Introduction: Mohs Micrographic Surgery is a well-known and established method in the United States, and is currently considered the gold standard treatment in many cases involving cutaneous neoplasias. Since it was first described by Dr. Frederic E. Mohs, the micrographic surgery technique has been continuously changed and adapted to better suit the daily life needs of dermatologic surgeons. This article examines different and innovative Mohs Micrographic Surgery techniques.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, CARCINOMA, SQUAMOUS CELL

Neurofibromatosis type 1, also known as von Recklinghausen neurofibromatosis, is an autosomal dominant disorder that affects 1 in 3,000 newborns. Approximately 50% of neurofibromatosis type 1 patients have no family history of the disease. The tongue, the alveolar ridge of the buccal mucosa, gums, lips, palate, floor of the mouth, and pharyngomaxillary fossa can be affected by tumors associated with this condition; the tongue is the most common site. We report the case of a 29-year-old female patient with neurofibroma in the tongue, highlighting the possibility of disease manifestations in the oral cavity and differential diagnoses.

Keywords: NEUROFIBROMATOSIS 1; NEUROFIBROMA, PLEXIFORM; NEUROFIBROMA; TONGUE NEOPLASMS.

Introduction: The reconstruction of surgical defects resulting from the excision of tumors in the nose is a challenge for dermatologic surgeons due to its rigid structure and low mobility. The Mohs Micrographic Surgery technique allows the preservation of healthy tissue and leads to a smaller surgical wound. Objective: To demonstrate techniques for surgical correction of defects after removal of tumors of the nose through Mohs Micrographic Surgery, according to the anatomical location of the tumor. Methods: Descriptive study of patients operated on using Mohs Micrographic Surgery during the period 1996-2010. Patient images taken pre-, intra-, and post-operatively were analyzed with the aim of classifying the defect's anatomic location and the type of surgical reconstruction adopted. Results: 170 patients (totaling 203 lesions) were included in the study. The most common locations for tumors were (in descending order): nasal ala, dorsum, tip, and lateral wall. The advancement flap was the most common reconstruction type for lesions located in the lateral wall and in the nasal ala. Grafts were most often used in lesions located in the tip of the nose. Grafts and advancement flaps were more frequently used in the dorsum of the nose. Conclusions: The parameters that provide guidance on choosing the best reconstruction method must take into consideration the size and location of the surgical defect.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, CARCINOMA, SQUAMOUS CELL

Introduction: Mohs micrographic surgery is a treatment option that increases the cure rate in various types of skin cancer, offering greater tissue preservation and lower recurrence rates. Objective: To describe clinically and histologically the tumors operated on with Mohs micrographic surgery, and to draw correlations to the number of stages and the type of surgical reconstruction performed. The operations were performed at a private clinic in the municipality of Rio de Janeiro, Brazil that is a specialist center for this technique. Methods: Retrospective, observational, cross-sectional/transversal study was carried out based on the review of medical records. Results: A study was conducted of 93 tumors in 84 patients, operated on between April 2010 and August 2012, and followed up with until August 2013 (12 to 42 months). Findings: 47.61% of patients were men and 52.38% were women, the mean age was 62.89 years; predominant phototypes: II (44%) and III (43%); 6 cases (6.45%) of squamous cell carcinoma, 87 (93.54%) of basal cell carcinoma; 74.19% were primary tumors; the nose was the most frequent site (46.24%); a single surgical stage was performed in most cases, with flaps (44%) being the more frequently performed type of closure. There was recurrence in one patient, who required reoperation in October 2012 and followed without new recurrence. Conclusions: Mohs surgery has proven effective with high cure rates and a minimal recurrence rate, especially in lesions located in the face's H area of risk.

Keywords: MOHS SURGRY, CARCINOMA, BASAL CELL, CARCINOMA, SQUAMOUS CELL.

Introduction: Infrared radiation (IR-A) causes structural changes in the skin, similar to those caused by prolonged exposure to ultraviolet radiation. Evaluation of efficacy and safety of cosmetic products concentrates in in vitro tests and clinical trials. A promising alternative is the use of fragments of human skin from elective cosmetic surgery, to evaluate the actual clinical benefits of a product applied topically.
Objective: The objective of this study was to correlate IR-A radiation effects in biopsies and in ex vivo skin fragments and in human fibroblasts culture by quantifying MMP-1, TIMP-1 and GADD45a mediators.
Methods: Collection of biopsies from 15 volunteers after IR-A applications for 5 consecutive days. Exposure to IR-A radiation of human skin fragments from elective cosmetic surgery, and human fibroblasts culture. Measurement of MMP-1, TIMP-1 and GADD45a mediators for further comparison of results.
Results: In the three models used, the IR-A radiation induced an increase in MMP-1, inhibited the synthesis of GADD45a, and did not changed TIMP-1 values.
Conclusion: Due to the positive correlation of the models studied, it may be suggested the use of ex vivo skin as plausible and sustainable tool to overcome differences between knowledge generated from in vitro and clinical experiments.

Keywords: SKIN AGING; MATRIX METALLOPROTEINASE 1; SOLAR RADIATION; IN VITRO TECHNIQUES

One of the resources available aimed at improving skin quality are chemical peels, that can include the use of several active substances. Superficial peels reach the epidermis only and usually cause a slight desquamation for cell renewal, however they are not free of complications. The authors present a report of a patient who had contact dermatitis linked to retinoic acid, after undergoing a combined peeling procedure with Jessner's solution followed by 5% retinoic acid.

