Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Keywords: ANESTHESIA, LIDOCAINE, AMBULATORY SURGICAL PROCEDURES, IONTOPHORESIS

INTRODUCTION: Photoprotection is indicated to reduce the exposure to cutaneous actinic damage and it is important to prevent skin cancer. The face is the most irradiated area of the body and is also where skin cancers most commonly occur.
OBJECTIVE: To evaluate the amount of sunscreen applied and its facial coverage in patients previously diagnosed with skin cancer, treated at a Brazilian public institution.
METHODS: Quasi-experimental study involving 40 patients undergoing skin cancer follow-up. Participants were asked to apply sunscreen on their face, as usual, and the mass used was measured. After, participants were photographed under Wood's light to evaluate the homogeneity of the sunscreen´s coverage, and facial sunscreen coverage failure.
RESULTS: Fourteen (35%) participants applied an estimated amount lower than recommended (2mg/ cm2). The regions with smallest coverage were the ears and the "H" area of the face.
CONCLUSIONS: The insufficient or heterogeneous sunscreen application on face, neck and ears may promote a false perception of protection, leading to irresponsible exposure. As the population ages and the incidence of skin cancers increases, it is essential to stimulate photoprotection, with appropriate information, especially among high-risk individuals.

Keywords: Sunscreening Agents; Skin Neoplasms; Sunburn; Sunlight

INTRODUCTION: Melasma is frequent among women, and it is associated with a significant psychosocial impact. The facial expressions recognition is a cognitive process directly related to our emotional and psychosocial status.
OBJECTIVES: This study evaluates the melasma patients' ability and healthy controls in identifying facial expressions reflecting six main emotions.
METHODS: This is a cross-sectional study, including 24 melasma patients and 24 healthy controls, matched for age. We collected demographic data, dermatology life quality index (DLQI), Hospital Anxiety and Depression Scale (HADS), and Social Phobia Inventory (SPIN). Also, we conducted a computerized facial emotion recognition test using 56 images.
RESULTS: The participants had a mean age of 39.8 (sd: 8.1), and the melasma patients reported a median of 84 months (p25-p75: 48-144) duration of the dermatosis and a median DLQI of 6 (2-10). Patients with melasma presented higher anxiety scores (9.4 [4] x 6.7 [4.3]; p=0.03) and showed higher accuracy in identifying emotions due to their greater success in recognizing fear (35 [13-52] x 13 [3-25]; p=0.03). The non-biased right answers' difference remained significant after multivariate analysis adjusted for the anxiety scores (p<0.01).
CONCLUSIONS: Women with melasma presented a higher accuracy in recognizing facial expressions of fear, suggesting differentiated brain processing of emotions in this population.

Keywords: Anxiety; Emotions; Melanosis

INTRODUCTION: With the advancement of digital image analysis, predictive analysis, and machine learning methods, studies have emerged regarding the use of artificial intelligence in imaging tests such as dermoscopy.
OBJECTIVE: Construction, testing, and implementation of an artificial neural network based on characteristics of dermoscopic images.
METHODS: 1949 images of melanocytic nevi and melanomas were included, both from the authors’ files and from dermoscopic image banks available on the internet, and routines and plugins were developed to extract 58 features applied to a multilayered neural network construction algorithm. Also, 52 dermatologists assessed 40 random images and compared the results compared.
RESULTS: The training and testing of the neural network obtained a correct percentage of classification of 78.5% and 79.1%, respectively, with a ROC curve covering 86.5% of the area. The sensitivity and specificity of dermatologists were 71.8% and 52%. For the same images and a cutoff point of 0.4 (40%) of the output value, the application obtained 62% and 56% values, respectively.
CONCLUSIONS: Multilayer neural network models can assist in the dermoscopic evaluation of melanocytic nevi and melanomas regarding the differential diagnosis between them.

Keywords: Artificial intelligence; Diagnosis; Melanoma; Nevus

Malignant fibrous histiocytoma (MFH) or undifferentiated pleomorphic sarcoma (UPS) is a sarcoma capable of invading adjacent structures. It is a mesenchymal neoplasia that predominates in men between the sixth and seventh decades of life. It is located mainly in the lower limbs and may affect the head and neck, trunk, and retroperitoneum, presenting a tendency to recurrence and local metastasis. This report aims to present a case of MFH in the ankle of a 49-year-old woman with an adjacent bone invasion, which evolved with transtibial amputation. Clinical, radiological, histopathological, and therapeutic aspects were addressed, highlighting the importance of early diagnosis.

Keywords: Amputation; Malignant fibrous histiocytoma; Sarcoma

Melanoma is a rare neoplasm in the pediatric population, and it is even rarer in children under 10 years of age. Total body mapping constitutes a low-cost and non-invasive method that increases diagnostic accuracy in evaluating pigmented lesions, especially in high-risk patients. We reported the case of a 9-year boy with dysplastic nevus syndrome, in which one lesion presented a subtle change (asymmetry of structures) within a 6-months follow-up. Its excision resulted in melanoma with a Breslow thickness of 1 mm and a negative sentinel lymph node. Total body mapping reduces the number of unnecessary excisions. It allows diagnosis of melanomas in early and potentially curable stages, especially in children and patients with risk factors such as dysplastic nevus syndrome. We report this case due to the rarity of the neoplasia in this age group and also to demonstrate the importance of sequential digital dermoscopy in early diagnosis of melanoma in this population.

Keywords: Dermoscopy; Melanoma; Dysplastic nevus syndrome

BACKGROUND: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies.
OBJECTIVE: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution.
METHODS: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education.
RESULTS: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01).
CONCLUSIONS: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response.

