Introduction: Local anesthesia is the most common form of anesthesia used in cutaneous surgery. Some patients have comorbidities that put them at risk for general anesthesia.Tumescent anesthesia is the technique of injecting a large amount of dilute local anesthesia into the subcutaneous plane of the skin.Tumescent anesthesia can minimize discomfort, aid in hemostasis, and contribute to the ease of closing large surgical defects that would otherwise be challenging. Objective: To discuss the pros and cons of using tumescent anesthesia in dermatologic surgery. Conclusion: Tumescent anesthesia is a viable option that can aid in cutaneous reconstructive surgery, especially when removing tissue in the deeper subcutaneous fat or fascia.Tumescent anesthesia is also associated with good results and few adverse reactions.

Keywords: ANESTHESIA, SKIN NEOPLASMS, MOHS SURGERY

Mohs Micrographic Surgery is regarded as a very useful technique for the excision of difficult to han- dle skin cancers. The procedure is divided into clearly defined steps: tumor evaluation and marking, tumor exeresis, tissue preparation and mapping, histologic processing and analysis, and closing of the surgical wound. The histologic analysis of all surgical margins leads to higher cure rates and tissue conservation, which make the procedure safer and more reliable.

Keywords: SKIN NEOPLASMS, MOHS SURGERY, FROZEN SECTIONS

Trichoblastoma is a slow-growing and well-circumscribed rare adnexal tumor. Although considered a benign neoplasm, there are cases of aggressive trichoblastomas. This paper reports a case of a 66-year-old female patient with a recurrent and continuously growing tumor in the right nasal wing that was treated with Mohs Micrographic Surgery.

Keywords: MOHS SURGERY, SKIN NEOPLASMS, SURGICAL FLAPS

Introduction: The paramedian forehead flap has been used for centuries in nasal reconstruction. It is a unique flap in terms of restoring complex nasal defects. It can adequately restore contour, texture, projection of the nasal tip and convexity of the ala, especially when combined with cartilage grafting. Objectives: To evaluate the versatility of the paramedian forehead flap in nasal reconstruction following Mohs micrographic surgery, especially in an outpatient setting and under local anesthesia. Furthermore, to discuss traditional approaches versus more recent refinements on its design and execution. Methods: Retrospective study of patients with surgical defects resulting from Mohs micrographic surgery that have been repaired using the paramedian forehead flap. Results: Nineteen patients were included in the study. Restoration or the nasal mucosa was required for full thickness defects in 4 (22%) patients. Structural support provided by auricular cartilage graft was required in 12 (67%) patients. The flap pedicle was designed ipsilaterally to the defect in 14 (74%) patients. Complications were minimal and unusual. Conclusions: The paramedian forehead flap is a valuable technique in the repair of extensive and deep nasal defects following Mohs micrographic surgery. With proper surgical planning, adequate measures for patient comfort, and meticulous technique, the paramedian forehead flap can be safely performed in an outpatient setting, achieving unique results in nasal reconstruction.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: The nasolabial interpolation flap is an essential flap in nasal reconstruction. Its main indications are deep and extensive defects of the nasal ala. Objectives: To evaluate the usefulness of the nasolabial fold interpolation flap for alar reconstruction after Mohs micrographic surgery-especially in an outpatient setting and under local anesthesia-as well as to discuss refinements in its design and execution. Methods: Retrospective study of patients with nasal ala defects resulting from Mohs micrographic surgery repaired with nasolabial interpolation flap. Results: Eighteen patients were included in the study; 7 (39%) had localized defects in the ala only and were reconstructed with an isolated nasolabial interpolation flap; however 11 (61%) had defects involving both the ala and some adjacent anatomical subunit. These patients underwent a combined reconstruction. Resection of the remaining portion of a subunit was performed in 14 (78%) cases. There were no complications or recurrence after an average follow up of 29 months. Excellent functional and aesthetic results were achieved in all patients. Conclusions: The nasolabial interpolation flap is essential in the reconstruction of alar defects after Mohs micrographic surgery. If adjacent subunits are involved-such as the medial cheek or nasal sidewall-the nasolabial interpolation flap must be combined with another method of repair. The flap can be safely performed in an outpatient setting.

Keywords: MOHS SURGERY; SURGICAL FLAPS; NOSE NEOPLASMS.

