Surg Cosmet Dermatol. 2021;13:e20210004.Abstract PDF Portuguese PDF English Text Portuguese Text English
Hematomas are common following cosmetic surgery. When minor, they are treated with observation only as they are most often reabsorbed. However, even with small collections of blood, if no early intervention is adopted, poor aesthetic outcomes may occur. Early drainage has been especially described in otorhinolaryngology and radiology journals. The authors present an approach to early treating hematomas. Special emphasis is given to the use of hyaluronidase, which is well known by dermatologists and plastic surgeons for its ability to dissolve hyaluronic acid, but its utility in the treatment of hematomas is not so commonly known by these experts.
Keywords: Hyaluronoglucosaminidase; Hyaluronic Acid; Hematoma; Fibrosis
Surg Cosmet Dermatol. 2021;13:e20210005.Abstract PDF Portuguese PDF English Text Portuguese Text English
INTRODUCTION: Cryolipolysis produces selective, controlled cooling, and it’s based on the concept that lipid-rich tissue is more susceptible to cold injury, reducing subcutaneous fat.
OBJECTIVE: To review the literature to assess the effectiveness of cryolipolysis in reducing subcutaneous fat.
METHODS: Systematic review with meta-analysis of studies published in the EBSCOhost, LILACS, and PUBMED databases.
RESULTS: Only one study did not present significant reduction in subcutaneous fat compared to the control group. There was a difference among the parameters in the studies.
CONCLUSION: Cryolipolysis is an effective tool for localized fat reduction.
Keywords: Apoptosis. Freezing. Subcutaneous Fat
Surg Cosmet Dermatol. 2021;13:e20210007.Abstract PDF Portuguese PDF English Text Portuguese Text English
The nasal region is a frequent site of keratinocyte carcinomas. Its peculiar anatomy, contour, and three-dimensionality make surgical repair challenging. Eventually, in situations of greater complexity, a single technique may not be sufficient to restore the original anatomy, requiring the association of methods. This article describes a strategy for reconstructing a full-thickness alar defect, including the nasal margin, based on the combination of a nasolabial transposition flap with a hinge flap. It is a safe procedure, dependent on the mobilization of local tissue and performed in a single surgical procedure.
Keywords: Surgical flaps. Nose neoplasms. Skin neoplasms. Mohs surgery. Carcinoma, basal cell
Surg Cosmet Dermatol. 2021;13:e20210008.Abstract PDF Portuguese PDF English Text Portuguese Text English
Tattooing is an ancient practice and very popular nowadays. The pigments used have changed over time but still present varied and poorly regulated compositions. There are many described cases of adverse effects after tattooing, mainly infectious and hypersensitivity reactions. We report the case of a 64-year-old woman, healthy, with papules on her eyebrows one month after performing micropigmentation. The excisional biopsy diagnosed molluscum contagiosum, and the lesions were curetted. There are few reports in the literature of the spread of molluscum contagiosum caused by tattooing.
Keywords: Molluscum contagiosum. Tattooing. Poxviridae infections.
Surg Cosmet Dermatol. 2021;13:e20210009.Abstract PDF Portuguese PDF English Text Portuguese Text English
Lipomas are frequent soft tissue tumors and can be found anywhere in the body; however, their location in hand is rare. They are called giants when they exceed 5 cm. In these cases, the differential diagnosis must be made with liposarcoma. These benign tumors must be characterized preoperatively with an imaging study, and their treatment is surgical. We present the case of a patient with a giant hand lipoma successfully treated with a modified Bruner incision approach.
Keywords: Lipoma; Liposarcoma; Neoplasms, adipose tissue; Hand
Surg Cosmet Dermatol. 2021;13:e20210010.Abstract PDF Portuguese PDF English Text Portuguese Text English
The reconstruction of nasal defects secondary to non-melanoma skin cancer represents a surgical challenge, especially in the nasal tip, due to its limited local laxity and possible asymmetries. There are multiple techniques to perform this closure, but most are flaps from distant locations that can lead to less aesthetic results. We present two cases of basal cell carcinoma on the nasal tip, where reconstruction with the east-west advancement flap was performed after tumor excision, with a modification of the flap in one of the patients, obtaining a good structural and aesthetic result.
