Introduction: The lower eyelid is often the site of basal cell carcinomas, with Mohs micrographic surgery (which allows precise histological control with maximum tissue preservation) being the ideal method for their treatment. Tumors that invade the posterior lamella cause full-thickness defects of the lower eyelid, for which several reconstruction techniques have been described with composite grafts. However, few authors use the helix of the ear as a donor area. Objective: To describe the applicability of ear helix composite grafts in the reconstruction of the lower eyelid. Methods: Retrospective study of a series of 6 cases of basal cell carcinoma in the lower eyelid, with tarsal invasion, operated through Mohs micrographic surgery in a private specialist service in the city of Rio de Janeiro, Brazil. All patients had full-thickness defects, and had undergone reconstruction of the posterior lamella through chondroperichondrial graft of the ear helix. The anterior lamella was reconstructed with the remaining eyelid tissue mobilization or with an advancement flap. Patients were assessed for functional capacity and aesthetics. Results: There was complete adaptation of the perichondrium to the conjunctiva, after contact with the eyeball for 8 weeks. All patients with mild escleral show without ectropion. Conclusions: Despite the small sample, all patients had excellent cosmetic and functional results.

Keywords: EYELID NEOPLASMS; CARCINOMA, BASAL CELL; MOHS SURGERY; EAR CARTILAGE.

Basal cell carcinoma is a locally invasive malignant tumor, most frequently affecting Caucasian people. The nasal ala is a frequent site for this neoplasia. The treatment of choice is surgical, and Mohs micrographic surgery is one of the indicated techniques for presenting great accuracy in the histological control of margins and high cure rates with low recurrence rates. In this location, not only is a cure needed, but also the maintenance of facial aesthetics. The authors describe five cases of complete amputation of the nasal ala after Mohs micrographic surgery, with reconstruction using the Spear's flap.

Keywords: CARCINOMA, BASAL CELL; MOHS SURGERY; SURGICAL FLAPS.

Introduction: Due to the risk of invasion of the orbital cavity and involvement of noble structures, the periocular region requires specific knowledge related to the anatomy and biological behavior of tumors in this region. Objective: To present the particularities and complexity of the approach to periocular tumors, through the analysis of cases treated at a Mohs micrographic surgery specialist center. Methods: A retrospective, observational, cross-sectional study was carried out based on data collected through a review of medical records, operative records, and photographic archives. Thirty-four cases were analyzed between April 2010 and April 2014. Results: Thirty-one basal cell carcinomas, two squamous cell carcinomas, and one sebaceous carcinoma were operated. Of these, 22 (64.70%) were primary tumors, and 12 (35.29%) were recurrent or incompletely excised. The nodular was the most common type of basal cell carcinoma (38.70%), followed by the micronodular (25.80%), the infiltrating (22.58%), the sclerodermiform (6.45%), the superficial (3.22%) and the adenoid (3.22%). Most of the lesions affected the lower eyelid (44.11%), followed in number by the internal canthus (41.17%), the upper eyelid (11.76%), and the external canthus (2,94%). There was only one recurrence following Mohs micrographic surgery. Conclusions: Most tumors had an aggressive histological subtype, especially those located in the internal canthus. Despite the study's limitations, the strict histological control of Mohs micrographic surgery, combined with the multidisciplinary approach to patients, provided excellent oncological, functional, and cosmetic results.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; CARCINOMA, SQUAMOUS CELL; EYELID NEOPLASMS; ORBIT EVISCERATION.

The reconstruction of nasal surgical defects, especially when there is total thickness bilateral simultaneous involvement of the nasal ala, tip, and dorsum, is complex. Several surgical options are described, and most authors recommend ear cartilage graft or chondro-mucous flap of the nasal septum, associated with the frontal median flap in order to lend structural rigidity to the nasal ala, preventing it from collapsing during inspiration. The authors describe an alternative reconstruction technique without the use of cartilage through the combination of hinge flaps from the nasogenian fold, associated with a frontal paramedian flap.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

There are many procedures for the rejuvenation of the cervical region. Nevertheless, the most invasive ones – such as the rhytidectomy – can lead to relatively large unaesthetic scars. In contrast, noninvasive procedures – such as the classic absorbable lifting threads – have no significant effect on the treatment of the most evident platysmal bands. Aiming at solving the problem of short durability linked to the lifting threads and eliminating the undesirable submental scar caused by rhytidoplasty, a less invasive technique is described for the treatment of cervical laxity. This technique can be used isolatedly in patients with small amounts of skin redundancy, or associated to mini face lifts in patients with considerable sagginess.

Keywords: Cosmetic techniques; Dermatologic surgical procedures; Esthetics; Lifting; Mandible; Neck muscles; Rejuvenation; Rhytidoplasty

The tissue processing in Mohs surgery aims at histological slides that allow the analysis of 100% of the surgical margins. The embedding tissue is a critical step and prone to errors. As there is no standardization when mounting the blocks, there may be unevenness in the different samples cutting surfaces, leading to the need for continuous adjustments on the X-Y axis inside the cryostat, slowing down the process. A device was developed to solve this problem, minimizing any blocks inclination, keeping the surgical margins parallel in all samples, accelerating the process, and maintaining the histological slides high quality.

Keywords: Mohs micrographic surgery; Laboratory equipment; Histology; Tissue embedding; Innovation

Basosquamous carcinoma has a high potential for local recurrence and metastasis, especially when it recurs and at the periocular area. A 49-year-old man underwent Mohs micrographic surgery and subtotal reconstruction of the lower eyelid with cartilage graft from the helix of the ear associated with the Tripier flap, evolving with excellent functional and aesthetic results.

Keywords: Basosquamous carcinoma; Eyelid Neoplasms; Mohs surgery; Skin Neoplasms