Minor salivary gland biopsy is essential for the diagnosis of Sjögren’s syndrome. The authors demonstrate the use of chalazion clamp to facilitate this procedure. Chalazion clamp retains the lip mucosal bleeding and exposes the salivary glands more easily for their dissection and excision individually, which facilitates the removal of various glands to histopathological examination.

Keywords: SJÖGREN’S SYNDROME, BIOPSY, SALIVARY GLANDS, MINOR

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

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.

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.

The basal cell nevus syndrome - also known as Gorlin-Goltz syndrome - is an autosomal dominant disorder that occurs with the development of basal cell carcinomas in young patients and other clinical and radiological findings. As this syndrome tends to be a systemic disease, a better understanding of it by the various medical specialties is important for early diagnosis, allowing appropriate treatment and secondary prevention. In the present case, the authors describe an adult patient with multiple exuberant basal cell carcinomas having spread through the body over 10 years.

Keywords: BASAL CELL NEVUS SYNDROME; CARCINOMA, BASAL CELL; EPIDERMAL CYST

The Highly Active Antiretroviral Therapy promoted a better quality of life for seropositive patients. However, metabolic changes in patients, such as HIV lipodystrophy syndrome, may occur with antiretroviral therapy. Thus, it is necessary to adopt strategies to prevent and treat lipodystrophy and other possible side effects of. We report the case of a female patient with prior antiretroviral therapy and decreased thickness of the lower limbs bilaterally, especially in knees and distal third of the legs. The sites with evidence of lipoatrophy were filled with polymethylmethacrylate, with satisfactory results and adherence by the patient.

Keywords: HIV-ASSOCIATED LIPODYSTROPHY SYNDROME; POLYMETHYL METHACRYLATE; ACQUIRED IMMUNODEFICIENCY SYNDROME.

Kaposi's sarcoma is a rare multicentric neoplasm originating from endothelial cells, with cutaneous and extracutaneous manifestation. The present paper describes a case of an uncommon clinic variant of a Kaposi’s sarcoma in a 32 year-old male patient bearer of acquired immunodeficiency syndrome (AIDS), with regression after undergoing combined treatment with antiretroviral therapy and radiotherapy.

Keywords: sarcoma, kaposi; herpesvirus 8, human; acquired immunodeficiency syndrome; keloid

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

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

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

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease where there is a mutation in the tumor suppressor gene, with a greater predisposition to neoplasms, especially of the gastrointestinal tract. The first manifestations begin during childhood with the presence of mucocutaneous melanosis and, later, gastrointestinal hamartomatous polyps. We describe a case of a young woman whose initial PJS manifestation started during her childhood with cutaneous melanosis. Three sessions with the Q-switched 1064nm Nd:YAG and 532nm KTP lasers were performed to treat the melanosis with excellent results and without recurrence.

Keywords: Lasers; Lentigo; Peutz-Jeghers syndrome

Anagen effluvium (AE) is a hair growth disorder that occurs due to a disturbance in the hair follicle cycling. The most common cause of AE is alopecia areata (AA). Autoimmune diseases like AA may develop after drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and are usually long-standing conditions. We report the case of a 17-year-old woman who developed a severe and abrupt AE after DRESS syndrome with a full and rapid recovery after two months of topical minoxidil.

Keywords: Alopecia; Alopecia Areata; Drug Hypersensitivity Syndrome; Case Reports

INTRODUCTION: For religious reasons, a portion of the population does not expose their body, showing only the feet.
OBJECTIVE: This study aimed to meet the demand for treatments to rejuvenate the dorsum of the foot, observe the safety of using calcium hydroxyapatite and its results, and discuss the region anatomy.
METHODS: Sixty women with an average age of 63 years and skin phototypes from I to VI had the dorsum of their foot's age classified by types from I to VII, and were injected with 0.75 ml to 3 ml of calcium hydroxyapatite per patient in this region, in a single session. A dermatologist who did not participate in the treatment and the patients conducted the evaluation through photos.
RESULTS: The results were considered good to very good depending on the aging stage of the dorsum of the feet. Complications were limited to local edema and erythema. Follow-up lasted from six months to one year.
CONCLUSION: The injection of calcium hydroxyapatite into the dorsum of the feet, based on knowledge of the anatomy of this region and correct volume, could be considered a body area treatment.

Keywords: Calcium Hydroxyapatite; Foot; Anterior Compartment Syndrome; Collagen