Keywords: Surgical flaps; Carcinoma, basal cell; Nose; Dermatologic surgical procedures
Surg Cosmet Dermatol. 2021;13:e2021001.Abstract PDF Portuguese PDF English Text Portuguese Text English
Congenital vascular lesions can be subdivided into tumors and malformations. Hemangiomas are benign vascular tumors resulting from the abnormal proliferation of endothelial cells, whereas port-wine stains are vascular malformations of a possible autosomal dominant inheritance. To date, there are no studies associating the use of intense pulsed light and CO2 laser as a therapeutic form for these pathologies. We present a series of 10 cases of vascular injuries treated with the combination of these forms of irradiation. This combined therapy can be effective in reducing the thickness of the lesions or in attenuating the color.
Keywords: Hemangioma; Lasers, gas; Laser therapy; Intense pulsed light therapy; Vascular malformations
Surg Cosmet Dermatol. 2021;13:e20210012.Abstract PDF Portuguese PDF English Text Portuguese Text English
Basal cell carcinoma (BCC) can affect the auricular region in several locations and sizes, with or without cartilage involvement. Sometimes resections are small and reconstructions are simple. Other times, when the lesions are more extensive, reconstructions are more complex, considering the limited amount of skin in the area and the peculiarity of the structures involved. We report a case of a retroauricular flap staged in two stages, after the excision of a BCC on the posterior face of the auricle, with partial involvement of the cartilage, showing a great aesthetic and functional result both in the recipient and donor area.
Keywords: Carcinoma, basal cell; Surgical flaps; Skin neoplasms; Ear neoplasms; Rotation
Surg Cosmet Dermatol. 2021;13:e20210013.Abstract PDF Portuguese PDF English Text Portuguese Text English
INTRODUCTION: Hidradenitis suppurativa (HS) is an inflamatory, chronic, recurrent, and debilitating condition. There is a lack of consensus about its treatment.
OBJECTIVE: We conducted a review of the national and international literature, searching for articles that addressed the use of botulinum toxin in HS, in addition to describing the doses and techniques used.
METHODS: A bibliographic search was performed in LILACS, Medline, and SciELO.
RESULTS: Botulinum toxin can be an effective therapy in patients with HS, especially in cases of concomitant hyperhidrosis and traditional therapies fail. It offers the possibility of conducting treatment with minimal adverse events, reproducible over time without loss of effectiveness, in addition to reducing pain.
CONCLUSIONS: Patients will likely need more than one treatment over time, as the lesions tend to recur after 6 to 10 months. The technique used has been the standard for hyperhidrosis. Further research is needed to understand its role in the management of HS, including the ideal dosage and frequency of administration.
Keywords: Hidradenitis suppurativa; Hidradenitis; Botulinum toxins; Botulinum toxins, type A
Surg Cosmet Dermatol. 2021;13:e20210014.Abstract PDF Portuguese PDF English Text Portuguese Text English
A Covid-19, doença causadora de síndrome gripal e insuficiência respiratória aguda, vem demonstrando provocar danos a diversos outros órgãos e sistemas. Várias manifestações dermatológicas já foram descritas. Relatamos um quadro de alopecia areata (AA) desencadeada possivelmente pela Covid-19 em paciente que, apesar de ter seu RT-PCR para SARS-CoV-2 negativo, apresentou IgM reagente e sintomatologia clássica relacionada à doença. Acreditamos que a Covid-19 possa ter desencadeado resposta imunológica autoimune, com a consequente produção de interferons, que levou ao quadro de AA.
