Desmoplastic melanoma is a rare variant of melanoma characterized by an invasive lesion of spindle cells and varying degrees of desmoplasia. It is more frequent in men of an advanced age having a history of chronic exposure to sunlight. The extremely variable and nonspecific clinical appearance makes it a challenging diagnosis. The authors present an exuberant case of desmoplastic melanoma in an unusual location, with an initial diagnosis of dermatofibrosarcoma.

Keywords: MELANOMA; DIAGNOSIS; HISTOLOGY; IMMUNOHISTOCHEMISTRY

Chondroid syringoma is a rare benign cutaneous adnexal tumor, also called mixed tumor of the skin, due to the presence of epithelial and mesenchymal components, as well as sweat glands elements. Due to the fact that it clinically resembles a variety of skin lesions, histological examination is crucial for diagnosis and hence treatment.

Keywords: NEOPLASMS, ADNEXAL AND SKIN APPENDAGE; SYRINGOMA; ADENOMA, PLEOMORPHIC

Carcinomas on the face are prevalent lesions, with potentially serious repercussions from aesthetic, psychological, and functional perspectives. Surgical reconstruction after excision of these lesions is a challenge for the dermatologic surgeon, requiring good knowledge of the anatomy of the face and accurate implementation of the most appropriate method for each case. Among the various reconstructive procedures are skin flaps, of which the island pedicle flap and its variants stand out. The present article demonstrates the use of the island pedicle flap transferred to the surgical defect through a subcutaneous tunnel, showing the application and characteristics of this method. Reconstruction using a tunneling island pedicle flap after the excision of a facial carcinoma showed good aesthetic and functional results, despite the difficult location of the lesions. This type of flap is a good option for facial reconstruction in difficult areas.

Keywords: CARCINOMA, BASAL CELL; SURGERY, PLASTIC; 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

Squamous cell carcinoma is the second most common skin tumor; even more aggressive than basal cell carcinoma. It mainly affects patients over 60 years of age and can be an important factor for morbidity and mortality in the elderly. Its treatment should take into account the characteristics of the lesion and the patient's general condition. The authors' goal is to demonstrate that not carrying out the primary closure after tumor excision in the scalp is a therapeutic option in the treatment of high-risk tumors.

Keywords: CARCINOMA, SQUAMOUS CELL; SCALP; WOUND HEALING

The authors present the surgical reconstruction after excision of two synchronous adjacent basal cell carcinomas in the left infraclavicular region, using the Zetaplasty transposition flap technique. Being versatile and simple to perform, Zetaplasty was proven a useful solution for the reconstruction of double defects within a single procedure.

Keywords: CARCINOMA, BASAL CELL; SKIN NEOPLASMS; SURGICAL FLAPS

Ultrasonography is a diagnostic imaging method, which is painless and non-radioactive, and based on the reflection of sound waves through the tissue. The recent development of high frequency and better resolution equipment has enabled the observation of superficial structures and the identification of the different layers, structures, and appendages of the skin, considerably increasing its use in various dermatological conditions - particularly in skin cancer. The authors present two cases in which the association of dermoscopic and ultrasound examinations allowed the careful in vivo analysis of tumor morphology, contents, size, thickness and vascularization, allowing the differentiation between basal cell carcinoma and hidrocystoma, and thus contributing to better pre-operative assessment.

Keywords: CARCINOMA, BASAL CELL; HIDROCYSTOMA; NEOPLASMS; ULTRASONICS

Laserlipolysis has been proven a safe and effective procedure for the treatment of the aging of the cervical region. The technique involves the use of laser energy to induce lipolysis and encouraging neocollagenesis,removing submental fat and acting on local skin sagging. The present article offers a brief review of laserlipolysis in the treatment of the cervical region and reports the authors' experience in the use of the technique.

