatment of choice in this area because it has the highest cure rate and preserves healthy tissue. Several methods are available for restoring the perioral region, and their selection is influenced by the surgical wound characteristics and the surgeon's preference.
OBJECTIVE: Describe the authors’ experience in perioral reconstruction after Mohs micrographic surgery and analyze the repair methods most frequently performed.
METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and perioral reconstruction.
RESULTS: The study included 108 cases from 103 patients. The mean number of Mohs surgery stages was 1.4, and the mean defect size was 16 mm. Primary closure was the most used technique for reconstruction, followed by flaps (mainly V-Y, single advancement, and rotation). The association of repair methods was used in 28.7% of cases, mostly combined with flaps. Four patients had complications (necrosis and graft infection, trapdoor effect, and partial wound dehiscence).
CONCLUSION: Primary closure was the most frequent repair method, followed by flaps. Knowing reconstruction strategies and possibilities of associations is essential for proper restoration of the perioral region, maintaining its functionality, sensitivity and aesthetics.

Keywords: Lip; Lip neoplasms; Mohs surgery; Skin neoplasms

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon^® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

Keywords: Mohs surgery; Carcinoma, Basal cell; Carcinoma, Squamous cell; Excision Margins