Introduction: The most common type of skin cancer is basocellular carcinoma, which frequently occurs on the face.Aesthetic and functional damage during treatment are of great concern to patients; Mohs Micrographic Surgery is a safe treatment that allows tissular preservation with minimum aes- thetic damage. Objective: To evaluate whether using Mohs Micrographic Surgery to treat basocellular carcinomas located in aesthetically important areas of the face preserves healthy tissue. Methods: Surgical procedures (n = 49) performed in the ABC Medical School in 2008 to treat tumors located in the peribuccal, periocular and alar areas, and in the ears,were evaluated.The tumors were classified according to clinical and histological features, and the surgical margins were analyzed and compared to those recommended by the literature.The patients were re-evaluated 2 years after treatment. Results: The margins removed by Mohs Micrographic Surgery were much smaller than those recommended for excisional surgery, with important tissular preservation. Conclusion: Mohs Micrographic Surgery permitted the preservation of healthy tissue (56-86%) in the treatment of basocellular carcinomas located in aesthetically important areas of the face, with minimal damage.Thus it is a safe therapeutic and aesthetical option in the treatment of facial basocellular carcinomas.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, ESTHETICS, FACE, SKIN NEOPLASMS

Seborrheic keratosis are benign epithelial tumors that are usually easily diagnosed through clinical and dermatoscopic examination. They can sometimes resemble malignant lesions, especially melanoma. This article illustrates two such cases, highlighting the detailed dermatoscopic observations that help distinguish these lesions, to help increase the accuracy of diagnoses.

Keywords: KERATOSIS, SEBORRHEIC, MELANOMA, DERMOSCOPY

First described in 1971 by Conley and colleagues, desmoplastic melanomas represent less than 4% of cutaneous melanomas. It is a distinctive and uncommon variant characterized by a spindle cell fibrous tumor of collagen forming cells, isolated by dense fibrous matrix. Desmoplastic melanomas are frequently misdiagnosed, mainly due to their similarity to other fibrous neoplasms. A review of about 600 reported cases unexpectedly revealed the pigmented clinical presentation of a deep and fibrous nodule that is classically associated with a precursor lesion. The ability to recognise this lesion’s characteristics is very important, due to its recurrent behaviour and subsequent need for a specialized surgical approach.

Keywords: MELANOMA, NEOPLASM RECURRENCE, LOCAL, GP100 MELANOMA ANTIGEN, MELANOMA-SPECIFIC ANTIGENS

Solitary pink lesions of the face may have nonspecific dermoscopic patterns, and are thus deemed difficult to diagnose. Differential diagnoses to consider are: actinic keratosis, squamous cell carcinoma, basal cell carcinoma, and amelanotic melanoma. Confocal microscopy can be used as an auxiliary clinical examination in their diagnosis and in determining the most significant sites for carrying out a biopsy. The authors describe a case that illustrates the usefulness of a confocal microscopy examination in pink lesions.

Keywords: DERMOSCOPY, MICROSCOPY, CONFOCAL, CARCINOMA, BASAL CELL, KERATOSIS ACTINIC

p>Pyogenic granuloma is a common, benign, vascular proliferation, usually secondary to other events, such as cutaneous trauma. It is known that some lesions can mimic melanoma and vice versa, and it is recommended that the lesion be surgically removed and analyzed histologically. The advent of technologies-such as dermoscopy-that amplify the image recognized by the eye through the identification of certain structures and specific patterns, can facilitate this differentiation and assist in decision-making. In rare situations, its clinical presentation is unusual. The current article is aimed at demonstrating this fact and reviewing the medical literature on the subject, focusing on dermoscopic findings.

Keywords: PYOGENIC GRANULOMA, DERMOSCOPY, MELANOMA.

Introduction: Chronic exposure to ultraviolet radiation is the primary cause of skin carcinomas. Actinic keratosis is considered a precursor lesion. Topical application of photolyase showed effectiveness with the removal of 40-45% of the dimers formed by ultraviolet radiation, contrasting with conventional photoprotection for its ability to repair already damaged cellular DNA. Confocal microscopy is used for the in vivo visualization of skin alterations. Objective: To evaluate the effects of the cream containing photolyase and SPF 100 sunscreen on facial actinic damage and keratoses, using dermoscopy and confocal microscopy as evaluation parameters. Methods: Observational longitudinal clinical trial in 17 actinic keratosis lesions. Dermatoscopy and confocal microscopy were carried out before applying the cream and 120 days after, with comparison of the images. Results: Of the 14 Grade I actinic keratoses, nine showed clinical and dermoscopic improvement, three remained unchanged and one progressed to Grade II actinic keratosis. Confocal microscopy showed a reduction of scales and improvement in the epidermal architecture in the five Grade I actinic keratoses. The three Grade II actinic keratoses analyzed did not show improvement. Conclusions: The application of photolyase in cream with sunscreen promotes photoprotection and DNA repair. Confocal microscopy is a useful tool for monitoring the treatment of actinic keratoses.

