This article describes the case of a soft fibroma of unusual size and development located in the vulva of a post-menopausal woman.

Keywords: FIBROMA, NEOPLASMS, FIBROUS TISSUE, VULVAR DISEASES, VULVAR NEOPLASMS

Flaps are widely used in the surgical reconstruction of the nasal region. During the post-operative period, an unattractive depressed scar in relation to the nearby skin can be observed. Even after abrasion – which the literature recommends 30-60 days after the procedure – this complaint often persists. This study proposes tangential excisions with a razor blade (shaving) of the flap''''''''s entire area until it is level with the surrounding region, followed by dermabrasion to refine any remaining irregularities. The results are deemed excellent since the scars become less noticeable – a very satisfactory outcome due to the aesthetic and social importance of the treated area.

Keywords: SURGICAL FLAPS, NEOPLASMS, DERMABRASION

Summary: Acquired digital fibrokeratoma is a rare benign fibroepithelial condition, which typically occurs as a solitary asymptomatic nodule in fingers and toes. The authors report the clinical case of a female patient affected by two digital fibrokeratomas in the 4th and 2nd left fingers, respectively.

Keywords: NEOPLASMS, FIBROEPITHELIAL; FIBROMA; FINGER INJURIES.

The dorsum of the hand is home to tumors that often require a surgical approach. Due to limited cutaneous mobility, wide surgical wounds become a challenge to dermatologic surgeons. The authors report the case of a patient with a tumor in the dorsal region of the left hand that, after removal with a safety margin, resulted in a wide surgical wound, and in the choice of reconstruction with an A-T flap. Six months later, the patient was cured, with total preservation of the hand's mobility and excellent aesthetic results. The concept of using flaps for closing wide surgical wounds, whenever possible, is reinforced.

Keywords: HAND, NEOPLASMS, SURGICAL FLAPS.

The authors describe the case of a 75-year-old female patient, bearing a single asymptomatic, nodular lesion of fibroelastic consistency for three years, located on the left hallux. Following surgical excision of the lesion, the pathological examination and immunohistochemistry revealed a superficial acral fibromyxoma. This type of lesion was first described in 2001 and today there are approximately 100 cases in the literature. It is a benign mesenchymal tumor of slow growth, with a predilection for ungual and peri-ungual regions. There are no reports of malignant transformation and recurrence has been associated with incomplete resection.

Keywords: FIBROMA; NEOPLASM; NAIL DISEASES.

Eccrine spiradenoma is a rare benign adnexal epithelial neoplasm characterized by a bluish-pink, slow-growing solitary nodule, coursing with paroxysmal pain, mainly in young adults. It is most commonly located in the trunk and extremities. Bleeding and/or ulceration are common in the giant vascular variant, which is characterized by a size greater than 2 cm in diameter and a high degree of vascularization seen on histology. Its clinical characteristics are unspecific and require biopsy with histological analysis for diagnosis. Its histology presents one or more basophilic intradermal lobules enveloped in a fibrous capsule without connection to the epidermis. It presents two types of cells: small cells with dark nuclei in the periphery and large cells with light nuclei in the center. An accurate diagnosis is important due to the fact that it can develop into a potentially fatal malignancy - which is a rare phenomenon and occurs most often in the multiple variant. A rare case of eccrine spiradenoma in the abdomen with bleeding associated is described in the present paper, as well as a discussion on possible treatments.

Keywords: ECCRINE SPIROADENOMA, BENIGN EPITHELIAL NEOPLASIA, SEBACEOUS GLANDS

Melanonychia corresponds to color patterns in the nail plate, ranging from brown to black. It is a diagnostic challenge due to the fact it has several differential diagnoses, including benign and malignant entities. There are no reports of pigmented fibroma of the nail matrix causing striata (or longitudinal) melanonychia. In light of this fact, the authors report a case of melanonychia striata secondary to pigmented fibroma of the nail, with clinical examination and dermoscopic findings suggestive of nodular melanoma.

