To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Keywords: Histology; Mohs Surgery; Skin Neoplasms

In the skin aging process, both intrinsic alterations, secondary to cell regeneration capacity loss resulting from chronological action, and extrinsic alterations, caused by to ultraviolet radiation exposure, can be observed. Treatments that restore collagen production and stimulate fibroblasts to synthesize and organize extracellular matrix are critical for morphogenesis, angiogenesis, and skin healing. Potential uses of products that stimulate collagen production, a component that plays a fundamental role in the extracellular matrix, represents a promising perspective for improving skin quality and its mechanical properties by introducing a new concept of therapeutic approach when treating changes caused by skin aging.

Keywords: Collagen; Hydroxyapatite; Skin Aging

INTRODUCTION: Basal cell carcinoma (BCC) is the most common malign neoplasm. It corresponds to 70-80% of skin tumors. The diagnosis is made based on clinical suspicion combined with dermoscopy, which also allows defining its limits.
OBJECTIVE: To assess whether clinical and dermoscopic criteria are sufficient for the diagnosis and treatment of primary and well-defined BCC.
MATERIALS AND METHODS: Review of suspected cases of well-defined primary BCC surgically approached by excisional biopsy (3 mm margin) at the Dermatology Service of the University of Mogi das Cruzes (2017 to 2019). The Chi-square test was applied to assess the significance of the margins.
RESULTS: 169 injuries were assessed, with a predominance of women in the 8th decade. The histopathological examination concluded on 141 BCCs. When evaluating the excision margins for BCC cases, there was 95% of free margins (p = 0.0004998).
DISCUSSION: There are common dermoscopic elements between BCC and other neoplasms and benign lesions, which justifies other diagnoses found. The 3 mm surgical margin was accurate for well-defined primary BCCs, speeding up healing time and reduces costs.
CONCLUSION: For clinical-dermatoscopic suspicions of well-defined BCC, an excisional biopsy was effective in the diagnosis and clinical safety margins.

Keywords: Dermatoscopy; Diagnosis; Free margins

INTRODUCTION: Seborrheic dermatitis is a chronic inflammatory disease in areas with a higher concentration of sebaceous glands and the participation of the fungi of the genus Malassezia sp.
OBJECTIVE: To assess the effectiveness of treating moderate to severe seborrheic dermatitis using two shampoo formulations in monotherapy.
METHODS: Patients with moderate to severe seborrheic dermatitis of the scalp, with or without chemically processed hair, were grouped according to the degree of affection and used one of two versions of shampoo monotherapy for four weeks. Relapse after treatment cessation was also evaluated.
RESULTS: There was a significant reduction (p <0.05) of oiliness since the first application. The other signs (erythema and peeling) showed significant improvement for both treatments. Participants also reported a considerable improvement in pruritus, erythema, and peeling. The effect on the hair strands was considered positive with both procedures. After one week of suspension, the relapse rate was considered non-significant (p <0.05).
CONCLUSIONS: Both versions of shampoos were able to promote effective control of moderate to severe seborrheic dermatitis. These formulations also demonstrated not to harm the hair strands, even when chemically processed, a fundamental fact to treatment adherence.

Keywords: Dermatitis Seborrheic; Inflammation; Keratolytic Agents; Malassezia; Sebum

INTRODUCTION: The characteristics of acral melanoma (MA) diagnosed in Brazil are poorly studied.
OBJECTIVES: To evaluate the MA characteristics of patients diagnosed at the Dermatology Service in a referral hospital and to verify whether the possible differences between them would be important in determining the diagnosis, treatment, and prognosis.
METHODS: The series was divided into localized and advanced disease. The patients were compared according to sex, color, age, thickness and level of invasion of the primary lesion, staging, and time from the tumor perception and doctor attendance.
RESULTS: Data analysis showed an increased frequency of MA in non-white patients, with a higher age range, but without significant differences. There were also no significant differences regarding sex and staging, as well as regarding the time from the tumor perception and doctor attendance.
CONCLUSIONS: MA occurs mainly in patients who are normally not aware of skin cancer (non-whites) and belong to a higher age group. This form of cancer is unknown to the general public; and in the medical population, the acral region, especially the feet, is overlooked on physical examination.

