Introduction: The subungual glomus tumor is characterized by painful nodules triggered by thermal and tactile change. A complete lesion excision is the treatment of choice but relapses are frequent. Objective: To compare the rates of recurrence of conventional surgeries described in the literature with the ones we found after the Mohs micrographic surgery (MMS). Material and ethods: We included 10 patients diagnosed with subungual glomus tumor of which 9 were female and 1 male and who also underwent withdrawal of these lesions by the technique of Mohs micrographic surgery. Results: Of the 10 patients, eight were considered cured after following 14 to 93 months (around 47.8 months). There were two recurrences which occurred after 47 and 51 months, respectively. One case was reoperated by MMS without evidence of disease after 24 months. Conclusion: The results obtained with the use of MMS in subungual glomus tumors were similar to those reported in the literature with conventional techniques, usually with more limited follow-up.

Keywords: MICROGRAPHIC SURGERY, MOHS MICROGRAPHIC SURGERY, GLOMUS TUMOR

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

The present study introduces an advancement and rotation flap that can be used for the reconstruction of surgical defects located in the malar region. The design is essentially a triangle containing the defect, where one line runs parallel to the lateral part of the nose along the nasolabial fold, while another starts at the same point and follows the dynamic lines of the malar region. In order to complete the geometrical shape of the flap, a Burow’s triangle is performed at the end of the fold. The final tension force occurs on the nasal wall, preventing ectropion. The repositioning of the malar fat restores the contour of the region.

Keywords: MOHS SURGERY, SURGICAL FLAPS, ZYGOMA

Dermatofibrosarcoma protuberans is a spindle cell neoplasm of intermediate malignancy, nonetheless it presents a high risk of local recurrence. It mainly affects the trunk and limbs, and is rare on the face. The treatment of the tumor can be carried out using conventional surgery with wide surgical margins or Mohs micrographic surgery. Radiation and chemotherapy can be indicated in selected cases. The present article reports the case of a 39-year-old male patient with a 0.7cm yellowish papule on the forehead, whose biopsy and immunohistochemistry confirmed the tumor's diagnosis. The lesion was treated through Mohs micrographic surgery with good aesthetic results.

Keywords: DERMATOFIBROSARCOMA; SARCOMA; MOHS SURGERY

Extramammary Paget's disease is a rare cutaneous neoplasm typically occurring in the vulva of Caucasian women after menopause. Clinically, the most common symptom is pruritus, when an erythematous, desquamative and eczematous lesion can be observed. Due to the rarity and nonspecific appearance of the disease, it can be confused with other dermatological conditions, delaying diagnosis. The present case demonstrates a form of vulvar extramammary unilateral Paget's disease confirmed by anatomical pathologic and immunohistochemical study. The standard treatment used for the disease in this case was surgical and the patient underwent complete excision of the lesion, with continued monitoring every six months.

Keywords: GENITAL NEOPLASMS, FEMALE; VULGAR NEOPLASMS; VULVAR DISEASES; PAGET DISEASE, EXTRAMAMMARY.

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: Extramammary Paget disease consists of a cutaneous adenocarcinoma in areas of apocrine glands. It is a rare neoplasia, and its surgical treatment yields satisfactory results. However, due to the high recurrence rates, surgeries are potentially disfiguring. Imiquimod is a topical immune-stimulant used for the treatment of anogenital warts and in situ carcinomas. Its use has been described in the scientific literature for the treatment of Extramammary Paget disease with satisfactory results.
OBJECTIVE: Describe the course of four cases of Extramammary Paget disease treated with imiquimod, to evaluate evolution and therapeutic response.
METHODS: A retrospective study was performed in a service of dermatology in the city of São Paulo, with the review of medical records of all patients diagnosed with Extramammary Paget disease and treated with imiquimod from January 2011 to July 2018.
RESULTS: Four patients were included, three with vulvar lesion and one with scrotal lesion. Two women presented completed resolution of the disease, one did not respond and the man progressed with 70% regression of the lesion, having undergone surgical excision of a considerably smaller area than the initial lesion.
CONCLUSIONS: Imiquimod presents as a valid therapeutic modality for the treatment of Extramammary Paget disease.

Keywords: Paget disease, extramammary; Neoadjuvant therapy; Gynecology; Urogenital neoplasms, female; Genital neoplasms, male; Neoplasm recurrence, local; Skin neoplasms; Therapeutics; Vulvar neoplasms;

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

Extramammary Paget’s disease (EMPD) is a rare malignancy and is quite difficult to diagnose. We report a case of a 51-year-old female patient with perianal EMPD. Because experience with this disease is still very limited, we searched international databases for similar publications. After consultation with an oncologist, the treatment was wide excision without adjuvant therapy. This treatment option was curative.

Keywords: Paget Disease, Extramammary; Surgery, Plastic; Anal Gland Neoplasms.

Eccrine spiradenoma is a rare benign epithelial neoplasm derived from the ductal and secretory portions of the eccrine sweat glands. It is characterized by slow growth and may, in some cases, undergo malignant transformation. This report describes a case involving a male patient with a painful, slow-growing lesion present for 3 years. The nodular, lobulated lesion was located on the left frontal region. Due to the left. On account of location, size, and vascularization of the lesion, as well as the need to preserve the facial musculature and ensure complete tumor removal of the tumor with minimal functional damage, Mohs surgery was chosen as the treatment technique.

Keywords: Mohs surgery; Skin; Sebaceous Glands

Extramammary Paget's disease is a slow-progressing, cutaneous adenocarcinoma of the apocrine glands with an uncertain etiology. The standard treatment is surgical removal of the tumor. However, the usual surgical methods - wide local excision and Mohs micrographic surgery - pose challenges and high recurrence rates. Often, these are extensive lesions with poorly defined boundaries located in critical anatomical regions. Additionally, they exhibit unpredictable subclinical intraepithelial spread. We present a case of a recurrent extramammary Paget's disease successfully treated with peripheric Mohs micrographic surgery associated with rapid immunohistochemistry for CK8/18.

Keywords: Paget Disease, Extramammary; Mohs Surgery; Immunohistochemistry