Introduction: One of the most challenging dermoscopic situations is to distinguish between early melanomas and doubtful benign nevi. At times, suspicious melanocytic lesions have dermoscopic features similar to melanomas, thus leading to excessive excisions of lesions.
Objective: To develop a dermoscopic model that helps to differentiate the doubtful nevus from the early melanoma.
Material and methods: A total of 219 histopathologically confirmed dermoscopic images were analyzed and a comparison between doubtful nevi and early melanomas was then performed.
Results: The final model was based on three dermoscopic features: radial streaming, blue hue and vascular structures. If all three features were absent, it was most likely a nevus; if one dermoscopic feature was present, it could be a nevus or melanoma; if two features were present, there was a greater probability of melanoma diagnosis; if three features were present, it was melanoma.

Keywords: DERMOSCOPY, MELANOMA, NEVUS, PIGMENTED

New imaging methods, such as optical coherence tomography, magnetic resonance and high frequency ultrasonography, have been developed for use in dermatology. Among the new methods, in vivo reflectance confocal microscopy, has presented the fastest growth in large cutaneous oncology centers and has generated the greatest number of articles in the literature recently, due to its resolution – similar to histological resolution. In vivo confocal microscopy has been particularly useful given the many limitations of the dermoscopic diagnosis of cutaneous neoplasias, especially of achromic or hypopigmented lesions, lesions in the face or in mucous membranes. Some studies have also suggested considerable utility in the assessment of surgical margins and in determining the best area of the body for carrying out excisional biopsies. This study briefly describes how the confocal laser reflectance microscope works and discusses some of the issues that arise in its use in the daily practice of dermatologic surgeons.

Keywords: MICROSCOPY, CONFOCAL, DETECTION OF CANCER, SKIN NEOPLASMS

The prognosis of cutaneous melanomas depends mainly on the lesions' thickness; early detection is of paramount importance for patient longer survival rates. An accuracy of approximately 90% can be achieved using dermoscopic assessment. Since early melanomas might not present specific dermoscopic features, they can only be diagnosed by observing alterations over time through total body mapping and serial digital dermoscopy. Patients with atypical nevus syndrome and multiple familial melanoma presented a higher sensitivity for the detection of melanoma using that technique.

Keywords: MELANOMA; DERMOSCOPY; DYSPLASTIC NEVUS SYNDROME.

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

Introduction: In vivo confocal microscopy is an auxiliary non-invasive diagnostic method used in the diagnosis of hyperpigmented lesions in scars. Objectives: To evaluate hyperpigmentation in the scars of benign and malignant melanocytic lesions through confocal microscopy examination. Methods: Clinical, dermoscopic, and confocal microscopy images of fourteen patients with hyperpigmentation in adequately treated melanoma scars and in excised melanocytic nevi, were evaluated. Results: Among the eight patients with hyperpigmentation in melanoma scars, four showed no suspicious structures after confocal microscopy examination and four showed suspicious structures. Among the six patients with hyperpigmentation in areas where melanocytic nevi had been excised, three had atypical structures, such as dendritic cells and non demarcated papillae. Patients with suspicious structures underwent histological examination, with one case of hyperpigmentation in a lentigo maligna scar evidencing recurrence. Conclusions: The examination method allowed for the avoiding of biopsy in confirming the diagnosis in six of the fourteen patients. The finding of cells with dendritic or pagetoid pattern in the confocal microscopy examination means a diagnostic challenge, for it can indicate melanocytes or Langerhans cells in the spinous layer. Therefore, lesions that have such structures must be removed for histology and differential diagnosis.

Keywords: MELANOMA, NEVUS, DERMOSCOPY, CONFOCAL MICROSCOPY.

Early diagnosis of basal cell carcinoma-a cutaneous neoplasia with high incidence-can bring great benefits to the patient. Often, slightly pigmented lesions, small initial lesions, and superficial lesions can represent a clinical and dermoscopic diagnostic challenge for not having the typical findings of this neoplasia. In such cases, optical coherence tomography-a promising technology in dermatology-is an auxiliary, non-invasive resource that can be incorporated into the clinical practice.

Keywords: BASAL CELL CARCINOMA, DIAGNOSTIC IMAGING, OPTICAL COHERENCE TOMOGRAPHY.

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.

Recurring nevus or pseudomelanoma is a benign melanocytic lesion that appears in the same location after an incomplete surgical removal of nevi. These pigmented melanocytic lesions can in some cases be a diagnostic challenge when examined through dermoscopy, especially if there is a clinical history of growth or recurrence of the lesion, as happens with the recurrent nevus phenomenon. Confocal reflectance microscopy is an in vivo non-invasive imaging technique with high histomorphological resolution of the skin that can be used to differentiate between benign and malignant lesions, increasing the in vivo diagnostic accuracy. Nonetheless, in some cases only the histological and immunohistochemical examinations of the complete lesion can clarify the diagnosis.

Keywords: CARCINOMA, BASAL CELL; EPIDEMIOLOGY; SKIN NEOPLASMS; PATHOLOGY; DERMATOLOGY

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

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