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

Reconstructions of the auricular pavilion are complex, especially when there is a loss of cartilaginous support. A case of chondrocutaneous defect reconstruction, after the exeresis of a basal cell carcinoma in the upper third of the auricular pavilion, is reported. Silicone fiber was used to model and provide support for the ear. The technique of using cartilage or compound grafts in the auricular pavilion is described.

Keywords: EAR CARTILAGES, SURGERY, PLASTIC, EAR DEFORMITIES, ACQUIRED, EAR, PROSTHESES AND IMPLANTS

Introduction: The lower eyelid is often the site of basal cell carcinomas, with Mohs micrographic surgery (which allows precise histological control with maximum tissue preservation) being the ideal method for their treatment. Tumors that invade the posterior lamella cause full-thickness defects of the lower eyelid, for which several reconstruction techniques have been described with composite grafts. However, few authors use the helix of the ear as a donor area. Objective: To describe the applicability of ear helix composite grafts in the reconstruction of the lower eyelid. Methods: Retrospective study of a series of 6 cases of basal cell carcinoma in the lower eyelid, with tarsal invasion, operated through Mohs micrographic surgery in a private specialist service in the city of Rio de Janeiro, Brazil. All patients had full-thickness defects, and had undergone reconstruction of the posterior lamella through chondroperichondrial graft of the ear helix. The anterior lamella was reconstructed with the remaining eyelid tissue mobilization or with an advancement flap. Patients were assessed for functional capacity and aesthetics. Results: There was complete adaptation of the perichondrium to the conjunctiva, after contact with the eyeball for 8 weeks. All patients with mild escleral show without ectropion. Conclusions: Despite the small sample, all patients had excellent cosmetic and functional results.

Keywords: EYELID NEOPLASMS; CARCINOMA, BASAL CELL; MOHS SURGERY; EAR CARTILAGE.

Introduction: Successful restoration of form and function of the nose after Mohs surgery requires thoughtful reconstructive planning. Nasal defects that are deep and extensive, especially those located on the ala, may require a cartilage graft to help restore nasal function, anatomy, and cosmesis. Objectives: To evaluate the usefulness of auricular cartilage grafts in nasal reconstruction after Mohs micrographic surgery, as well as to describe a cartilage graft harvesting technique. Methods: Retrospective study of patients with nasal defects following Mohs surgery who were submitted to an auricular cartilage graft. Results: Ten patients were included in the study. The cartilage graft was harvested from the scaphoid fossa/antihelix in six (60%) patients, and from the concha in four (40%) patients. All scaphoid fossa/antihelix cartilage grafts were harvested through anterior incision, while conchal grafts were removed through posterior incision. One patient developed a hematoma, which drained spontaneously. Conclusions: auricular cartilage grafts are a versatile, reliable, and predictable method of providing structural support in nasal restoration. It is crucial to identify patients who can benefit from this technique. Through careful planning and adequate execution, ear cartilage grafts help to improve nasal reconstructions results in selected cases.

Keywords: MOHS SURGERY; EAR CARTILAGE; SURGICAL FLAPS; NOSE NEOPLASMS; BASAL CELL CARCINOMA

The reconstruction of nasal surgical defects, especially when there is total thickness bilateral simultaneous involvement of the nasal ala, tip, and dorsum, is complex. Several surgical options are described, and most authors recommend ear cartilage graft or chondro-mucous flap of the nasal septum, associated with the frontal median flap in order to lend structural rigidity to the nasal ala, preventing it from collapsing during inspiration. The authors describe an alternative reconstruction technique without the use of cartilage through the combination of hinge flaps from the nasogenian fold, associated with a frontal paramedian flap.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

In search of a perfect aesthetic, facial filling procedures have been widely used. The presence of animal proteins or synthetic substances in some cutaneous fillers can cause serious allergic reactions, especially when performed by untrained professionals. There are not ideal, pure and free of side effects substances available in the marketplace. The present article is aimed at reporting a case where a facial filling was performed by a non-medical professional, resulting in foreign body reaction and severe skin infection, leading to deformities caused by the procedure carried out. The complications entailed invasive procedures for removal of the material used, and treatment with corticosteroids.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; NOSE NEOPLASMS; SURGICAL FLAPS; NASAL CARTILAGES

The basal cell and squamous cell carcinomas are known as non-melanoma skin cancers, having amounted to 98,420 new cases in men and 83,710 in women in Brazil in 2014. The reconstruction of surgical defects in the nose is a challenge for dermatologic surgeons regarding good functional and aesthetic results, since its structure is rigid and of little mobility. The authors introduce an interesting reconstruction method of a large nasal defect after excision of a basal cell carcinoma, using auricular cartilage graft and unipedicled advancement flap from the lower cheek.

