Exogenous ochronosis is a chronic skin disorder characterized by dermal hyperpigmentation, often resulting from prolonged use of hydroquinone. This review analyzed 29 studies (2000-2025) assessing treatments for exogenous ochronosis. Laser and light-based therapies, particularly in combination regimens, showed the greatest efficacy, while microneedling and chemical peels provided moderate improvement. Topical agents alone offered limited benefit. Post-inflammatory hyperpigmentation was the most frequent adverse event. Emerging modalities, including intradermal vitamin C, exosome therapy, and platelet-rich fibrin lysate, demonstrated promising early results. Overall, multimodal and light-based therapies appear to be the most effective; however, further controlled studies are essential to confirm their safety and long-term outcomes.

Keywords: Ochronosis; Hyperpigmentation; Dermabrasion

BACKGROUND: TikTok is a short-video platform popular among the young, the age group most affected by acne. Health-related content is often produced by creators without academic backgrounds in health care, raising concerns about information quality and reliability.
OBJECTIVE: To evaluate the educational quality, reliability, and evidence-based accuracy of TikTok videos on acne treatment in Brazilian Portuguese.
METHODS: The top 30 videos for “tratamento da acne” (acne treatment) were selected using a new TikTok account. Educational quality was assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V), accuracy using the 2024 American Academy of Dermatology (AAD) Guidelines of Care for the Management of Acne Vulgaris, and reliability using the Journal of the American Medical Association (JAMA) Benchmark Criteria.
RESULTS: Only 10% of videos recommended treatments consistent with AAD guidelines. No non-medical creator provided correct recommendations, and only 33% of physician-created videos were correct. PEMAT-A/V scores were high, indicating well edited and understandable content, whereas JAMA scores were uniformly low, reflecting poor reliability..
CONCLUSIONS:Caution is warranted when using TikTok as a source of information on acne treatment in Brazilian Portuguese, as most videos analyzed were incorrect or imprecise.

Keywords: Acne Vulgaris; Cross-sectional studies; Social Media; Health Communication

INTRODUCTION: Dermatologic surgery is widely used in the treatment of cutaneous neoplasms, but early and late complications remain underreported despite their functional and aesthetic impact.
OBJECTIVE: To analyze complications in dermatologic surgery and their correlation with the repair technique, anatomical location, and tumor subtype.
METHODS: A retrospective study of 107 lesions from 86 patients who underwent resection of skin tumors under local anesthesia between May 2023 and March 2024. Clinical, histological, and technical variables were assessed. Early complications (≤ 4 weeks) and late complications (1-6 months) were analyzed using SPSS v.29 (p < 0.05).
RESULTS: Mean patient age was 73.3 years, and 57% were women. Most lesions were located on the face (69.2%), and basal cell carcinoma was the most frequent subtype (64.5%). Primary closure was performed in 49.5% of cases, and flaps in 44.9%. Early complications occurred in 42.1%, mainly dehiscence; late complications occurred in 13.1%, predominantly unaesthetic scars. Flaps had higher rates of early (53.7% vs. 30.2%) and late complications (25.9% vs. 1.9%). Lower-limb lesions showed a high complication rate. Early complications strongly correlated with late events (33.3% vs. 2.1%)..
CONCLUSIONS: Complications are frequent and influenced by technique and location. Complex techniques and early events increase the risk of late outcomes.

Keywords: Dermatology; Skin Neoplasms; Surgical Flaps; Medical Oncology; Postoperative Complications

Nodular hidradenoma is a rare benign adnexal tumor originating from the sweat glands, which clinically presents as a tumor mimicking primary or metastatic malignant lesions. Dermoscopy, as well as clinical characteristics, reveals structural patterns that allow for broad differential diagnoses. Dermatological ultrasonography has become a scientifically recognized diagnostic tool to enable early and accurate diagnosis of hidradenoma, supporting surgical treatment and histopathological analysis. This study reports a rare case of nodular hidradenoma, highlighting the diagnostic innovation achieved through low-frequency ultrasonography, which includes clinical, radiological, and histopathological characteristics.

Keywords: Skin neoplasms; Ultrasonography; Diagnostic imaging; Clinical diagnosis

Scalp reconstructions can be challenging for dermatologic surgeons because the site has little elasticity and is located over a convex, rather than flat, area. The pinwheel flap is a type of rotational flap used for the vertex region of the scalp. We describe two cases, one male and one female, using the technique to reconstruct defects after skin cancer excisions in the vertex and the frontal region of the scalp.

Keywords: Scalp; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Surgical Flaps

Angiokeratoma circumscriptum is a rare vascular malformation characterized by dilated papillary dermal vessels associated with epidermal hyperkeratosis. This study reports the case of a 10-year-old male patient presenting violaceous, verrucous plaques on the right forearm since birth, with recurrent bleeding after minor trauma. Diagnosis was established through clinical, dermoscopic, and histopathological findings. Cryotherapy with liquid nitrogen was chosen as treatment using freeze-thaw cycles. The procedure led to a marked reduction in bleeding episodes and improvement in functional and psychosocial aspects. Cryotherapy proved to be a safe, effective, and minimally invasive therapeutic option for angiokeratoma circumscriptum.

