The responsibility of the dermatologist continues after the end of a dermatologic surgery and must be shared with the patient. That is why the guidelines on postoperative care necessary with wounds are critical and need to be passed on clearly, at the patient's understanding level, and reinforced in writing. Good communication with patients helps the surgeon to avoid complications. The authors' concern to standardize the postoperative guidelines in dermatologic surgery originated the development of this article. A literature review, with the authors' main inquiries, was organized in questions and answers form, to assist dermatologists when performing surgical procedures.

Keywords: Postoperative care; Bandages; Postoperative complications

Q-switched lasers are widely used in dermatology to treat one of the most common complaints of dermatological routine: the pigmented lesions. The several pigments, targets of laser treatment on the skin, have different characteristics as color, size, tissue location, and origin. Q-switched lasers can interact with the pigments in various ways. Since the emergence of Q-switched technology, different and new ways of use have emerged. Understanding the mechanisms of action involved and their main clinical applicabilities is essential to optimize the therapeutic outcomes.

Keywords: Lasers; Tattooing; Melanosis; Skin pigmentation

INTRODUCTION: Vitiligo is a pigmentation disorder characterized by white spots on the skin and mucous membranes. Wnt1 protein belongs to the Wnt signaling pathway. Wnt1 induction is linked with melanocyte stem cell differentiation in hair follicles on lentigo solaris, which is a hyperpigmentation skin disorder in sun-exposed area. This assumes the possibility of Wnt1 induction with NB-UVB therapy, which causes perifollicular repigmentation on vitiligo.
OBJECTIVES: To compare Wnt1 expressions in vitiligo repigmentation after NB-UVB treatment and to identify the relationship between Wnt1 expressions and vitiligo repigmentation area.
MATERIALS AND METHODS: The subjects of the study were 18 vitiligo patients. Immunohistochemical examination was conducted on vitiligo skin tissues pre- and post-phototherapy treatment twice a week for two months.
RESULTS: There were significant differences in the vitiligo lesion area between pre and post-therapy. Also, there were significant differences in Wnt1 expressions between pre and post-therapy. There was a correlation between the post-therapy Wnt1 expressions and the post-therapy vitiligo lesion area.
CONCLUSIONS: Wnt1 induction occurs in hair follicles post-NB-UVB therapy, causing pigmentation around hair follicles. Further studies are needed on the Wnt1 protein mechanism resulting in pigmentation around hair follicles.

Keywords: Hair Follicle; Melanocytes; Ultraviolet Therapy; Wnt1 Protein; Phototherapy; Vitiligo

INTRODUCTION: In Brazil, skin cancer is the most common type of cancer, and melanoma is the most lethal.
OBJECTIVES: To analyze the temporal trend of mortality due to melanoma in Brazil between 2000 and 2016.
METHODS: Ecological time-series study involving all deaths from melanoma in Brazil from 2000 to 2016. The crude death rate, adjusted for the Brazilian population and the world population, was analyzed. For the analysis, we used the regression model by inflection point with 5% significance.
RESULTS: In the period, 22,963 deaths from melanoma were recorded in Brazil, with an increasing trend in the crude death rate (2.6%), and in the adjusted rates for the Brazilian (0.6%) and the world population (0.5%). In the Southeast, we observed a steady trend in the crude death rate and the adjusted rate for the Brazilian population, as well as a decreasing trend in the world population rate. The crude death rate (77.77%; n=21); the Brazilian population (59.25%; n=16), and the world population adjusted rates (55.55%; n=15) presented an increasing trend. Only São Paulo and Rio de Janeiro showed a decreasing trend in the death rate adjusted for the Brazilian and the world population.
CONCLUSIONS: The study showed an increase in mortality from melanoma in Brazil. Policies should be implemented to favor early diagnosis and timely treatment.

Keywords: Melanoma; Time series studies; Epidemiology

INTRODUCTION: Actinic cheilitis (AC) is a premalignant condition resulting from chronic sun exposure that affects the lower lip vermillion. Daylight Photodynamic Therapy (DL-PDT) is a new alternative to conventional therapy, being more straightforward, more accessible, and with better tolerability.
OBJECTIVE: To evaluate the efficacy and applicability of DL-PDT in the treatment of AC and to determine the most prevalent adverse events.
MATERIAL AND METHODS: Experimental study, uncontrolled clinical trial type. The included patients were selected based on clinical and histopathological diagnosis of AC. Aminolevulinic acid was applied to the lower lip, and the sun exposure was conducted (3 sessions/ 2-week interval). We performed pre and post-treatment biopsies, took photographs for documentation, and filled out a default form.
RESULTS: The study included 11 patients (63.6% men); mean age 59 years, and predominance of Fitzpatrick skin phototype II (45.4%). We observed a statistically significant clinical improvement (p = 0.026), but not histologically confirmed. The adverse events were minimal (46% asymptomatic).
CONCLUSIONS: The study evaluated the efficacy and applicability of DL-PDT in the treatment of AC and determined the prevalent adverse events, motivating, and supporting future studies.

