Giant congenial melanocytic nevi are uncommon lesions that have a higher risk of developing into cutaneous melanomas. When located on the face, they can cause neurological problems, including leptomeningeal melanocytosis and epilepsy. They can also be unattractive. A case of a 17-year-old female patient with congenial melanocytic nevus affect- ing one-third of the right side of her face is reported. The patient underwent the lesion’s resection and reconstruction with a partial skin graft in a single surgery. The objective of this study was to demonstrate a therapeutic proposal for congenial melanocytic nevi located in the periorbicular region.

Keywords: NEVUS, PIGMENTED, NEVI AND MELANOMAS, SKIN, TRANSPLANTATION, AUTOLOGOUS

Introduction: One of the most challenging dermoscopic situations is to distinguish between early melanomas and doubtful benign nevi. At times, suspicious melanocytic lesions have dermoscopic features similar to melanomas, thus leading to excessive excisions of lesions.
Objective: To develop a dermoscopic model that helps to differentiate the doubtful nevus from the early melanoma.
Material and methods: A total of 219 histopathologically confirmed dermoscopic images were analyzed and a comparison between doubtful nevi and early melanomas was then performed.
Results: The final model was based on three dermoscopic features: radial streaming, blue hue and vascular structures. If all three features were absent, it was most likely a nevus; if one dermoscopic feature was present, it could be a nevus or melanoma; if two features were present, there was a greater probability of melanoma diagnosis; if three features were present, it was melanoma.

Keywords: DERMOSCOPY, MELANOMA, NEVUS, PIGMENTED

Giant congenital melanocytic nevi are extremely rare, however there is a 5-10% chance they will develop into melanomas. Laser-based treatment of this type of lesion is still very controversial. Some studies report great success without malignant development and others have achieved good aesthetic results but with malignancy. This article describes the clinical and histological development of a case of a female patient with a giant congenital melanocytic bathing trunk nevus, after 14 sessions of 1,064 nm Q-Switched Nd:YAG laser and three years of follow-up without histological signs of malignancy. The authors highlight the need for histological monitoring of this type of lesions.

Keywords: NEVUS, NEVUS, PIGMENTED, LASER THERAPY

The prognosis of cutaneous melanomas depends mainly on the lesions' thickness; early detection is of paramount importance for patient longer survival rates. An accuracy of approximately 90% can be achieved using dermoscopic assessment. Since early melanomas might not present specific dermoscopic features, they can only be diagnosed by observing alterations over time through total body mapping and serial digital dermoscopy. Patients with atypical nevus syndrome and multiple familial melanoma presented a higher sensitivity for the detection of melanoma using that technique.

Keywords: MELANOMA; DERMOSCOPY; DYSPLASTIC NEVUS SYNDROME.

Talon noir was first described in 1961 by Peachey as atraumatic petechial eruption characteristic of basketball players' heels, and were originally called calcaneal petechiae. It is a dermatosis linked to trauma, with asymptomatic lesions, marked by the presence of blood within the stratum corneum. It presents varied clinical manifestations, with the location depending on the involved provocative fac-tor. The present study describes a case of talon noir in a patient with psoriasis vulgaris and demonstrates the importance of the correlation of clinical, dermoscopic, and histopathological characteristics.

Keywords: BLOOD STAINS, NEVI AND MELANOMAS, FOOT

Introduction: In vivo confocal microscopy is an auxiliary non-invasive diagnostic method used in the diagnosis of hyperpigmented lesions in scars. Objectives: To evaluate hyperpigmentation in the scars of benign and malignant melanocytic lesions through confocal microscopy examination. Methods: Clinical, dermoscopic, and confocal microscopy images of fourteen patients with hyperpigmentation in adequately treated melanoma scars and in excised melanocytic nevi, were evaluated. Results: Among the eight patients with hyperpigmentation in melanoma scars, four showed no suspicious structures after confocal microscopy examination and four showed suspicious structures. Among the six patients with hyperpigmentation in areas where melanocytic nevi had been excised, three had atypical structures, such as dendritic cells and non demarcated papillae. Patients with suspicious structures underwent histological examination, with one case of hyperpigmentation in a lentigo maligna scar evidencing recurrence. Conclusions: The examination method allowed for the avoiding of biopsy in confirming the diagnosis in six of the fourteen patients. The finding of cells with dendritic or pagetoid pattern in the confocal microscopy examination means a diagnostic challenge, for it can indicate melanocytes or Langerhans cells in the spinous layer. Therefore, lesions that have such structures must be removed for histology and differential diagnosis.

