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

New imaging methods, such as optical coherence tomography, magnetic resonance and high frequency ultrasonography, have been developed for use in dermatology. Among the new methods, in vivo reflectance confocal microscopy, has presented the fastest growth in large cutaneous oncology centers and has generated the greatest number of articles in the literature recently, due to its resolution – similar to histological resolution. In vivo confocal microscopy has been particularly useful given the many limitations of the dermoscopic diagnosis of cutaneous neoplasias, especially of achromic or hypopigmented lesions, lesions in the face or in mucous membranes. Some studies have also suggested considerable utility in the assessment of surgical margins and in determining the best area of the body for carrying out excisional biopsies. This study briefly describes how the confocal laser reflectance microscope works and discusses some of the issues that arise in its use in the daily practice of dermatologic surgeons.

Keywords: MICROSCOPY, CONFOCAL, DETECTION OF CANCER, SKIN NEOPLASMS

Basal cell carcinoma is the most common malignant skin tumor. Reflectance confocal microscopy is a non-invasive technique that provides real-time, in vivo, horizontal tissue images, at a quasi-histological resolution, by employing a low-power laser beam of 830 nm. In this paper, we review the major morphological criteria for diagnosing this tumor using reflectance skin confocal microscopy.

Keywords: CARCINOMA, BASAL CELL, MICROSCOPY, CONFOCAL, DIAGNOSIS

Solitary pink lesions of the face may have nonspecific dermoscopic patterns, and are thus deemed difficult to diagnose. Differential diagnoses to consider are: actinic keratosis, squamous cell carcinoma, basal cell carcinoma, and amelanotic melanoma. Confocal microscopy can be used as an auxiliary clinical examination in their diagnosis and in determining the most significant sites for carrying out a biopsy. The authors describe a case that illustrates the usefulness of a confocal microscopy examination in pink lesions.

Keywords: DERMOSCOPY, MICROSCOPY, CONFOCAL, CARCINOMA, BASAL CELL, KERATOSIS ACTINIC

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.

Early diagnosis of basal cell carcinoma-a cutaneous neoplasia with high incidence-can bring great benefits to the patient. Often, slightly pigmented lesions, small initial lesions, and superficial lesions can represent a clinical and dermoscopic diagnostic challenge for not having the typical findings of this neoplasia. In such cases, optical coherence tomography-a promising technology in dermatology-is an auxiliary, non-invasive resource that can be incorporated into the clinical practice.

Keywords: BASAL CELL CARCINOMA, DIAGNOSTIC IMAGING, OPTICAL COHERENCE TOMOGRAPHY.

Introduction: Chronic exposure to ultraviolet radiation is the primary cause of skin carcinomas. Actinic keratosis is considered a precursor lesion. Topical application of photolyase showed effectiveness with the removal of 40-45% of the dimers formed by ultraviolet radiation, contrasting with conventional photoprotection for its ability to repair already damaged cellular DNA. Confocal microscopy is used for the in vivo visualization of skin alterations. Objective: To evaluate the effects of the cream containing photolyase and SPF 100 sunscreen on facial actinic damage and keratoses, using dermoscopy and confocal microscopy as evaluation parameters. Methods: Observational longitudinal clinical trial in 17 actinic keratosis lesions. Dermatoscopy and confocal microscopy were carried out before applying the cream and 120 days after, with comparison of the images. Results: Of the 14 Grade I actinic keratoses, nine showed clinical and dermoscopic improvement, three remained unchanged and one progressed to Grade II actinic keratosis. Confocal microscopy showed a reduction of scales and improvement in the epidermal architecture in the five Grade I actinic keratoses. The three Grade II actinic keratoses analyzed did not show improvement. Conclusions: The application of photolyase in cream with sunscreen promotes photoprotection and DNA repair. Confocal microscopy is a useful tool for monitoring the treatment of actinic keratoses.

Keywords: KERATOSIS, ACTINIC; MICROSCOPY, CONFOCAL; DERMOSCOPY.

A Wood's lamp is a cost effective, safe, easy to use diagnostic tool that is readily available at medical practices. However, its dermatological application has been restricted to the detection of cutaneous infections, the evaluation and classification of pigmentation disorders (such as melasma and vitiligo), and the analysis of disturbances in the metabolism of porphyrins. In the present report the authors demonstrate the use of a Wood's lamp as an alternative to confocal optical microscopy, in the delimitation of the surgical margins of a hypomelanotic lentigo maligna melanoma, whose lack of melanin pigmentation and tumor location in a photodamaged area had hampered a patient's surgical planning.

