Introduction: The most common type of skin cancer is basocellular carcinoma, which frequently occurs on the face.Aesthetic and functional damage during treatment are of great concern to patients; Mohs Micrographic Surgery is a safe treatment that allows tissular preservation with minimum aes- thetic damage. Objective: To evaluate whether using Mohs Micrographic Surgery to treat basocellular carcinomas located in aesthetically important areas of the face preserves healthy tissue. Methods: Surgical procedures (n = 49) performed in the ABC Medical School in 2008 to treat tumors located in the peribuccal, periocular and alar areas, and in the ears,were evaluated.The tumors were classified according to clinical and histological features, and the surgical margins were analyzed and compared to those recommended by the literature.The patients were re-evaluated 2 years after treatment. Results: The margins removed by Mohs Micrographic Surgery were much smaller than those recommended for excisional surgery, with important tissular preservation. Conclusion: Mohs Micrographic Surgery permitted the preservation of healthy tissue (56-86%) in the treatment of basocellular carcinomas located in aesthetically important areas of the face, with minimal damage.Thus it is a safe therapeutic and aesthetical option in the treatment of facial basocellular carcinomas.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, ESTHETICS, FACE, SKIN NEOPLASMS

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: Due to the risk of invasion of the orbital cavity and involvement of noble structures, the periocular region requires specific knowledge related to the anatomy and biological behavior of tumors in this region. Objective: To present the particularities and complexity of the approach to periocular tumors, through the analysis of cases treated at a Mohs micrographic surgery specialist center. Methods: A retrospective, observational, cross-sectional study was carried out based on data collected through a review of medical records, operative records, and photographic archives. Thirty-four cases were analyzed between April 2010 and April 2014. Results: Thirty-one basal cell carcinomas, two squamous cell carcinomas, and one sebaceous carcinoma were operated. Of these, 22 (64.70%) were primary tumors, and 12 (35.29%) were recurrent or incompletely excised. The nodular was the most common type of basal cell carcinoma (38.70%), followed by the micronodular (25.80%), the infiltrating (22.58%), the sclerodermiform (6.45%), the superficial (3.22%) and the adenoid (3.22%). Most of the lesions affected the lower eyelid (44.11%), followed in number by the internal canthus (41.17%), the upper eyelid (11.76%), and the external canthus (2,94%). There was only one recurrence following Mohs micrographic surgery. Conclusions: Most tumors had an aggressive histological subtype, especially those located in the internal canthus. Despite the study's limitations, the strict histological control of Mohs micrographic surgery, combined with the multidisciplinary approach to patients, provided excellent oncological, functional, and cosmetic results.

Keywords: MOHS SURGERY; CARCINOMA, BASAL CELL; CARCINOMA, SQUAMOUS CELL; EYELID NEOPLASMS; ORBIT EVISCERATION.

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

INTRODUCTION: The nose is frequently affected by cutaneous carcinomas. Due to its functional and cosmetic importance, tumors on this location are preferably treated by Mohs micrographic surgery, which provides the highest cure rates. For repairing of surgical defects several options are available, including healing by second intention, primary closure, skin grafts, and flaps. In certain cases, one should consider a combination of methods.
OBJECTIVE: To describe the authors' experience in nasal reconstruction after Mohs surgery and to assess if the number of involved subunits influenced the use of combined repairs.
METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and nasal reconstruction by one of the authors during a 3-year period.
RESULTS: 208 cases were included, and the most common repair method were flaps (n = 82). Combined methods were performed in 44/154 (29%) cases with involvement of only one nasal anatomical subunit and 29/54 (54%) cases with multiple nasal subunits involved.
CONCLUSIONS: The dermatologic surgeon should be familiar with different options for nasal reconstruction. The combination of repair methods was often performed, mainly for wounds that affected more than one nasal subunit.