Introduction: Mohs micrographic surgery is a technique that offers high cure rates for non-melanoma skin cancer.
Objective: To describe the clinical and epidemiological profile of patients who underwent Mohs micrographic surgery in a reference center in dermatologic surgery.
Methods: Medical records of patients who underwent Mohs micrographic surgery in the period 2014-2015 at a dermatology reference center, in the city of Mogi das Cruzes (SP, Brazil), were analyzed.
Results: The patients' ages ranged from 38 to 87 years; of these 54% were women. The most affected topography was the nose (54% of patients). Previous history of skin cancer was positive in 62% of cases. The indication driver for micrographic surgery was the lesion's location in 67% of the patients, followed by the size (23%) and tumor recurrence (10%). The most prevalent intraoperative diagnosis was basal cell carcinoma (90%).
Conclusions: Mohs micrographic surgery is an excellent therapeutic option in cases of tumors of aggressive nature, large diameter and high-risk location. This study is in line with the current literature regarding the epidemiological data linked to the occurrence of nonmelanoma skin cancer.

Keywords: MOHS SURGERY; SKIN NEOPLASMS; DERMATOLOGIC SURGICAL PROCEDURES

Introduction: In the dermatologic surgery practice, Mohs micrographic surgery is of great value in the excision of cutaneous neoplasias. Nevertheless, in certain types of neoplasia, immunohistochemistry can increase diagnostic accuracy.
Objective: To describe the use of Mohs micrographic surgery associated to immunohistochemistry and evaluate their effectiveness regarding traditional methods.
Method: Mohs micrographic surgery was performed in 5 cases of diverse cutaneous neoplasias. Tissue evaluation with hematoxylin-eosin and immunohistochemistry were carried out intraoperatively.
Results: There was greater prevalence of elderly female patients with higher frequency of recurred basal cell carcinomas in the face. In all cases it was possible to perform immunohistochemistry in the frozen specimen. In most cases, primary closure was carried out in the first stage of the Mohs surgery, without postoperative complications.
Conclusion: The combination of the two techniques can increase the procedure's sensitivity, guaranteeing the presence of free margins, leading to fewer recurrences and allowing the preservation of a greater amount of neoplasia-free tissue.

Keywords: MOHS SURGERY, IMMUNOHISTOCHEMISTRY, SKIN NEOPLASMS

Introduction: The cutaneous upper lip is often affected by malignant skin neoplasms. Surgical treatment is preferred for most lesions in this site. Whenever available, tumors in the perioral area should be managed with Mohs micrographic surgery.
Case report: The author of the present article describes the implementation of a rotation flap in the cutaneous upper lip of a patient who underwent Mohs micrographic surgery.
Discussion: There are a number of options for repairing surgical defects in the cutaneous upper lip. When primary closure is not possible, rotation flaps are considered because they allow camouflaging of the rotation arc in the nasolabial fold, and the other incisions in the perioral rhytids.

Keywords: LIP NEOPLASMS; MOHS SURGERY; SURGICAL FLAPS

To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Keywords: Histology; Mohs Surgery; Skin Neoplasms

We report the case of a 13-year-old girl with a diagnosis of extra-abdominal desmoid fibromatosis, a neoplasm of benign origin but uncommon in the soft tissues. This study aims to expose the rarity of the tumor and its challenging therapeutic approach due to its high frequent local recurrence rates. For the treatment, Mohs micrographic surgery was performed in two stages to obtain a free margin.

Keywords: Fibromatosis, Aggressive; Mohs Surgery; Neoplasms

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

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

Sarcomas são neoplasias mesenquimais malignas, raras, que acometem, principalmente, crianças e adolescentes. O rabdomiossarcoma, subtipo oriundo da musculatura esquelética, é condição incomum em adultos, acometendo sítios de localização não habitual, crescimento rápido e de difícil tratamento. Apresenta-se caso de adulto jovem com nodulação em lóbulo auricular esquerdo, cuja análise histopatológica e imuno-histoquímica confirmou tratar-se de rabdomiossarcoma alveolar, o qual foi conduzido em conjunto com a Oncologia.

Keywords: Rabdomiossarcoma Alveolar; Miogenina; Desmina; Excisão de Linfonodo

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

Histopathology reports are the pathologist's description of a microscopic morphological image, which can be understood as long as the basic elements of the histological structures are known. However, actually viewing the morphological image can be more helpful in understanding what is really being described, similar to the examination of radiograms, which is directly performed by the orthopedist despite the report being made by the radiologist. This article discusses this scenario, with the aim of encouraging surgeons to view and inspect morphological images to improve their understanding of the clinical-surgical status and their analysis of the state of the surgical margins or the histological subtype.

Keywords: Mohs Surgery; Official laboratory; Pathology; Reoperation; Skin Neoplasms