The aim of this report is to highlight and warn cosmetic dermatologists about the need of a complete and careful examination of any patient that looks for our evaluation, even when they ask only for cosmetic treatments and/or procedures. This is nowadays a very important concern as people and some physicians are involved in an exaggerated search for eternal beauty. This represents a very profitable practice for dermatologists and plastic surgeons. But we should never forget that a dermatologic consultation can be an opportunity to discover an unnoticed dermatosis or signs related to systemic diseases.

Keywords: ANEURYSM, CAROTID ARTERY, EXTERNAL, ESTHETICS

Split earlobe usually results from sudden trauma or continuous use of heavy earrings. Among the various surgical techniques proposed for split earlobe correction, the choice will depend on the existing split, partial or total, and should offer a lower chance of recurrence. The total split corrections may be made with or without preservation of the earring orifi ce. Lobe fixation during intervention is essential, whatever the technique used, and can be done with tongue blade or sterile chalazion clamp. For the surgical procedure, we used Adson clamp, iris scissors, and scalpel blade 11 or 15. Skin suture was done with mononylon 5.0 or 6.0. In the new technique, besides the advantage of maintaining the orifi ce, there is greater security to upport the earring with less chance of recurrence.

Keywords: EAR, EAR, EXTERNAL, EAR DEFORMITIES, ACQUIRED, OTOLOGIC SURGICAL PROCEDURES, OUTPATIENT SURGICAL PROCEDURES

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

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.

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

Non-melanoma skin cancer is the most common type of neoplasia. Basal cell carcinoma is the most common cancer of them, the incidence of which is steadily increasing, implying an important public and financial health issue. The authors present the case of a patient with an extensive basal cell carcinoma affecting part of the external auditory canal and auricular concha, treated with a combination of surgical techniques: flap-plasty associated with second intention closure of the external auditory canal. Due to the excellent aesthetic and functional outcomes, this technique should be considered as a therapeutic option for auricular lesions.

Keywords: Carcinoma, Basal cell; Dermatology; Ear neoplasms; Ear, external; Surgical flaps

Skin cancers in the head and neck region account for 70-75% of malignant cutaneous tumors, of which 80% are basal cell carcinomas. Between 3-6% of malignant cutaneous tumors occur in the auricular pavilion. The authors of the present paper report an alternative technique for reconstructing the ear helix after excision of tumors, without the use of the classic compensation triangle. This method allows that the scar be located in the helical sulcus, resulting in a better aesthetic result, without unaesthetic retractions or scars located transversely to the helix.

Keywords: Dermatologic surgical procedures; Ear, External; Ear neoplasms

Non-melanoma skin cancer is the most common neoplasia in humans, and basal cell carcinomas (BCC) account for approximately 80% of cases. Cumulative exposure to ultraviolet radiation (UV) is the main risk factor associated to BCC, with a higher incidence in photoexposed areas, including the auricular region. The auricular region is a noble cosmetic unit, with anatomical peculiarities that lead surgeries to require the excision of a large amount of tissue, presenting a challenge for the dermatological surgeon. The authors present a case of helix reconstruction with a triple transposition flap.

Keywords: Carcinoma, basal cell; Dermatologic surgical procedures; Dermatology; Ear neoplasms; Ear, external

Earlobes deformities caused by adornments and ornaments are prevalent. The use of plugs and piercings in this topography generates a large partial cleft in the earlobes, which causes aesthetic and social damage when abandoning its use. The literature has already proposed several surgical techniques to correct defects in the earlobes. This case report describes a new, simple, and fast surgical approach, which had satisfactory aesthetic results in significant partial cleft cases: the adapted "L-plasty" technique.

Keywords: Acquired Ear Deformities; External Ear; Otologic Surgical Procedures; Ambulatory Surgical Procedures

The lower eyelid is one of the sites most affected by basal cell carcinoma (BCC). We present an option of inner corner skin flap with oral mucosa graft for eyelid reconstruction after BCC excision. This tumor affects approximately 60% of the lower eyelid and shows complete lower lacrimal canaliculus involvement. The use of internal corner skin transposition flap and oral mucosa graft is safe. The technique is reproducible and with good postoperative evolution. Positioning and eyelid movement were restored, allowing tear drainage through the upper canaliculus with complete correction of the tears’ overflow (epiphora).

Keywords: Basal cell carcinoma; Skin Neoplasms; Dermatological Surgical Procedures; Surgical Flaps

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