Keywords: Trichloroacetic acid; Cryosurgery; Sexually transmitted diseases; Papillomavirus infections; Warts

INTRODUCTION: Actinic keratoses are premalignant lesions with a risk of transformation to invasive squamous cell carcinoma. There is no identified correlation between clinical classification and histological grade of these lesions.
OBJECTIVES: To correlate the clinical characteristics of actinic keratoses of the forearms and back of the hands with the degree of histological atypia (Keratinocyte Intraepidermal Neoplasia); to develop and validate a clinical severity scale correlated with the histological grade of actinic keratoses.
METHODS: Cross-sectional study with 162 actinic keratoses clinically evaluated for diameter, erythema, infiltration, hyperkeratosis, and exulceration and 34 lesions with different patterns were biopsied. Clinical features were correlated with the degree of histological atypia and p53 and Ki-67 expression.
RESULTS: Only the diameter of the lesions was significantly correlated with the degree of atypia (p=0.04), and only the erythema, hyperkeratosis, and the diameter linked with the immunohistochemical markings. A clinical score including diameter, hyperkeratosis, and exulceration was developed, which associated significantly with the degree of atypia (Spearman’s Rho=0.43; p=0.01).
CONCLUSIONS: A score composed of diameter, hyperkeratosis, and exulceration correlated with the histological grade of actinic keratoses of the upper limbs was developed.

Keywords: Carcinoma in situ; Carcinoma squamous cell; Keratosis actinic; Skin diseases

Low-grade fibromyxoid sarcoma (LGFS) is a rare, indolent spindle cell sarcoma with a risk of recurrence and metastasis. We report the case of a 34-year-old man with a tumor in his thumb that had recurred after excision eight years ago, with slow and progressive growth. The pathological examination was suggestive of SFBG, and we proceeded with the disarticulation of the phalanx. The patient remains in follow-up, with no evidence of metastases. Although rare, it is essential to recognize the diagnosis of an LGFS with its potential risk of recurrences and metastases, especially as a differential diagnosis of acral soft tissue tumors.

Keywords: Dermatology; Neoplasms; Sarcoma

Eruptive vellus hair cyst is a rare and benign dermatological condition in the development of vellus-type hair follicles. It affects mainly children and young adults, and is characterized by multiple asymptomatic papules, especially on the trunk. We report the case of a 33-year-old white man who presented multiple erythematous papules and pustules located on the trunk for about five years, refractory to topical treatments for acne. Dermoscopy revealed oval lesions with eccentric exulceration and rare protruding filiform structures. We established the diagnosis of eruptive vellus hair cyst based on the findings of dermoscopy and histopathological examination.

Keywords: Cysts; Acneiform eruptions; HIV

Extraskeletal Ewing sarcoma (EES) is a rare tumor that affects men between 10-20 years old and represents 25% of Ewing sarcomas. We report a case due to the previous diagnosis of a fast-growing lipoma to highlight the importance of histopathological diagnosis. A 14-year-old boy presented 10x10 cm tumor in the right shoulder for a year with ultrasonography suggesting lipoma. The lesion was excised and EES was confirmed by immunohistochemical analysis. EES diagnosis in young people is challenging compared to subcutaneous tumors, and histopathology is essential. The rapid progression of the tumor and high metastatic rates highlight the significance of early treatment.

Keywords: Sarcoma, Ewing; Neuroectodermal tumors; Sarcoma

INTRODUCTION: Many options for anogenital warts (AGWs) treatment are available. Recently, trichloroacetic acid (TAA) and liquid nitrogen (LN) began to be associated to treat AGWs.
METHODS: Randomized, parallel, controlled clinical trial involving patients with penile AGWs. Patients were treated with LN, TAA, or their combination and reevaluated after 28 days.
RESULTS: Among therapy with TAA, LN, and their combination, the clearance rate was 22.9% (95% CI: 8.6%-34.3%), 46.2% (95% CI: 30.8%-59.0%), and 25.7% (95% CI: 11.4%-37.2%), respectively.
DISCUSSION: All therapeutic options were effective. Though, there was no statistically significant difference between the groups.

Keywords: Nitrogen; Papillomavirus infections; Sexually transmitted diseases; Cryotherapy

We report a case of a 72-year-old man who underwent surgical excision of a keratoacanthoma centrifugum marginatum (KCM) located on the left forearm. It is an uncommon variant of keratoacanthoma, which can assume large dimensions (up to 20 cm) and does not tend to spontaneous regression. The lesion is usually single, with raised borders, and has progressive centrifugal growth associated with central healing and atrophy. Due to its rarity and lack of pathognomonic histopathological features, KCM can be a diagnostic challenge for dermatologists and pathologists.

Keywords: Keratoacanthoma; Neoplasms; Skin neoplasms

INTRODUCTION: An 85% phenol and 4% croton oil solution (SFC) has cytotoxic effect on the epithelium; however, it has not been evaluated in the treatment of anogenital warts (AGW).
OBJECTIVE: To evaluate the effectiveness of SFC in the treatment of penile AGW in immunocompetent patients.
METHODS: Open, uncontrolled clinical trial (proof-of-concept), involving patients with penile AGW treated with SFC and reevaluated after 28 days.
RESULTS: We evaluated 16 treatments in 9 participants. SFC promoted total clearance of the lesions in 25% (95% CI 2-48%) of treatments.
CONCLUSIONS: Although well tolerated, SFC caused insufficient rates of total clearance.

Keywords: Condylomata Acuminata; Phenol; Papillomavirus Infections; Sexually Transmitted Diseases.