Keywords: MELANOMA, NEVUS, DERMOSCOPY, CONFOCAL MICROSCOPY.

Introduction: Tuberous sclerosis is a dominant autosomal genodermatosis, classically characterized by facial angiofibromas, fibrotic plaques, periungual fibromas, leaf-shaped hypochromic maculae and fibrous frontal plaques.
Case report: A patient bore this disease, with Koenen tumors in all nail beds of hands and feet, which were resistant to the conventional treatment — simple excision and electrosurgery. Amputation of the nail beds was performed followed by reconstruction with full thickness skin grafts.
Conclusion: The amputation of the nail apparatus and reconstruction with full thickness skin grafts in aggressive, recurrent or high morbidity cases can be an effective therapeutic option.

Keywords: DERMATOLOGY; DERMATOLOGIC SURGICAL PROCEDURES; TUBEROUS SCLEROSIS; SKIN TRANSPLANTS

The nevus spilus (NS), also known as speckled lentiginous nevus or nevus on nevus, is represented by a brownish macule on which small macules of darker shades appear. It is more common on the trunk and lower limbs. The general population's prevalence is 0.2% to 2.3%, and they have a benign character. The exact risk for malignant transformation is still unknown; thus, it demands a routine clinical-dermoscopic follow-up. We present a case of malignant melanoma on acquired nevus spilus, in which early an excision was performed, with no recurrence, highlighting the importance of follow-up of these patients.

Keywords: Melanoma; Nevi and melanomas; Nevus

Patients with giant congenital melanocytic nevus are at higher risk of developing melanoma. After the first diagnosis of melanoma, there is also a higher incidence of subsequent melanomas in the same patient. However, the ideal therapy for this type of nevus is still controversial. We report the case of a patient with giant congenital nevus associated with multiple synchronous melanomas and the proposed treatment.

Keywords: Melanoma; Nevi and melanomas; Neoplasms

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

The divided nevi occur in contiguous areas of the skin that are mostly benign lesions. We report six cases of nevus divided on the penis and its dermoscopic patterns. Clinical follow-up was the best therapeutic option for this group of patients, considering the location of these lesions.

Keywords: Dermoscopy; Nevus; Intradermal nevus; Pigmented nevus; Penis

Melanoma is a rare neoplasm in the pediatric population, and it is even rarer in children under 10 years of age. Total body mapping constitutes a low-cost and non-invasive method that increases diagnostic accuracy in evaluating pigmented lesions, especially in high-risk patients. We reported the case of a 9-year boy with dysplastic nevus syndrome, in which one lesion presented a subtle change (asymmetry of structures) within a 6-months follow-up. Its excision resulted in melanoma with a Breslow thickness of 1 mm and a negative sentinel lymph node. Total body mapping reduces the number of unnecessary excisions. It allows diagnosis of melanomas in early and potentially curable stages, especially in children and patients with risk factors such as dysplastic nevus syndrome. We report this case due to the rarity of the neoplasia in this age group and also to demonstrate the importance of sequential digital dermoscopy in early diagnosis of melanoma in this population.

Keywords: Dermoscopy; Melanoma; Dysplastic nevus syndrome

Modern hair transplant is constantly evolving. We intend to demonstrate our techniques and methodologies, and especially to describe the dynamics of the entire surgical process of the FUE (Follicular Unit Extraction), technique, from the discussion of the surgical strategy with the patient and evaluation of the donor area to extraction and implantation. The dermatologist must understand the complexity of the procedure and the need for adequate training to achieve a good surgical result.

Keywords: Alopecia; Hair; Hair follicle; Transplant donor site

Hair transplant is a common procedure worldwide, and the method of extracting follicular units is currently the most used. This technique is used not only for androgenetic alopecia but also for other areas such as eyebrows and beard. It is essential to observe the angle of the incisions and implantation of the hairs to conduct the eyebrow transplant so the result is as natural as possible. However, in addition to being rigorous with the design of the shape and position of the eyebrow, care must be taken with the preparation from the receiving site.

Keywords: Transplants; Alopecia; Hair follicle

Hair transplantation is an option for anyone with Androgenetic Alopecia, including transgender patients who want to align their appearance with their gender identity. Thus, hair transplantation can help transform appearance and boost self-esteem, especially if hair loss is a source of gender dysphoria. We report two cases of hair transplantation in transgender patients with good results, using the Follicular Unit Extraction and Follicular Unit Transplantation techniques. Due to the scarcity of specific articles about hair transplantation in this population, we report these cases for a better understanding of the specific needs of these patients.

Keywords: Hair; Transplants; Transgender People; Gender Dysphoria; Gender Identity; Feminization.