Keywords: LIGHT; MELANOMA; MELANOMA, AMELANOTIC; MICROSCOPY, CONFOCAL;

Introduction: Confocal laser reflectance microscopy has been regarded as a tool with extensive application in dermatology, emerging as a revolutionary factor in the diagnosis of skin disorders and the evaluation of cutaneous characteristics. This is due to the fact that it allows cellular level visualization with almost histological resolution of cellular and tissular features through a non-invasive method, in real time. Objective: To evaluate the morphological and structural characteristics of skin aging in the epidermis and papillary dermis using confocal laser reflectance microscopy. Methods: Forty female volunteers with II, III, and IV skin phototypes were selected and divided into two age groups: young skin (18-35 years old) and aged skin (40-65 years old). The evaluation of the cellular characteristics of the different cutaneous layers was performed using a confocal laser reflectance microscope Vivascope 1500. Results: Using the confocal microscopy analysis, it was possible to observe an irregular pigmentation pattern, irregularly distributed keratinocytes, flattening of the dermal-epidermal junction, presence of damaged collagen fibers, and solar elastosis in the aged skin. Conclusions: Confocal laser reflectance microscopy is a technique that is highly useful for assessing morphological and structural characteristics of cutaneous aging at the epidermis and papillary dermis levels.

Keywords: MICROSCOPY, CONFOCAL; SKIN AGING; EPIDERMIS; DERMATOLOGY

The diagnosis of pigmented facial lesions is considered challenging since benign and malignant lesions might have similar clinical and dermoscopic features – especially in the early stages of the lesion – entailing that it is often difficult to identify lentigo maligna lesions in the face. In this way, confocal reflectance microscopy has the potential to become a useful tool both in the diagnosis and surgical planning of lentigo maligna.

Keywords: Dermoscopy; Hutchinson's melanotic freckle; Keratosis, actinic; Melanoma; Microscopy, confocal

Introduction: Photoaging and melasma are frequent dermatological complaints. Confocal reflectance microscopy (CRM) is a recent technique that can be used for diagnostic evaluation of these dermatoses.
Objectives: To evaluate the characteristics of the epidermis and dermis containing pigmentary alterations caused by photodamage and melasma with the assistance of CRM, and compare the findings linked to these changes with the perilesional region.
Methods: A pilot study was conducted with eight female individuals (aged 38 to 50 years, Fitzpatrick phototypes from II to IV) with clinical diagnoses of photodamage (n = 4) and melasma (n = 4) in the facial malar region. The perilesional and lesional regions were compared regarding the thickness of the stratum corneum and viable epidermis, the depth of the interpapillary crests, and the presence of hyper-refractive structures.
Results: The pigmentary alterations in the photodamaged skin revealed a morphological pattern — such as an increase in the depth of the interpapillary ridges in the lesion region — typical of solar lentigo. In the lesional region of volunteers bearing melasma, it was possible to observe the presence of dendritic cells in the epidermis and melanophages in the dermis. All volunteers had hyper-refractive keratinocytes in the lesional epidermis region.
Conclusions: Considering the number of patients evaluated, it was possible to characterize and compare cutaneous pigmentary alterations caused by photodamage to those cause by melasma.

Keywords: Aging; Microscopy, confocal; Diagnosis

Scabies is a contagious cutaneous infection, caused by burrowing of the mite Sarcoptes scabiei var. hominis in the epidermis. The clinical suspicion is due to the history, clinical distribution of lesions and its aspect; however, the confirmation is with the detection of the parasite. We present the features of the diagnostic methods for scabies, from its detection through direct microscopy of skin scrapings from a lesion or with the use of an adhesive tape on the lesions, to its detection using the dermatoscope, a tool available in most dermatology clinics, which, even in unexperienced hands, has acceptable sensitivity and specificity.

Keywords: Dermoscopy; Diagnostic imaging; Microscopy; Scabies; Skin and connective tissue diseases; Skin diseases;

INTRODUCTION: Actinic keratosis (AK) is a pre-malignant lesion that can progress to squamous cell carcinoma. The diagnosis is through clinical, dermatoscopic and confocal microscopy assessment. Currently, the approach is the treatment of the field cancerization, comprising of clinically visible and subclinical AKs, for which photodynamic therapy (PDT) is a therapeutic option.
OBJECTIVE: To evaluate improvement of AKs and cancerization field in patients submitted to daylight PDT, with clinical, dermatoscopic and confocal microscopy assessment.
METHODS: Ten patients with multiple AKs on the face were selected. Daylight PDT was performed using methyl aminolevulinate and clinical, dermatoscopic and confocal microscopy photographic documentation was performed before and 60 days after the treatment.
RESULTS: Of the nine patients who completed the treatment, 8 (88.8%) showed clinical improvement and reduction in the severity of AK with one treatment. On dermatoscopy, 4 patients (44.4%) showed significant improvement, 3 patients (33.3%) showed partial improvement and 2 patients (22.2%) had no change. On confocal microscopy, 6 (66.6%) patients presented reduction in the severity of the lesion.
CONCLUSIONS: Daylight PDT proved to be effective for the treatment of AKs, with high tolerability and efficacy, besides a good safety profile.

Keywords: Dermoscopy; Keratosis, Actinic; Microscopy, Confocal; Photochemotherapy

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

The globular dermoscopic pattern in pigmented lesions of basal cell carcinoma can cause diagnostic confusion, especially in cases in which other more commonly observed structures are absent. Therefore, the use of refletance confocal microscopy becomes important to determine the diagnosis and eliminate the need for biopsies.

Keywords: Carcinoma, Basal Cell; Dermoscopy; Microscopy, Confocal.