Keywords: Hyaluronic acid; Skin aging; Skin care

INTRODUCTION: Cutaneous squamous cell carcinoma may originate from premalignant lesions, with actinic keratosis (AK) being the most frequent. The field cancerization is defined as an area of apparently healthy skin, but with important photodamage around the AK lesions. In this study, we compared imiquimod, an immunomodulator , to a medium-strength chemical peel, with Jessner’s solution combined with 35% trichloroacetic acid.
OBJECTIVE: To compare the efficacy/ acceptability of the two methods in treating the facial field cancerization.
METHODS: Ten patients who underwent the two forms of treatment were selected: in one hemiface, they used 5% imiquimod cream three times a week for 4 weeks; in the other, they applied the medium-strength chemical peel, with Jessner’s solution combined with 35% trichloroacetic acid. Patients were evaluated 30 days after the end of the treatment by counting the AKs and recording the degree of patient satisfaction and the adverse effects with both treatment modalities.
RESULTS: Treatment with imiquimod led to the resolution of 51.8% of the AKs and melanoses together and 72.8% when only the AKs were evaluated. Peeling treated 74.9% of AKs and melanoses and 79.1% of AKs. All patients felt satisfied at some level with both forms of treatment, with greater satisfaction with the chemical peel.
CONCLUSION: Both modalities were effective, but the chemical peel was more efficient and easier to apply, however, with more intense adverse effects

Keywords: Skin, cancer; Keratosis, actinic; Chemexfoliation

INTRODUCTION: Ingrown toenail is the leading cause of nail surgery. Techniques have been described for better exposure of the nail matrix in Grade III treatment, such as block excision of the hypertrophic skin margins and the subcutaneous nail blade involved, removing a semi-elliptic wedge and or L-incision, both advocating closure by suturing the skin and the nail blade. Authors describe the application of an incision technique at the intersection of the lateral and proximal nail fold to expose the matrix and the performing of a wedge in the cutaneous hypertrophy. At the site of the nail blade removal a fragment is left by second intention.
OBJECTIVE: To assess the comfort and effectiveness of the new surgical technique for onychocryptosis.
METHODS: Observational and retrospective study through the analysis of 29 patients with onychocryptosis who underwent the new technique.
RESULTS: Of the 34 nail folds (5 patients had 2 affected nail folds) submitted to surgery using the new technique, only one patient had recurrence in one of the folds and underwent a new intervention. No complaints of postoperative discomfort or complications were observed.
CONCLUSIONS: The applied technique was satisfactory, with a low recurrence rate, and also easy to perform, presenting no discomfort complaints from patients.

Keywords: onychocryptosis; ingrown toenail; operative treatment; surgical technique

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

INTRODUCTION: The treatment of hypochromic scars is challenging, and the techniques used so far show unsatisfactory results. Bimatoprost, an analog of prostaglandin F2-alpha, has been used as a topical pigment agent, and its application as drug delivery can optimize its delivery to the dermis and potentiate pigmentation.
OBJECTIVE: To evaluate the safety and efficacy of Ablative Fractional Laser (AFL) treatment associated with bimatoprost 0.03% drug delivery in hypopigmented scars.
METHODS: The patients were submitted to the AFL, followed by the application of bimatoprost 0.03% in 4 sessions with biweekly intervals. Clinical evaluations and standardized photographs were performed. Patients’ satisfaction was assessed using a 5-question questionnaire.
RESULTS: All patients had clinical improvement in the treated areas. The degree of patient satisfaction agreed with the clinical evaluation and photographic records.
CONCLUSION: The application of AFL associated with bimatoprost 0.03% drug delivery can be a potentially effective and safe treatment for hypochromic scars.

Keywords: Lasers; Hypopigmentation; Laser Therapy

The “harpoon nail” is a variant of the ingrown toenail. In this condition, the nail spicule pierces the distally growing periungual tissue and may emerge through the hyponychium. Its diagnosis can be confirmed by high-frequency ultrasound, facilitating the therapeutic programming.

Keywords: Dermoscopy; Nail diseases; Onychomycosis

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

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

Desmoplastic melanoma (DM) represents less than 4% of cutaneous melanomas and is characterized by invasive proliferation of spindle cells in the dermis, often with neurotropism. The nonspecific clinical appearance and the absence of pigmentation usually lead to a clinical misdiagnosis. The authors report a case of DM located in a cutaneous field cancerization simulating actinic keratosis.

Keywords: Melanoma; Immunohistochemistry; Histology

A 77-year-old patient presents a case of primary cutaneous ductal eccrine carcinoma in the parietal region of the scalp. The biopsy showed a carcinoma with a ductal and infiltrative pattern, suggestive of metastatic neoplasia. An invasive carcinoma with eccrine tubular pattern was identified. The mastologist and oncologist did not detect primary lesions in other organs. Based on clinical and immunohistochemical analyses, the diagnosis was primary cutaneous eccrine carcinoma. Mohs micrographic surgery was performed with three phases to get a free margin. The tumor presented deep infiltration of the subcutaneous tissue and galea aponeurotica.

Keywords: Carcinoma, intraductal, noninfiltrating; Eccrine glands; Mohs Surgery

The Keystone flap is a versatile and reliable option for the reconstruction of major defects, especially those located in the lower limbs. With its use, there is  a low risk of necrosis, being a way to avoid the use of a graft. We report the case of a 92-year-old female patient who was submitted to the Keystone flap after Mohs surgery for pre-tibial Bowen's disease treatment, with good evolution. The Keystone flap is based on musculocutaneous and fasciocutaneous perforators, has high flap survival rates, low risk of complications, reduced pain and morbidity of the donor site, in addition to rapid patient recovery

Keywords: Perforator flap; Mohs surgery; Lower extremity