Introduction: Transcutaneous ultrasound procedures are viewed as the most effective non-surgical treatment for facial skin rejuvenation, although their mechanisms of action are poorly understood. Objective: This study aims to evaluate the morphological changes induced by ultrasound treatments on skin tissue: epidermis, papillary and reticular dermis, and subcutaneous fat. To evaluate the clinical efficacy of ultrasound treatment for facial skin tightening. Methods: Ex vivo human skin samples were sham-treated or treated with high-frequency ultrasound using MedVisage^TM (General Project Ltd.). Different parameters of power output (1.5 and 3.0 W) and frequency modulation (100, 500, 3,000, 3,500 Hz) were compared. Clinical efficacy was evaluated based on a single 5-minute ultrasound treatment (3.0 W, 3,000 Hz) on 4 volunteers. Results: Ultrasound treatment caused significant compaction of collagen and elastic fibers in the reticular dermis, whereas less prominent changes occurred in the papillary dermis. The overall effects varied depending on energy output and modulation frequency. No changes to subcutaneous adipocytes, blood capillaries, epidermal keratinocytes, dermal fibroblasts and mast cells were observed. Clinically, ultrasound treatment consistently resulted in a well-tolerated, objective reduction of facial skin wrinkles. Conclusion: High-frequency ultrasound treatment is an effective and safe noninvasive technique for skin-tightening purposes.

Keywords: HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION; SKIN AGING; HISTOLOGY; DERMIS.

Desmoplastic melanoma is a rare variant of melanoma characterized by an invasive lesion of spindle cells and varying degrees of desmoplasia. It is more frequent in men of an advanced age having a history of chronic exposure to sunlight. The extremely variable and nonspecific clinical appearance makes it a challenging diagnosis. The authors present an exuberant case of desmoplastic melanoma in an unusual location, with an initial diagnosis of dermatofibrosarcoma.

Keywords: MELANOMA; DIAGNOSIS; HISTOLOGY; IMMUNOHISTOCHEMISTRY

Introduction: The trends of malignant melanoma in Brazil are aligned with those worldwide: increasing incidence with reduced degree of severity at diagnosis. Objective: To use the prognostic criteria of the Grupo Multicêntrico e Multidisciplinar Brasileiro para Estudo do Melanoma (Brazilian Multicenter and Multidisciplinary Group for the Study of Melanoma) combined with clinical characteristics aimed at developing a clinical and histopathological profile of melanoma cases. Methods: A cross-sectional descriptive study was carried out, with the retrospective analysis of medical records of patients diagnosed with melanoma at a tertiary dermatology reference unit in the city of Bauru, in the Brazilian southeast State of São Paulo, between January 2007 and July 2014. Results: Female patients accounted for 56.2%, with ages ranging from 27 to 95 years (Mean = 61.4 years), with a lesion having been detected on physical examination in 36% of cases. The highest incidence of the disease was in the lower limbs (23.5%), with the superficial spreading subtype corresponding to 79.6% of biopsies. The average Breslow thickness was 2.9 mm, and in 28.1% of cases, the lesion was in situ. Conclusions: The following profile emerged: women, 61-years-old, with lesions in the lower limbs, superficial spreading subtype and with evidence of good prognostic. Studies like this are important due to the fact they provide subsidies for the design of strategies to treat the population.

Keywords: EPIDEMIOLOGY; MELANOMA; HISTOLOGY; PATHOLOGY, SURGICAL; SKIN NEOPLASMS

Introduction: Subcutaneous mycoses caused by dematiaceous fungi are classified according to their characteristics in the tissue: chromoblastomycosis (with the presence of fumagoid corpuscles), phaeohyphomycosis (with dematiaceous septate hyphae) and eumicetoma (with grains composed of septate hyphae). Several treatments are proposed, among them, surgical excision. Surgical treatment is more indicated in cases where there is localized infection and where excision is possible, yielding good therapeutic outcomes and low recurrence rates.
Objective: To describe the experience of a dermatological service in the surgical treatment of subcutaneous mycosis cases caused by dematiaceous fungi, discussing the surgical approach and its results.
Methods: A retrospective study was carried out with the descriptive analysis of cases treated from April 2014 to December 2016, at a dermatological clinic in the Brazilian Southeast city of São Paulo. All cases diagnosed with subcutaneous mycoses caused by dematiaceous fungi were included and surgically treated with total exeresis of the lesion.
Results: A total of 7 cases were analyzed – 2 eumicetomas, 1 chromoblastomycosis and 4 phaeohyphomycoses. Only one on the cases was not treated at an ambulatory surgical center. All cases progressed without sequelae or recurrences during the clinical follow-up.
Conclusions: When surgical treatment is possible, the exeresis of the lesion is a good therapeutic option in cases of subcutaneous mycoses caused by dematiaceous fungi.