Keywords: Alopecia em áreas; Autoimunidade; Coronavirus
Surg Cosmet Dermatol. 2021;13:e20210015.Abstract PDF Portuguese PDF English Text Portuguese Text English
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
Surg Cosmet Dermatol. 2021;13:e20210023.Abstract PDF Portuguese PDF English Text Portuguese Text English
Squamous cell carcinoma (SCC) has the second highest incidence rate among non-melanoma skin cancers. About 5% of cases progress to locally advanced and/or metastatic lesions, making the surgical approach often unfeasible. Based on this, we performed a literature review on the use of immunotherapy drugs to treat advanced SCC. The results showed that immunotherapy is a potential therapeutic strategy due to the antitumor activity promotion through the individual immune response, reducing the adverse events of surgeries, chemotherapy, and radiotherapy
Keywords: Squamous cell carcinoma; Tumor Evasion; Immunotherapy; Skin neoplasms
Surg Cosmet Dermatol. 2021;13:e20210002.Abstract PDF Portuguese PDF English Text Portuguese Text English
Exogenous ochronosis is a cutaneous hyperpigmentation condition caused by the accumulation of substances derived from phenol on the skin or mucous membranes without affecting other tissues. It occurs mainly due to the use of bleaching agents, most frequently hydroquinone. The lesions are difficult to treat, being resistant to several approaches. Sometimes it’s necessary to use laser technologies or intense pulsed light to achieve some degree of improvement. The present work consists of a literature review of publications on these technologies in exogenous ochronosis from January 1990 to July 2020.
Keywords: Hyperpigmentation; Intense pulsed light therapy; Lasers; Ochronosis
Surg Cosmet Dermatol. 2021;13:e20210017.Abstract PDF Portuguese PDF English Text Portuguese Text English
The closure of large defects on the nasal dorsum is a challenge for dermatologic surgeons. The alternatives to repair the defect are a skin graft and some forms of skin flaps. One particular defect closure technique is the crescentic advancement flap, which uses crescent incisions at the nasolabial fold to accommodate the excess tissue. This flap is best used if the defect is in the lateral nose, alar, and nasolabial fold. We report a large defect of the nasal dorsum in a 65-year-old woman that was successfully reconstructed using bilateral cheek-to-nose crescentic advancement flap. The patient showed excellent cosmetic and outcome.
Keywords: Dermatology; Nasal Bone; Surgical Flaps
Surg Cosmet Dermatol. 2021;13:e20210022.Abstract PDF Portuguese PDF English Text Portuguese Text English
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
Surg Cosmet Dermatol. 2021;13:e20210028.Abstract PDF Portuguese PDF English Text Portuguese Text English
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
Surg Cosmet Dermatol. 2021;13:e20210019.Abstract PDF Portuguese PDF English Text Portuguese Text English
INTRODUCTION: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea.
OBJECTIVE: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea.
METHODS: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient.
RESULTS: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed.
CONCLUSIONS: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.
Keywords: Erythema; Rosacea; Flushing; Botulinum toxins
Surg Cosmet Dermatol. 2021;13:e20210021.Abstract PDF Portuguese PDF English Text Portuguese Text English
BACKGROUND: Sentinel Lymph Node (SLN) status has been shown to be the strongest independent prognostic factor of cutaneous melanoma (CM) stage I-II patients. Few papers on CM at private clinics (PC) are available.
OBJECTIVE: To present clinical and histologic data, complications and frequency of SLN involvement in CM patients diagnosed and followed at a dermatology/cutaneous oncology PC in São Paulo/Brazil, who were submitted to SLNB.
METHODS: Retrospective, single-center cohort of patients who attended PC from June 1998 to Jan 2020. Electronic files were selected and analyzed. Minimum period for considering the patient eligible was 1 year.
RESULTS: 215 CM lesions were identified in 184 patients(1.2 melanoma/patient). Forty-seven patients (25.5%) were submitted to SLNB and 59 SLN for histologic examination (1.2 SLN/patient). 10,9% tested positive. SLN identification happened in 95.7%. In 38/47 (80,8%) patients single LBD was found, while multiple-LBD was found in 9/47(19.1%). Eighteen(72,0%) out of 25 trunk lesions drained to single basin, while in 7 patients multiple LBD was found. Complication rate was 6,0%.
