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.

Introduction The pigment mainly responsible for the color of the skin, melanin is directly influenced by exposure to sunlight. Objective: The present study assessed the effects of solar radiation on the levels of melanin in areas exposed and not exposed to the sun, taking into consideration the seasonality of exposure. Methods: Melanin levels were evaluated on the forehead, sacral region, and forearm, in the post-summer and post-winter periods, using spectrophotometry. Results: The levels of melanin after winter were lower than those after summer in the forehead (168.1 vs. 177.0), sacral region (132.0 vs. 140.4), and forearm (218.7 vs. 260. 4), with a statistically significant reduction only in the forearm (p<0.0001).Additionally, erythema was significantly less intense in the forearm and forehead (p<0.0001 and p=0.002) after winter than after summer. Conclusion: The significant reduction of melanin levels in the forearm after winter reinforces the influence of seasonality on skin pigmentation changes to body areas exposed to the sun without protection.The small variation in the levels of melanin found in the unexposed area (sacrum) confirms that the effect of exposure to the sun on the levels of melanin is predominantly local. Increased production of melanin is directly related to local exposure to UV rays.

Keywords: MELANINS; ERYTHEMA;SOLAR RADIATION; PIGMENTATION.

Introduction: Childhood is considered a critical period for photoprotection, since approximately 80% of the exposure to the sun occurs during this phase of life. Objectives: To evaluate the characteristics of the knowledge and sun protection habits of children and their caregivers. Methods: A cross sectional study was conducted with questionnaires from October 2011 to July 2012. Results: 177 children (mean age = 7.66 years); 64.9% of children assessed exposure to the sun as dangerous, 88.7% knew what sunscreen is, and 94.3% considered its use important; however, 66.6% believed it was necessary only in summer. Regarding photoprotection habits, 37.3% reported exposure to the sun between 10a.m. and 4p.m. Among caregivers, 81.3% reported an absence of daily application of sunscreen on their children, and 33.9% reported that their children had already had some type of sunburn. Conclusions: Strong dissociation between knowledge and practice regarding exposure to the sun was observed in the present study. The discrepancy between knowledge and habits that was observed in the two groups can be explained by the quality of information on exposure to the sun. The present study’s data point to the need for a wider dissemination of adequate knowledge, both by the media and by physicians, to nurture healthy practices regarding exposure to the sun.

Keywords: SOLAR ACTIVITY; SUN PROTECTION FACTOR; SUNSCREENING AGENTS; CHILD RESTRAINT SYSTEMS; CAREGIRVES

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

Introdução: Hyperpigmentation is a common dermatological condition, usually associated with exposure to the sun and relative difficulty of treatment. Pycnogenol^® is an extract obtained from the French pine tree Pinus pinaster, with known antioxidant and anti-inflammatory activity, having been proven to inhibit melanin synthesis in previous studies. Objective: To evaluate the whitening activity of Pycnogenol^® in an ex vivo experimental model after exposure to ultraviolet A and B, infrared-A radiations and visible light. Method: Human skin fragments obtained from elective plastic surgery were treated with Pycnogenol ^® and then irradiated with ultraviolet A and B, and infrared-A radiations, and visible light, having been sent for histological evaluation of melanin pigmentation by the Fontana-Masson staining technique. Results: The histological evaluation demonstrated an increase in melanin deposition in all irradiated groups. However, fragments pre-incubated with Pycnogenol^® showed a reduction in the deposition of this pigment after irradiation. Conclusions: This study demonstrates the reduced melanin deposition in skin culture treated with Pycnogenol^® after irradiation with ultraviolet A and B, and infrared-A radiations, and visible light, concluding that this substance may have lightening properties.