Keywords: Chemexfoliation; Receptors, retinoic acid; Skin aging

INTRODUCTION: The interaction between the skin and air pollutants has demonstrated effects in the cutaneous barrier, as well as triggering oxidative processes related to premature ageing of the skin. The aryl hydrocarbon receptor (ArH) is a transcription protein that interacts with xenobiotics, regulating the transcription of genes involved with oxidative stress, inflammation, immunosuppression and pigmentation, besides leading to processes related to ageing and carcinogenesis.
OBJECTIVE: Evaluate the anti-pollution efficacy of an antioxidant association for the prevention of the nuclear translocation of the AhR receptor.
METHODS: A in vitro model (keratinocyte culture) was exposed to cigarette smoke and the presence of AhR was measured through sanduwich ELISA assay.
RESULTS: The treated culture demonstrated inhibition of the nuclear translocation of AhR in all concentrations evaluated: ArH increase of 75.38%; 59.88% and 117.79% are seen with the concentrations of 0.316; 0.100 and 0.0316mg / mL, respectively.
CONCLUSION: The results suggest the ability of the formulation analyzed in preventing the activation of genes responsible for the damaging effects of cigarette smoke.

Keywords: DNA Damage; Air Pollution; Aryl Hydrocarbon Receptor Nuclear Translocator

Type 1 neurofibromatosis has multiple cutaneous lesions and limited treatment options. CO₂ laser is a useful tool for the removal of neurofibromas, the main source of cosmetic disfiguration for these patients. We present the treatment of neurofibromas with CO₂ laser in a patient over 4.5 years. The patient had lesions with variable diameter, diffusely distributed. After 16 sessions of CO₂ laser, we observed clinical improvement. Although it is a palliative treatment, the cosmetic improvement achieved substantiates the demanded effort and time in view of the psychological gains for the patient.

Keywords: Lasers, Gas; Laser Therapy; Neurofibromatosis 1

The cuniculatum carcinoma is a rare, slow-growth, local aggressive subtype of the squamous cell carcinoma, presented as a verrucous lesion with a low metastasis capacity. Its histopathology shows keratin-filled crypts, and its etiology is linked with HPV, especially 11 and 16 subtypes. The treatment of choice is surgical excision, followed by regular monitoring due to the high risk of local recurrence. We report a case of a woman with Cuniculatum carcinoma treated with surgery with perioperative frozen section procedure, graft, and good evolution.

Keywords: Carcinoma; Carcinoma, Squamous Cell; Foot

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

A woman with type I diabetes and Hashimoto’s disease presented necrobiosis lipoidica at 15 years of age. Cyclosporine 100 mg/day was prescribed; however, an abscess in the inguinal region led to treatment interruption. Then, she tried dimethyl fumarate at increasing doses up to 120 mg/day. The lack of results led to the discontinuation of the therapy. The third attempt was isotretinoin 40 mg/day for eight months, with wound healing. Recently, after a knee scar repair surgery, necrobiosis lipoidica lesions appeared at the suture site. The patient received isotretinoin 40 mg/day again, and the lesion regressed in three months.

Keywords: Necrobiosis Lipoidica; Diabetes Mellitus, Type 1; Bacterial Infections

INTRODUCTION: Warts or verrucae, caused by the human papillomavirus (HPV), are a benign epidermal proliferation of the skin. Most patients seek medical advice as warts are cosmetically unacceptable and can be painful. Plantar warts, in particular, are typically refractory to treatment requiring multiple treatment sessions. High recurrence rates, pain, and scarring limit the available therapeutic modalities. In contrast, immunotherapeutic approaches stimulate the host immune system by enhancing cellular immunity to eliminate the virus.
OBJECTIVE: To assess the safety and efficacy of intralesional vitamin D3 injection to treat multiple recurrent plantar warts.
METHODS: 60 patients with multiple recurrent warts were divided into two groups of 30 each. Group 1 received 0.5 ml intralesional vitamin D in the base of the largest wart, and Group 2 received 0.5 ml of normal saline. The sessions were repeated every two weeks for a maximum of four sessions, and patients were followed up for 12 months to detect any recurrences.
RESULTS: The study group showed complete clearance in 73.3% (22) individuals, while most controls (70%) showed no response.
CONCLUSION: Intralesional vitamin D3 is a safe and effective treatment option for multiple recurrent plantar warts.

Keywords: Cellular immunity; Injections, intralesional; 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

We report a case involving a 71-year-old male with a history of kidney transplant on immunosuppressive therapy and non-melanoma skin cancers who developed persistent lesions on the cheek and forehead after multiple skin cancer treatments. Biopsies identified poorly differentiated cutaneous squamous cell carcinoma. The patient underwent excisional salvage therapy with flap reconstruction, complicated by infection requiring debridement. He subsequently presented with in-transit dermal metastases and began treatment with cemiplimab. Unfortunately, after two cycles, he faced graft rejection and transitioned to hemodialysis. A recent PET-CT revealed no evaluable disease, and there were no clinical signs of recurrence at his last follow-up.

Keywords: Programmed Cell Death 1 Receptor; Carcinoma, Squamous Cell; Graft Rejection; Kidney Diseases.