CONCLUSION: Percentage of CM patients that undergo SLNB, node positivity for metastasis, draining basins and complications in this study were similar to studies in northern hemisphere patients. Clinical and epidemiologic characteristics of CM patients differ markedly between PC and PHS patients.
Keywords: Biopsy; Melanoma; Sentinel lymph node
Surg Cosmet Dermatol. 2021;13:e20210029.Abstract PDF Portuguese PDF English Text Portuguese Text English
Oral mucosa melanoma (OMM) represents 0.2% to 8% of melanoma cases. It mainly affects the palate and gums of patients between 40 and 70 years old. It is initially asymptomatic, contributing to late diagnosis and poor prognosis. The treatment of choice consists of surgical resection, and adjuvant radiotherapy and chemotherapy may be used. We report a case in an 80-year-old male patient with primary gingival and hard palate melanoma who underwent tumor resection followed by palate reconstruction. We emphasize the importance of a complete physical examination and active search for lesions in the oral mucosa for early diagnosis.
Keywords: Melanoma; Mouth mucosa; Palate
Surg Cosmet Dermatol. 2021;13:e20210030.Abstract PDF Portuguese PDF English Text Portuguese Text English
Hot asphalt burns are a health threat due to the risk of death and adhesion to tissues.
A 40-year-old man suffered first and second-degree burns by hot asphalt on 20% of the body surface area. The asphalt adhered to the skin was removed on the 4th day of the ICU stay with liquid petroleum jelly, and the burns were treated with healing gel.
Burns caused by hot asphalt are serious and represent 1.4% of hospitalized cases. They affect young people in the skin and airways by inhaling the vapors.
Removing asphalt from the skin is a major therapeutic challenge.
Keywords: Burns. Burns, Chemical. Petroleum. Accidents. Accidents, Occupational
Surg Cosmet Dermatol. 2021;13:e20210032.Abstract PDF Portuguese PDF English Text Portuguese Text English
The "gummy smile" occurs when more than 3-4 mm of gingiva appears during the act of smiling. It is considered unattractive and causes aesthetic disharmony. It has a multifactorial etiology, with several techniques described for its correction. Myomodulation with hyaluronic acid is a non-surgical alternative with immediate and lasting results. In this article, we present a case of myomodulation with hyaluronic acid to correct "gummy smile" in a 31-year-old patient.
Keywords: Hyaluronic acid; Gingiva; Smile
Surg Cosmet Dermatol. 2021;13:e20210031.Abstract PDF Portuguese PDF English Text Portuguese Text English
INTRODUCTION: Cutaneous cancer has a high incidence, can be screened with dermatological clinical examination and confirmed by cutaneous biopsy.
OBJECTIVE: To verify the prevalence of pathological diagnoses for suspected non-melanoma skin cancer (NMSC) lesions in a Reference Service.
METHODS: Observational and cross-sectional study. Patients with indication of skin biopsy for suspected NMSC were included. Variables analyzed: age, gender, personal history of skin cancer, number of biopsies, biopsy site, and pathological outcome, divided into Group 1 (neoplastic lesions); Group 2 (premalignant lesions), and Group 3 (benign lesions).
RESULTS: A total of 287 patients, with an average of 1.33 biopsies per patient. The median age in the sample was 71 years, and 56.1% were women. Personal history of skin cancer: 44.95%. General sample: group 1: 62%; group 2: 21% and group 3: 17%. Neoplasms found: 68% were BCC, 30% were SCC, and other neoplasms: 2%. In the group of premalignant lesions: mainly actinic keratosis; in the group of benign lesions: diagnostic variety. The cephalic segment was the most frequently biopsied topography (58%).
CONCLUSIONS: In this study, we showed a higher incidence of skin cancer in women, with the majority of elderly patients being the most frequent diagnosis of BCC.
Keywords: Basal Cell; Biopsy; Carcinoma; Neoplasms; Skin neoplasms; Squamous cell.