Keywords: CHROMOBLASTOMYCOSIS; PHAEOHYPHOMYCOSIS; BACTERIAL INFECTIONS AND MYCOSES; MYCOSIS; MYCETOMA; AMBULATORY SURGICAL PROCEDURES; BLOODLESS MEDICAL AND SURGICAL PROCEDURES; HISTOLOGY; THERAPEUTICS

INTRODUCTION: Identification of the underlying causes of idiopathic cutaneous hyperchromia at the orbital region (ICHOR) is crucial in selecting the best therapeutic management.
OBJECTIVE: This study aims to evaluate the histopathological changes of different types of ICHOR.
METHODS: Forty-nine healthy volunteers were classified into (i) hyperpigmented (ii) hypervascularised or (iii) tear trough groups. Melanin deposit, hemosiderin deposit, blood vessels dilatation, perifollicular inflammation, structures of epidermis ridges were assessed histologically. Its association with the type of ICHOR was analysed using Pearson's chi-squared test.
RESULTS: A total of 53.1% ICHOR subjects was diagnosed as hyperpigmented, 16.3% as hypervascularised and 30.6% as tear trough and. Pearson's chi-squared test showed that hyperpigmented group associated with high level of melanin deposit (p<0.05), and invagination of melanin pigments into the dermal layer (p<0.05). Hypervascularity was associated with dilated blood vessel (p<0.05). Interestingly, tear trough was associated with dilated blood vessels (p<0.05) and perifollicular inflammation (p<0.05).
CONCLUSION: Each type of ICHOR showed distinct histopathological changes, selection of precise targeted therapy is important in treating ICHOR effectively.

Keywords: Hyperpigmentation; Histology; Melanosis

INTRODUCTION: The chest is a photoexposed area that shows effects of photodamage. Microneedling is a safe option for the rejuvenation of this area, also leading to improvement in dyschromias.
OBJECTIVE: To evaluate histologic cutaneous response after three monthly sessions of microneedling for the treatment of dyschromias on the chest.
METHODS: Three monthly sessions of microneedling, with 1.5mm length needles were performed, as well as skin biopsies before and 90 days after commencement of the study. Histologic samples were evaluated with H&E and Fontana-Masson stains. Melanin content was measured based on dermal clusters.
RESULTS: Six patients between 38 and 67 years of age, phototypes II-III, Glogau scale II-IV were included. A positive correlation was observed between the time and dermal content of melanin (p=0.029): three sessions of microneedling reduced this content on D90 compared to the beginning (6.4 ± 1.7 MC on D0 versus 3.1 ± 0.4 on D90, p = 0.05). Three patients reported global skin improvement on D90.
CONCLUSIONS: The proposed mechanism of microneedling to promote lightening includes fibroblast proliferation and neocollagenesis in the upper dermis. This is the first study to evaluate the histology of the findings associated to lightening of the chest due to microneedling.

Keywords: Histology; Melanins; Needles; Thorax

Skin biopsy is an important introductory tool and also essential for the dermatologist. The conventional biopsy method, with the use of local anesthetics, sterile fields, surgical instruments (punch, scalpel, forceps, scissors) and suture material demand staff, time and considerable financial investment. Criobiopsy is a simple method, where by using the cryocautery an extraction of good quality skin fragments is made for histopathologic analysis, making it an excellent alternative to the conventional biopsies.

Keywords: Ambulatory Surgical Procedures; Biopsy; Cryosurgery; Dermatology; Histology

Desmoplastic melanoma (DM) represents less than 4% of cutaneous melanomas and is characterized by invasive proliferation of spindle cells in the dermis, often with neurotropism. The nonspecific clinical appearance and the absence of pigmentation usually lead to a clinical misdiagnosis. The authors report a case of DM located in a cutaneous field cancerization simulating actinic keratosis.

Keywords: Melanoma; Immunohistochemistry; Histology

To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Keywords: Histology; Mohs Surgery; Skin Neoplasms

The tissue processing in Mohs surgery aims at histological slides that allow the analysis of 100% of the surgical margins. The embedding tissue is a critical step and prone to errors. As there is no standardization when mounting the blocks, there may be unevenness in the different samples cutting surfaces, leading to the need for continuous adjustments on the X-Y axis inside the cryostat, slowing down the process. A device was developed to solve this problem, minimizing any blocks inclination, keeping the surgical margins parallel in all samples, accelerating the process, and maintaining the histological slides high quality.

Keywords: Mohs micrographic surgery; Laboratory equipment; Histology; Tissue embedding; Innovation

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

Chromoblastomycosis is a chronic granulomatous infection caused by dematiaceous fungi with varied clinical presentations, which may represent a therapeutic challenge. In this report, we present a case of chromoblastomycosis in a localized form, with a long evolution, in an elderly patient, resistant to previous drug therapies, successfully treated by the association of a physical method with systemic pharmacological treatment, which allowed the use of a reduced dose of the drug.

Keywords: Chromoblastomycosis; Cryosurgery; Itraconazole