Keywords: CARCINOMA, BASAL CELL; NOSE NEOPLASMS; NASAL SURGICAL PROCEDURES; EAR CARTILAGE; SURGICAL FLAPS

Introduction: Numerous techniques have been described to treat the earlobe aging. Surgical and nonsurgical methods as peelings, CO₂ laser and fillings have been proposed to produce collagen remodeling.
Objective: The objective of this retrospective clinical study was to evaluate the effectiveness of microneedling assisted radiofrequency for earlobe aging.
Methods: Retrospective study of the technique's safety and effectiveness through the evaluation of the results with the application of a satisfaction questionnaire to patients and of the analysis of clinical outcomes by independent dermatologists.
Results: Twelvy patients aged between 48 and 67 years who underwent the technique were evaluated. One hundred percent of the patients reported satisfaction with the results, whereas in the comparative evaluation of the photographs carried out by two independent dermatologists the rate of improvement was 75% in four patients, 100% in eigth patients. Post-inflammatory hyperpigmentation was observed ten to 15 days after the treatment in five patients, though it was reversed after clinical treatment.
Conclusion: This new procedure emerges as an alternative treatment for earlobe aging.

Keywords: EAR CARTILAGE; PULSED RADIOFREQUENCY TREATMENT; REJUVENATION

Introduction: Tuberous sclerosis is a dominant autosomal genodermatosis, classically characterized by facial angiofibromas, fibrotic plaques, periungual fibromas, leaf-shaped hypochromic maculae and fibrous frontal plaques.
Case report: A patient bore this disease, with Koenen tumors in all nail beds of hands and feet, which were resistant to the conventional treatment — simple excision and electrosurgery. Amputation of the nail beds was performed followed by reconstruction with full thickness skin grafts.
Conclusion: The amputation of the nail apparatus and reconstruction with full thickness skin grafts in aggressive, recurrent or high morbidity cases can be an effective therapeutic option.

Keywords: DERMATOLOGY; DERMATOLOGIC SURGICAL PROCEDURES; TUBEROUS SCLEROSIS; SKIN TRANSPLANTS

Reconstruction of the nasal area is a challenge due to its vascularization and abundance of fibrotic tissue. Graft in a large defect in the nasal area has a high risk of necrosis and often produces deformity and color mismatch. We report the case of a 65-year-old man with basal cell carcinoma in the left nasal ala. Mohs surgery was performed, obtaining free margin. The final defect measured 2 cm in diameter with partial loss of skin thickness. The combination of a melolabial interpolation flap and an ear cartilage graft was used, with excellent results. This combination led to good structural and aesthetic results.

Keywords: Surgical Flaps; Bone transplantation; Ear cartilage; Carcinoma, Basal cell

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

Modern hair transplant is constantly evolving. We intend to demonstrate our techniques and methodologies, and especially to describe the dynamics of the entire surgical process of the FUE (Follicular Unit Extraction), technique, from the discussion of the surgical strategy with the patient and evaluation of the donor area to extraction and implantation. The dermatologist must understand the complexity of the procedure and the need for adequate training to achieve a good surgical result.

Keywords: Alopecia; Hair; Hair follicle; Transplant donor site

Hair transplant is a common procedure worldwide, and the method of extracting follicular units is currently the most used. This technique is used not only for androgenetic alopecia but also for other areas such as eyebrows and beard. It is essential to observe the angle of the incisions and implantation of the hairs to conduct the eyebrow transplant so the result is as natural as possible. However, in addition to being rigorous with the design of the shape and position of the eyebrow, care must be taken with the preparation from the receiving site.

Keywords: Transplants; Alopecia; Hair follicle

Hair transplantation is an option for anyone with Androgenetic Alopecia, including transgender patients who want to align their appearance with their gender identity. Thus, hair transplantation can help transform appearance and boost self-esteem, especially if hair loss is a source of gender dysphoria. We report two cases of hair transplantation in transgender patients with good results, using the Follicular Unit Extraction and Follicular Unit Transplantation techniques. Due to the scarcity of specific articles about hair transplantation in this population, we report these cases for a better understanding of the specific needs of these patients.

Keywords: Hair; Transplants; Transgender People; Gender Dysphoria; Gender Identity; Feminization.