Keratoacanthoma may be easily mistaken with squamous cell carcinoma, both clinically as well as histopathologically. However, only keratoacanthoma can regress spontaneously.We report a case of a patient with a exophytic, ulceraded, infiltrated lesion in their scalp that was initially diagnosed as a keratoacanthoma. The histopathologic examination confirmed the presence of squamous cell carcinoma, and the tomography of the skull showed that the cancer had spread within the cranium. A surgical excision with wide margins and rotation flap was conducted, followed by adjuvant chemotherapy and radiotherapy treatments.There are a great number of accounts of squamous cell carcinoma erroneously diagnosed as keratoacanthomas in the specialist literature, illustrating the difficulty in differentiating between them.While there is no established effective method to distinguish between the two conditions, surgical excision should be the treatment of choice.

Keywords: CARCINOMA, SQUAMOUS CELL, KERATOACANTHOMA, SURGERY

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

A case of pigmented basocellular carcinoma clinically mimicking a malignant lentigo melanoma in the temporal region of a black female patient is reported. Basal cell carcinoma rarely occurs in black patients. When present, however, it is the second most common malignant skin neoplasia, and is usually pigmented. When the face is affected in such patients, it is difficult to differentiate between malignant lentigo melanoma and basal cell carcinoma. Dermatoscopy is a very helpful diagnostic tool in these cases.

Keywords: CARCINOMA, BASAL CELL, MELANOMA, DERMOSCOPY

Dermoscopy is increasingly used to diagnose non-melanocytic skin tumors. Basal cell carcinoma presents some highly suggestive structures for its diagnosis. The presence of chrysalides-like structures is also frequently found in other benign and malignant skin tumors, and their significance in basal cell carcinoma has yet to be determined. HPV is a virus with oncogenic potential and its involvement in the pathogenesis of basal cell carcinomas is also not yet clearly understood.

Keywords: CARCINOMA, BASAL CELL, DERMOSCOPY, ONCOGENES

Merkel cell carcinomas are highly aggressive neuroendocrine skin tumors that have a poor prognosis. The authors present a case report and emphasize the importance of early diagnosis and treatment.

Keywords: CARCINOMA, MERKEL CELL, IMMUNOHISTOCHEMISTRY, SKIN

Introduction: The reconstruction of surgical defects resulting from the excision of tumors in the nose is a challenge for dermatologic surgeons due to its rigid structure and low mobility. The Mohs Micrographic Surgery technique allows the preservation of healthy tissue and leads to a smaller surgical wound. Objective: To demonstrate techniques for surgical correction of defects after removal of tumors of the nose through Mohs Micrographic Surgery, according to the anatomical location of the tumor. Methods: Descriptive study of patients operated on using Mohs Micrographic Surgery during the period 1996-2010. Patient images taken pre-, intra-, and post-operatively were analyzed with the aim of classifying the defect's anatomic location and the type of surgical reconstruction adopted. Results: 170 patients (totaling 203 lesions) were included in the study. The most common locations for tumors were (in descending order): nasal ala, dorsum, tip, and lateral wall. The advancement flap was the most common reconstruction type for lesions located in the lateral wall and in the nasal ala. Grafts were most often used in lesions located in the tip of the nose. Grafts and advancement flaps were more frequently used in the dorsum of the nose. Conclusions: The parameters that provide guidance on choosing the best reconstruction method must take into consideration the size and location of the surgical defect.

Keywords: MOHS SURGERY, CARCINOMA, BASAL CELL, CARCINOMA, SQUAMOUS CELL

Introduction: Mohs micrographic surgery is a treatment option that increases the cure rate in various types of skin cancer, offering greater tissue preservation and lower recurrence rates. Objective: To describe clinically and histologically the tumors operated on with Mohs micrographic surgery, and to draw correlations to the number of stages and the type of surgical reconstruction performed. The operations were performed at a private clinic in the municipality of Rio de Janeiro, Brazil that is a specialist center for this technique. Methods: Retrospective, observational, cross-sectional/transversal study was carried out based on the review of medical records. Results: A study was conducted of 93 tumors in 84 patients, operated on between April 2010 and August 2012, and followed up with until August 2013 (12 to 42 months). Findings: 47.61% of patients were men and 52.38% were women, the mean age was 62.89 years; predominant phototypes: II (44%) and III (43%); 6 cases (6.45%) of squamous cell carcinoma, 87 (93.54%) of basal cell carcinoma; 74.19% were primary tumors; the nose was the most frequent site (46.24%); a single surgical stage was performed in most cases, with flaps (44%) being the more frequently performed type of closure. There was recurrence in one patient, who required reoperation in October 2012 and followed without new recurrence. Conclusions: Mohs surgery has proven effective with high cure rates and a minimal recurrence rate, especially in lesions located in the face's H area of risk.

Keywords: MOHS SURGRY, CARCINOMA, BASAL CELL, CARCINOMA, SQUAMOUS CELL.