Keywords: Carcinoma, basal cell; Mohs surgery; Nose neoplasms; Surgical flaps

Penile cancer is a rare tumor that has a significant impact on patients’ quality of life. In Brazil, the incidence is 5.7 cases/ 100,000 men/year, representing 2% of all types of cancer affecting men in the country and, in 2015, it culminated in 402 deaths. The traditional treatment is total penectomy with perineal urethrostomy and the consequent loss of normal sexual and urinary functions. For the preservation of penile function, organ-sparing surgery is preferred when possible, and Mohs micrographic surgery is an essential surgical alternative.

Keywords: Carcinoma, Squamous Cell; Mohs Surgery; Penile Neoplasms

Skin cancer frequently occurs on the pinna. The three-dimensional conformation and the limited availability of redundant regional skin make the reconstruction of this anatomical area challenging. We report the reconstruction of anti-tragus using an earlobe transposition flap.

Keywords: Carcinoma, Squamous cell; Ear auricle; Mohs surgery; Skin neoplasms; Surgical flaps

INTRODUCTION: Mohs micrographic surgery (MMS) can achieve high cure rates in skin cancer treatment and remove as little healthy tissue as possible.
OBJECTIVE: This study aims to characterize patients undergoing Mohs micrographic surgery and to assess predictive factors for a higher number of surgical phases.
METHODS: Observational, cross-sectional, retrospective, and descriptive study conducted in a reference service for micrographic surgery from 2013 to 2019. The medical records of 230 patients (256 lesions) were reviewed.
RESULTS: Injuries with recurrence had significantly more stages than injuries without recurrence (1.69 stages versus 1.31 stages). Tumors greater than 2 cm had a greater number of phases than those smaller than 1 cm and between 1.1 and 2.2 cm (2.0 versus 1.08 and 1.22, respectively). When comparing the locations of the lesions with the number of phases, there was no significant difference. There was a considerable difference regarding the preoperative histological subtypes: aggressive basal cell carcinomas (BCC) required a higher number of phases than non-aggressive BCCs.
CONCLUSIONS: Our study demonstrates, corroborating data from the literature, that the risk factors described are directly related to a greater number of stages of Mohs micrographic surgery.

Keywords: Mohs Surgery; Skin Neoplasms; Carcinoma, Basal Cell; Carcinoma, Squamous Cell Surg Cosmet

Basosquamous carcinoma has a high potential for local recurrence and metastasis, especially when it recurs and at the periocular area. A 49-year-old man underwent Mohs micrographic surgery and subtotal reconstruction of the lower eyelid with cartilage graft from the helix of the ear associated with the Tripier flap, evolving with excellent functional and aesthetic results.

Keywords: Basosquamous carcinoma; Eyelid Neoplasms; Mohs surgery; Skin Neoplasms

The recurrent squamous cell carcinoma (SCC) needs an appropriate approach to decrease the risk of recurrences. We report the case of a man diagnosed with SCC on the left temporal region treated by conventional surgery, with infiltration and erythema in the scar area. Reflectance confocal microscopy suggested the diagnosis of recurrent SCC confirmed by histopathology. New surgery and traditional intraoperative frozen section were performed. After two months, the patient had a new relapse, finally treated with Micrographic surgery without new involvement. This article highlights the importance of micrographic surgery in treating SCC, aiming to decrease new recurrences.

Keywords: Skin Neoplasms; Mohs Surgery; Carcinoma, Squamous Cell

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

The nasal region is a frequent site of keratinocyte carcinomas. Its peculiar anatomy, contour, and three-dimensionality make surgical repair challenging. Eventually, in situations of greater complexity, a single technique may not be sufficient to restore the original anatomy, requiring the association of methods. This article describes a strategy for reconstructing a full-thickness alar defect, including the nasal margin, based on the combination of a nasolabial transposition flap with a hinge flap. It is a safe procedure, dependent on the mobilization of local tissue and performed in a single surgical procedure.

Keywords: Surgical flaps. Nose neoplasms. Skin neoplasms. Mohs surgery. Carcinoma, basal cell