Keywords: NAILS; MALFORMED NAILS; NEOPLASMS; FIBROMA

Pachydermodactyly is a rare, benign and acquired form of digital fibromatosis characterized by the thickening of soft tissues in the lateral regions of the proximal interphalangeal joints, typically of the digiti II, III and IV of both hands. In most cases it is associated with repeated digital microtraumas. The authors of the present article report the case of a 22-year-old patient with a typical clinical presentation of the condition. The treatment with triamcinolone injections led to a partial reduction of the thickening, in addition to hypopigmentation and hyperemia, meaning it was an unfavorable option. Although rare and benign, this typical clinical condition deserves attention, and unnecessary and costly investigations, as well as inappropriate treatments should be avoided.

Keywords: HAND DERMATOSES; SOFT TISSUE NEOPLASMS; FINGERS; YOUNG ADULT; GLUCOCORTICOIDS; CUMULATIVE TRAUMA DISORDERS; FIBROMA; TREATMENT OUTCOME

INTRODUCTION: Acrochordons are very prevalent in dermatological offices and can reach almost 60% of the population over 70. One possible therapeutic approach is contact cryotherapy.
OBJECTIVES: Compare pain tolerance, aesthetic results, and the preference of participants for electrocoagulation or contact cryotherapy techniques in the treatment of acrochordons.
METHODS: Ten participants, with at least four acrochordons each, had their lesions divided into two groups. One group was submitted to electrocoagulation and the other to contact cryotherapy. We measured pain tolerance using the analog pain scale (EAD). The aesthetic result was assessed by visual comparison between the treatment groups in each participant, and the patient’s preference was evaluated by asking the participant objectively.
RESULTS: All points analyzed had statistical significance. The participants gave lower scores in EAD for lesions submitted to contact cryotherapy. The esthetic result evaluated after 30 days was superior in the lesions of the electrocoagulation group. All participants preferred the contact cryotherapy technique.
CONCLUSIONS: Contact cryotherapy is the preferred method with better pain tolerance in treating acrochordons, but the aesthetic result was better with electrocoagulation.

Keywords: Cryosurgery; Cryotherapy; Electrocoagulation; Electrosurgery; Fibroma

Koenen tumors are nail fibromas included among the main diagnostic criteria of tuberous sclerosis. Elongated and thin papules, firm, with smooth surface and broad base characterize these lesions, which are slightly erythematous and present varying sizes. Koenen tumors commonly affect toenails and result in aesthetic and functional concerns associated with deformities, pain, and bleeding. Several therapeutic options are described for Koenen tumors; however, there is a lack of consensus in the literature regarding standard treatment. We report the case of a patient who underwent surgery with excellent outcomes. Additionally, we discuss the advantages and disadvantages of each therapeutic modality.

Keywords: Dermatologic Surgical Procedures; Fibroma; Nails; Tuberous Sclerosis

Superficial acral fibromyxoma is a rare and benign mesenchymal tumor. It mainly affects middle-aged men; however, it can occur in any gender and age group. It has a slow growth, with a preference for nail and periungual areas.

Keywords: Ambulatory surgical procedures; Fibroma; Antigens, CD34; Fingers

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

The reconstruction of deep surgical defects of the nasal tip and wing of the nose often presents a challenge to the surgeon. In these cases, full-thickness skin grafting is widely used, but it often results in sinking or graft depression. We present a surgical technique that is easy to perform and reproducible; nonetheless still very little diffused in Brazil: the “Drumhead” graft. This method performs the grafting of a rigid plastic suspension together with the full-thickness skin graft. Thus, this technique constitutes another tool for the dermatological surgeon to prevent irregularities of undesirable contours, graft depression, and nasal vestibule collapse.

Keywords: Nose; Nose neoplasms; Skin neoplasms; Skin transplantation

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

We report a case of a 72-year-old man who underwent surgical excision of a keratoacanthoma centrifugum marginatum (KCM) located on the left forearm. It is an uncommon variant of keratoacanthoma, which can assume large dimensions (up to 20 cm) and does not tend to spontaneous regression. The lesion is usually single, with raised borders, and has progressive centrifugal growth associated with central healing and atrophy. Due to its rarity and lack of pathognomonic histopathological features, KCM can be a diagnostic challenge for dermatologists and pathologists.

Keywords: Keratoacanthoma; Neoplasms; Skin neoplasms