Keywords: REJUVENATION; LIPOLYSIS; COLAGEN; NECK; LASERS

Introduction: Acne vulgaris is one of the most common skin diseases and most often results in scars that are typically associated with aesthetic and psychological problems. To date, there is no standardized treatment for this kind of scarring. Objectives: To evaluate the improvement of distensible type acne scars on the face after treatment with the microneedling technique, followed by the topical application of a gel containing growth factors. Methods: Ten patients with acne scars who were treated from 2012 to 2014 and met the inclusion criteria were selected. All underwent 3 microneedling sessions with intervals of 1 to 2 months, with a 1-year follow up. Pre- and post- procedure photographs were carried out with a regular digital camera, and with a digital camera with a 3D system. Skin biopsies were performed prior to treatment, and 30 days after the last session. Results: Eight patients completed the study. Among these, seven showed a random reduction in the roughness of the scars in the analyzed area, seven showed a decrease in melanin with a homogenization of its distribution across the skin, and seven patients showed an increase in hemoglobin in the area being studied. The appearance of the scars varied among the eight patients. Deep ice-pick type scars did not improve with the procedure. Conclusions: The studied treatment promotes overall improvement in skin texture and a discreet effect on acne scars.

Keywords: ACNE VULGARIS; CICATRIX; COMBINED MODALITY THERAPY; ESTHETICS

Cellulite or gynoid lipodystrophy in its various degrees is extremely common in the female population, setting on between the ages of 15 and 45 years of age, which corresponds to a woman's reproductive phase. Around 95% of women will present some degree of cellulite at some point in their lives. Despite being highly prevalent, only a few studies have been published in the international literature - many with contradictory conclusions - making it difficult to choose the appropriate treatment regimen.
The present study discusses anatomical differences in the hypodermis of men and women, the complex physiopathology of gynoid lipodystrophy, and mechanisms involved in its development.
Gynoid lipodystrophy is a skin disorder, which can only be controlled and not fully cured due to the fact that it is not a true disease, but rather a predisposition. Nevertheless, persistent or more advanced cases should be considered pathological, and be treated and controlled, given that they are indicative of peripheral vascular insufficiency.

Keywords: ADIPOCYTES; LYMPHATIC SYSTEM; LIPODYSTROPHY

Introduction: Lipo-reductive ultrasound devices are commonly used for non-invasive body sculpting purposes because they can achieve clinically appreciable subcutaneous fat pad reduction and are safe and well tolerated by patients. Objective: This study aims to evaluate the morphological changes induced on the different cell components of human skin as a result of weakly focused high-frequency ultrasound. Methods: Full-thickness skin samples exposed or not to ultrasound ex vivo, and skin biopsies from patients pre-treated or not with ultrasound before lipo-reductive surgery, were analyzed to evaluate possible morphological changes of adipocytes. Adipocyte apoptosis and triglyceride release were also assayed. Clinical evaluation of the effects of repeated ultrasound treatment vs. sham-treatment was also performed. Results: Compared with the control samples, ultrasound treatment induced an appreciable reduction in adipocyte size, the appearance of plasma membrane micropores and triglyceride release, without appreciable changes in microvascular, stromal and epidermal components, and in the number of apoptotic adipocytes. Clinically, the ultrasound treatment resulted in a time-dependent significant reduction of abdominal fat. Conclusions: This study supports the safety and efficacy of trans-cutaneous weakly focused high-frequency ultrasounds for localized fat reduction, and provides experimental evidence for a possible mechanism of action.

Keywords: ADIPOCYTES, WHITE; HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION; SUBCUTANEOUS FAT

Introduction: Introduction: Androgenic alopecia is the most common type of alopecia. It is characterized by alterations in the hair cycle, leading to progressive follicular miniaturization. Platelet-rich plasma, promotes angiogenesis in the tissue by action of growth factors, which stimulate the hair follicle Objective: To eveluate the hair growth in androgenic alopecia, through cell stimulation performed with the subcutaneous injection of platelet-rich plasma. Methods: Three injections of platelet-rich plasma were performed in 18 patients, at 21-day intervals.The evaluation was performed through comparative clinical photographs, dermoscopy, as well from responses to questionnaires. The Mann-Whitney test and Wilcoxon test were used to analyze the results. Results: For seven women who completed the study, the average improvement was 42.85% (patients) and 35.71% (external observer). For the 9 males, the average improvement was 25.55% (patients) and 18.88% (external observer). In Dermoscopy were observed thickening of hairs, improved local circulation and increased number of follicles. Conclusions: An effective and satisfactory response in androgenic alopecia was verified in relation to the platelet-rich plasma injection technique.