Keywords: Vascular Malformations; Angiokeratoma; Cryotherapy

Odontogenic cutaneous fistulas represent a tract between the oral cavity and the skin. They are manifestations of pulpal necrosis and chronic apical periodontitis, caused by caries, infections, or trauma. Cutaneous manifestations include nodules and cysts and may present with perilesional retraction. They pose a diagnostic challenge, as most patients do not report toothache. We report a case with delayed diagnosis due to lack of clinical suspicion where the patient underwent multiple treatments, including surgery, because of clinical resemblance to cutaneous neoplasia. The lesion resolved completely after dental treatment.

Keywords: Oral Fistula; Fistula; Carcinoma, Basal Cell

Basal cell carcinoma is the most frequent periocular neoplasm. Although mortality is low, orbital invasion represents a severe complication associated with high morbidity. We report the case of a 49-year-old male smoker with an aggressively evolving periocular lesion culminating in amaurosis. Treatment included orbital exenteration and complex reconstruction using local and regional flaps, complicated by partial necrosis and bone exposure, requiring multiple debridements. Histopathological examination revealed a sclerodermiform pattern with squamous differentiation. This case highlights the devastating consequences of locally advanced basal cell carcinoma as well as the importance of early diagnosis and a multidisciplinary approach to prevent deformity and loss of function.

Keywords: Carcinoma, Basal Cell; Orbital Exenteration; Skin Neoplasms

Frontal fibrosing alopecia (FFA) is a condition characterized by cicatricial alopecia affecting the frontal hairline, causing aesthetic and psychosocial repercussions. This case report describes a 47-year-old patient with no comorbidities and stable FFA. After two years of clinical treatment, she underwent frontoplasty combined with Follicular Unit Extraction (FUE) hair transplantation, with implantation of 2,100 follicular units. Combining the two surgical techniques in a single procedure proved safe and effective, with good aesthetic results after 15 months. Disease stabilization and a multidisciplinary intervention were key. A combined approach of medical and surgical treatment is feasible and enhances results in selected cases.

Keywords: Alopecia; Hair; Atrophy; Lichen planus

Amivantamab is a bispecific anti-EGFR and anti-MET monoclonal antibody indicated for non-small cell lung cancer harboring EGFR exon 20 insertion mutations. Although effective, it may cause cutaneous adverse events such as paronychia and pyogenic granulomas. We report a case of periungual pyogenic granuloma in a patient undergoing amivantamab therapy, emphasizing the causal relationship, clinical evolution, and surgical management. Early recognition and a multidisciplinary approach are crucial to maintain oncological treatment while ensuring adequate control of dermatologic manifestations.

Keywords: Granuloma, Pyogenic. Drug-Related Side Effects and Adverse Reactions; Molecular Targeted Therapy

Granular cell tumors are rare neurogenic neoplasms, usually benign, with a nonspecific clinical presentation. We report the case of a 70-year-old woman with an ulcerated nodular lesion on the arm, showing progressive growth, pain, and pruritus. Findings from complementary examinations, including magnetic resonance imaging, histopathological examination, and immunohistochemistry, confirmed, respectively, an expansive subcutaneous mass, a proliferation of polyhedral cells with granular cytoplasm, and positivity for the S100 protein, consistent with a diagnosis of granular cell tumor. The report discusses the importance of early diagnosis, complete surgical excision, and clinical follow-up to prevent recurrences and to monitor the rare risk of malignancy.

Keywords: Granular Cell Tumor; Schwann Cells; Neoplasms by Site

Amelanotic malignant melanoma (AMM) is a rare and diagnostically challenging variant, especially when located on tattooed skin, where visual clues may be obscured. We report the case of a young male patient with AMM over a deltoid tattoo, initially misdiagnosed as a benign lesion.

Histopathology revealed melanoma in situ with a Breslow thickness of 0.7 mm. This case deviates from the typical AMM profile and raises questions about the potential role of tattoos in skin carcinogenesis. Although a causal link is unproven, the rising prevalence of tattoos highlights the need for clinical vigilance and further research into this possible association.

Keywords: Melanoma; Melanoma, Amelanotic; Tattooing

This Letter to the Editor comments on the article “Lip reconstruction using superficial flaps: functional and aesthetic integration.” The reported case series provides valuable clinical examples of individualized superficial flap selection for upper and lower lip reconstruction following excision of non-melanoma skin cancer. We emphasize the importance of tailored reconstructive planning while suggesting that objective functional outcome measures and clearer flap-selection criteria could further strengthen the translational impact of the study.

Keywords: Plastic Surgery Procedures; Surgical Flaps; Dermatologic Surgical Procedures