Keywords: HYPERPIGMENTATION; SKIN LIGHTENING PREPARATIONS; SOLAR RADIATION

Introduction: Infrared radiation (IR-A) causes structural changes in the skin, similar to those caused by prolonged exposure to ultraviolet radiation. Evaluation of efficacy and safety of cosmetic products concentrates in in vitro tests and clinical trials. A promising alternative is the use of fragments of human skin from elective cosmetic surgery, to evaluate the actual clinical benefits of a product applied topically.
Objective: The objective of this study was to correlate IR-A radiation effects in biopsies and in ex vivo skin fragments and in human fibroblasts culture by quantifying MMP-1, TIMP-1 and GADD45a mediators.
Methods: Collection of biopsies from 15 volunteers after IR-A applications for 5 consecutive days. Exposure to IR-A radiation of human skin fragments from elective cosmetic surgery, and human fibroblasts culture. Measurement of MMP-1, TIMP-1 and GADD45a mediators for further comparison of results.
Results: In the three models used, the IR-A radiation induced an increase in MMP-1, inhibited the synthesis of GADD45a, and did not changed TIMP-1 values.
Conclusion: Due to the positive correlation of the models studied, it may be suggested the use of ex vivo skin as plausible and sustainable tool to overcome differences between knowledge generated from in vitro and clinical experiments.

Keywords: SKIN AGING; MATRIX METALLOPROTEINASE 1; SOLAR RADIATION; IN VITRO TECHNIQUES

Introduction: The number of cases of cutaneous carcinoma has been steadily increasing, which calls for the necessity of improving cost effective health strategies aimed at preventing that disease and related complications.
Objective: To perform a cross-sectional study with data collected directly from the participants, through the application of a questionnaire.
Methods: Once the data was collected, the bivariate logistic regression was used to calculate the odds ratio (OR) and the 95% confidence interval (CI) between the independent variables and the risk behavior, which corresponded to the non-daily use of sunscreen and/or other photoprotection method. The sample consisted of 200 students – of which 50% studied mathematical sciences and 50% studied biological sciences.
Results: There was no significant difference between the students' behavior according to the different science field they were studying. Women presented lower risk behavior as compared to men (OR = 0.07; CI 95% = 0.01 - 0.56).
Conclusions: Most university students do not protect themselves adequately when exposed to the sun, with this risk behavior being lower in women. Actions aimed at photo-educating students are important.

Keywords: Disease prevention; Skin; Solar radiation; Students

INTRODUCTION: Polypodium Leucatomos Extract (PLE) is a recognized topical and oral photoprotective agent that adds biological protection to physical and chemical filters.
OBJECTIVE: To evaluate the efficacy of an SPF 90 sunscreen containing physical and chemical filters, and PLE in reducing sun damage when compared to the same formulation but without the presence of PLE.
METHODS: Ten volunteers were included, each representing 4 areas (non-irradiated skin; irradiated and unprotected skin; irradiated and protected with sunscreen not containing PLE; irradiated and protected with sunscreen containing PLE) exposed to solar radiation. Colorimetric evaluations of erythema and pigmentation were performed. Samples were collected for histopathology.
RESULTS: The area treated with PLE-containing SPF 90 sunscreen, compared to the sunscreen of the same formulation but without the presence of PLE, showed lower intensity of erythema and pigmentation, lower generation of sunburn cells, p53, and MMP-1, and higher CD1-a cell positivity (lower Langerhans cell depletion).
CONCLUSIONS: The association of Polypodium Leucatomos Extract with physical and chemical filters is effective in reducing the damage caused by solar radiation. The presence of EPL in the formulation contributed to the reduction of damage when compared to the formulation without the active.

Keywords: Sunscreens; Polypodium; Solar radiation

The increase in the incidence of basal cell carcinoma (BCC) affects all age groups, including young patients under twenty years old. Because it is poorly remembered in this group of patients, late diagnosis and treatment of this neoplasia may be more common. Like other age groups, excessive exposure to ultraviolet radiation is the main associated risk factor; however, genetic factors may also be involved in non-syndromic cases. We report a case of BCC on the face of an adolescent treated with Mohs micrographic surgery.

Keywords: Adolescent; Carcinoma, Basal Cell; Epidemiology; Mohs Surgery; Solar Radiation

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

Polypodium leucotomos extract was first described in the literature 55 years ago, demonstrating anti-inflammatory action in dermatoses such as vitiligo and psoriasis. It is currently available as an oral and topical photoprotection agent in more than 26 countries to prevent and treat dermatoses resulting from solar radiation, such as polymorphous light eruption, melasma, actinic keratoses, skin cancer, and photoaging, among others. In Brazil, ANVISA registered the patented Polypodium leucotomos extract in 2012. After 10 years of its launch, its recommendation by Brazilian dermatologists is well established and is presented in this review paper.

Keywords: Solar radiation; Sunscreening agents; Polypodium

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