Keywords: ALOPECIA; PLATELET-RICH PLASMA; DERMATOLOGY

Introduction: The trends of malignant melanoma in Brazil are aligned with those worldwide: increasing incidence with reduced degree of severity at diagnosis. Objective: To use the prognostic criteria of the Grupo Multicêntrico e Multidisciplinar Brasileiro para Estudo do Melanoma (Brazilian Multicenter and Multidisciplinary Group for the Study of Melanoma) combined with clinical characteristics aimed at developing a clinical and histopathological profile of melanoma cases. Methods: A cross-sectional descriptive study was carried out, with the retrospective analysis of medical records of patients diagnosed with melanoma at a tertiary dermatology reference unit in the city of Bauru, in the Brazilian southeast State of São Paulo, between January 2007 and July 2014. Results: Female patients accounted for 56.2%, with ages ranging from 27 to 95 years (Mean = 61.4 years), with a lesion having been detected on physical examination in 36% of cases. The highest incidence of the disease was in the lower limbs (23.5%), with the superficial spreading subtype corresponding to 79.6% of biopsies. The average Breslow thickness was 2.9 mm, and in 28.1% of cases, the lesion was in situ. Conclusions: The following profile emerged: women, 61-years-old, with lesions in the lower limbs, superficial spreading subtype and with evidence of good prognostic. Studies like this are important due to the fact they provide subsidies for the design of strategies to treat the population.

Keywords: EPIDEMIOLOGY; MELANOMA; HISTOLOGY; PATHOLOGY, SURGICAL; SKIN NEOPLASMS

Introduction: The skin may present dysfunctions that result in histological alterations and elementary lesions, many of them caused by immunologic mechanisms and/or alterations in the epidermal barrier. Objective: The present study was aimed at verifying in vitro whether some cosmetic products marketed in Brazil in the form of liquid soaps, have anti-inflammatory and protective efficacy in the skin barrier. Methods: An in vitro study was carried out with four commercial soaps, which were evaluated in a cell culture of human keratinocytes for the determination of their anti-inflammatory and epidermal barrier restorative effects, as well as their capacity to reduce cutaneous hypersensitivity. Concentrations of keratin 10 and 14, loricrin, IL-12, IFN-γ and TRP V-1 were measured in the cell culture supernatants of human keratinocyte through the sandwich ELISA assay. Results: The four test substances led to significant reductions in the synthesis of IFN-γ and IL-12. Only the test substance C triggered a significant increase in the synthesis of keratin 10. All test substances showed significant reductions in the synthesis of keratin 14 and TRPV-1, and a significant increase in the synthesis of loricrin. Conclusions: Some cosmetic products in the form of soap can have in vitro results regarding their anti-inflammatory, epidermal barrier restoration and skin hypersensitivity reduction effects.

Keywords: ANTI-INFLAMMATORY AGENTS/ADVERSE EFFECTS; DERMATITIS, ATOPIC; SOAPS

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

Introduction: The loss of dermal density and thickness, characterized by sagging and thinning skin, may be related to various conditions such as aging (both intrinsic and extrinsic) as well as abrupt changes in body mass - such as pregnancy or increased weight - and the resulting rupture of collagen fibers. Some nutrients can positively affect the dermal metabolism, thus improving its functional properties. Objective: To evaluate clinically and through ultrasound the effect of a nutritional supplement on the thickness of the dermis and on its functional properties. Methods: Twenty-eight female patients between the ages of 35 and 65 years, with facial sagging complaints, used the supplement for 90 days, having been evaluated subjectively and through ultrasound for clinical safety and efficacy. Results: The studied nutritional supplement provided a significant increase in dermal thickness after 30 days of use, in the areas evaluated. There was significant improvement in the firmness, elasticity, hydration and overall appearance of the skin. No adverse reaction related to the product was observed during the study period. Conclusions: The nutritional supplement was effective in improving the conditions of the dermis, increasing its thickness and clinical parameters of firmness, elasticity, and hydration, and has been proven safe and well-tolerated when used as instructed.

Keywords: COLLAGEN; DERMIS; NUTRIENTS; SKIN AGING