Basal cell carcinoma is the most common type of cancer and its non-surgical treatment has been the subject of many studies. Large lesions of this tumor are therapeutic challenges and the effective topical treatment has good applicability. The authors present a female patient diagnosed with multicentric superficial basal cell carcinoma in the lumbar region for more than 20 years, who refused to be treated surgically. The tumor reached dimensions of 12 cm x 10 cm. A decision was made for a non-surgical therapy, with the application of Imiquimod in a treatment of 5 weekly applications for 2 months. The treatment led to a clinical and histological cure, without recurrence to date (36 months), with excellent aesthetic results and few side effects.

Keywords: CARCINOMA, BASAL CELL; THERAPEUTICS; NEOPLASMS

INTRODUCTION: Extramammary Paget disease consists of a cutaneous adenocarcinoma in areas of apocrine glands. It is a rare neoplasia, and its surgical treatment yields satisfactory results. However, due to the high recurrence rates, surgeries are potentially disfiguring. Imiquimod is a topical immune-stimulant used for the treatment of anogenital warts and in situ carcinomas. Its use has been described in the scientific literature for the treatment of Extramammary Paget disease with satisfactory results.
OBJECTIVE: Describe the course of four cases of Extramammary Paget disease treated with imiquimod, to evaluate evolution and therapeutic response.
METHODS: A retrospective study was performed in a service of dermatology in the city of São Paulo, with the review of medical records of all patients diagnosed with Extramammary Paget disease and treated with imiquimod from January 2011 to July 2018.
RESULTS: Four patients were included, three with vulvar lesion and one with scrotal lesion. Two women presented completed resolution of the disease, one did not respond and the man progressed with 70% regression of the lesion, having undergone surgical excision of a considerably smaller area than the initial lesion.
CONCLUSIONS: Imiquimod presents as a valid therapeutic modality for the treatment of Extramammary Paget disease.

Keywords: Paget disease, extramammary; Neoadjuvant therapy; Gynecology; Urogenital neoplasms, female; Genital neoplasms, male; Neoplasm recurrence, local; Skin neoplasms; Therapeutics; Vulvar neoplasms;

Warts are the most frequent periungual tumors presented in dermatological consultations. They are caused by several types of human papillomavirus (HPV), and some of these lesions evolve to a spontaneous cure. However, there are lesions that do not regress without a therapeutic approach, and some of them are resistant to several therapies. I present a case of a 14-year-old patient with disseminated periungual warts in both hands, resistant to several previous therapies, and who evolved with cure after the use of occlusive imiquimod.

Keywords: Warts; Nails; Drug therapy; Drug therapy, combination; Immunotherapy; Immunotherapy, active; Neoadjuvant therapy

Buschke-Lowenstein tumor (BLT) is an extremely rare variant of condylomata acuminata that presents a benign biological behavior and histological characteristics despite being clinically presented by large lesions. Many therapeutic approaches are available, many of which rely on extensive and mutilating surgical procedures. We present two cases of patients with BLT treated with topical podophyllin whose therapeutic responses were extremely favorable in both cases.

Keywords: Podophyllin; Condylomata Acuminata; Carcinoma, Verrucous; Neoadjuvant Therapy

Genital infection by Human Papillomavirus occurs 65% of the time after contact with contaminated skin and mucosa. Most people eliminate the virus through the immune system. Individual factors such as smoking, age, multiparity, prolonged use of hormonal contraceptives, sexual behavior, and infection by other Sexually Transmitted Diseases cause viral perpetuation and genital lesions, most of them asymptomatic. The most affected regions are anogenital. Treatment should be individualized. Excessive treatment can lead to scarring. We report a case of multiple treatments for removal of genital condyloma with consequent formation of extensive vulvar keloid.

Keywords: Condyloma acuminatum; Scar; Scar, Hypertrophic; Keloid

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

INTRODUCTION: Actinic keratoses are premalignant lesions with a risk of transformation to invasive squamous cell carcinoma. There is no identified correlation between clinical classification and histological grade of these lesions.
OBJECTIVES: To correlate the clinical characteristics of actinic keratoses of the forearms and back of the hands with the degree of histological atypia (Keratinocyte Intraepidermal Neoplasia); to develop and validate a clinical severity scale correlated with the histological grade of actinic keratoses.
METHODS: Cross-sectional study with 162 actinic keratoses clinically evaluated for diameter, erythema, infiltration, hyperkeratosis, and exulceration and 34 lesions with different patterns were biopsied. Clinical features were correlated with the degree of histological atypia and p53 and Ki-67 expression.
RESULTS: Only the diameter of the lesions was significantly correlated with the degree of atypia (p=0.04), and only the erythema, hyperkeratosis, and the diameter linked with the immunohistochemical markings. A clinical score including diameter, hyperkeratosis, and exulceration was developed, which associated significantly with the degree of atypia (Spearman’s Rho=0.43; p=0.01).
CONCLUSIONS: A score composed of diameter, hyperkeratosis, and exulceration correlated with the histological grade of actinic keratoses of the upper limbs was developed.

Keywords: Carcinoma in situ; Carcinoma squamous cell; Keratosis actinic; Skin diseases

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon^® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

Keywords: Mohs surgery; Carcinoma, Basal cell; Carcinoma, Squamous cell; Excision Margins