Keywords: KERATOSIS, ACTINIC; MICROSCOPY, CONFOCAL; DERMOSCOPY.

Solar or actinic keratosis is a frequent pre-malignant lesion that often occurs in areas exposed to sunlight, and has a 6-10% relative risk of developing into squamous cell carcinoma. Patients with actinic keratosis have multiple and confluent subclinical lesions, leading to the characterization of the condition as being of the field cancerization type. They are multifocal areas with genetic mutations that may become the site of new primary tumors and local recurrence. In recent years, there has been increasing interest in the development of non-invasive diagnostic tests and treatment for these subclinical lesions, with an aim at preventing squamous cell carcinoma.

Keywords: KERATOSIS, ACTINIC; CARCINOMA, SQUAMOUS CELL; PHOTOTHERAPY.

The diagnosis of pigmented facial lesions is considered challenging since benign and malignant lesions might have similar clinical and dermoscopic features – especially in the early stages of the lesion – entailing that it is often difficult to identify lentigo maligna lesions in the face. In this way, confocal reflectance microscopy has the potential to become a useful tool both in the diagnosis and surgical planning of lentigo maligna.

Keywords: Dermoscopy; Hutchinson's melanotic freckle; Keratosis, actinic; Melanoma; Microscopy, confocal

INTRODUCTION: Actinic keratosis (AK) is a pre-malignant lesion that can progress to squamous cell carcinoma. The diagnosis is through clinical, dermatoscopic and confocal microscopy assessment. Currently, the approach is the treatment of the field cancerization, comprising of clinically visible and subclinical AKs, for which photodynamic therapy (PDT) is a therapeutic option.
OBJECTIVE: To evaluate improvement of AKs and cancerization field in patients submitted to daylight PDT, with clinical, dermatoscopic and confocal microscopy assessment.
METHODS: Ten patients with multiple AKs on the face were selected. Daylight PDT was performed using methyl aminolevulinate and clinical, dermatoscopic and confocal microscopy photographic documentation was performed before and 60 days after the treatment.
RESULTS: Of the nine patients who completed the treatment, 8 (88.8%) showed clinical improvement and reduction in the severity of AK with one treatment. On dermatoscopy, 4 patients (44.4%) showed significant improvement, 3 patients (33.3%) showed partial improvement and 2 patients (22.2%) had no change. On confocal microscopy, 6 (66.6%) patients presented reduction in the severity of the lesion.
CONCLUSIONS: Daylight PDT proved to be effective for the treatment of AKs, with high tolerability and efficacy, besides a good safety profile.

Keywords: Dermoscopy; Keratosis, Actinic; Microscopy, Confocal; Photochemotherapy

Microneedling is an ambulatory surgical procedure that can be used for different indications with the objective of stimulating the production of collagen. Five cases were evaluated in the first 72 hours after the procedure by reflectance confocal microscopy in order to evaluate the pores lifetime.

Keywords: Collagen; Wound healing; Ambulatory surgical procedures

The recurrent squamous cell carcinoma (SCC) needs an appropriate approach to decrease the risk of recurrences. We report the case of a man diagnosed with SCC on the left temporal region treated by conventional surgery, with infiltration and erythema in the scar area. Reflectance confocal microscopy suggested the diagnosis of recurrent SCC confirmed by histopathology. New surgery and traditional intraoperative frozen section were performed. After two months, the patient had a new relapse, finally treated with Micrographic surgery without new involvement. This article highlights the importance of micrographic surgery in treating SCC, aiming to decrease new recurrences.

Keywords: Skin Neoplasms; Mohs Surgery; Carcinoma, Squamous Cell

Neurothekeomas are rare, benign dermal tumors of presumed fibrohistiocytic lineage. They present multiple differential diagnoses, making their identification challenging at the dermatological and anatomopathological examination. We report the case of a 28-year-old man who presented a hardened papule growth on the left upper eyelid with histopathology and immunohistochemistry suggestive of neurothekeoma.

Keywords: Eyelid neoplasms; Neurothekeoma; Case reports