Keywords: Melanoma; Prognosis; Survival Analysis

INTRODUCTION: The lips have a huge importance in facial aesthetics, and the use of fillers to improve the region is growing with a variety of different techniques described.
OBJECTIVE: To report the experience with the "lip tenting" lip filling technique.
METHODS: 20 female patients between 18 and 60 years of age obtained lip filling through vertically serial punctures from the lip vermilion border, depositing a small amount of product by retroinjection, in the superficial muscular plane.
RESULTS: All treated patients reported a high degree of aesthetic satisfaction with the result of the procedure, with edema and local ecchymosis transiently present in most patients.
CONCLUSIONS: This is an easy execution technique compared to other filling techniques, presenting very satisfactory aesthetic results.

Keywords: Anatomy; Lip; Rejuvenation

INTRODUCTION: The rejuvenation of the perioral region is considered a significant challenge. Numerous therapeutic modalities are used; however, there is no specific single gold standard, and the literature agrees that the best option is to associate techniques. Fractional lasers provide excellent results, and the CO₂ laser is described as quite effective.
OBJECTIVE: To increase the efficiency of fractional CO₂ laser for the perioral region rejuvenation, using the modified CROLL technique.
METHODS: We selected 12 female patients, between 50 and 68 years, who underwent application of the CO₂ laser in two moments. Initially, the modified CROLL technique was applied to the perioral rhytids, and later the laser was used, with less power, on the entire face, including the perioral area. Three sessions were conducted with an interval of 45-60 days.
RESULTS: There was an improvement in tissue elasticity and rhytids superficialization, and the degree of satisfaction of all patients was in line with the clinical evaluation and photographic records.
CONCLUSIONS: The CO₂ laser offers excellent results for the perioral region rejuvenation, especially when enhanced with the modified Croll technique.

Keywords: Laser Therapy; Lip; Rejuvenation; Research and New Techniques

INTRODUCTION: Acne vulgaris, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics is a good adjunctive treatment option due to its anti-inflammatory effect.
OBJECTIVE: Based on the promising character of these studies, which derive mostly from oral probiotic therapy, we decided to investigate what results could come from the topical use of a probiotic bacterium that has undergone the tyndallization process.
METHODS: In this study, we demonstrated the topical use of Lactobacillus plantarum GMNL06, alone, for three months.
RESULTS: We obtained a therapeutic response considered good or very good in 90% of mild or moderate acne cases.
CONCLUSIONS:Vulgar acne, considered a chronic inflammatory and multifactorial disease, presents several therapeutic options. The use of probiotics has become an adjunct treatment due to its anti-inflammatory effect. In this study, we demonstrated that the use of topical probiotics, in monotherapy, for three months obtained therapeutic response considered good or very good in 90% of mild or moderate acne cases.

Keywords: Probiotics; Bacteria; Acne; Treatment

INTRODUCTION: Idiopathic guttate hypomelanosis (IGH) is a common photoaging manifestation, with no standard treatment and presenting mixed results to interventions. In Brazil, the use of micro-needling associated with 5-fluorouracil (5-FU) has been proposed to treat IGH.
OBJECTIVE: To compare the use of MMP^® (micro-infusion of drugs on the skin) with 5-FU, with MMP^® only as micro-needling (with no drugs), and intralesional 5-FU injected with an insulin syringe in the treatment of IGH.
METHODS: In a single blind randomized clinical trial, we compared the three treatments: MMP^® versus MMP with 5-FU and intralesional 5-FU injection for 180 IGH lesions in the forearm of nine patients.
RESULTS: After two treatment sessions, 5-FU alone was the most effective treatment, with statistical significance, compared with micro-needling alone. MMP+5-FU efficacy was lower than intralesional 5-FU injection and higher than micro-needling alone, although without statistical significance.
CONCLUSIONS: The intralesional application of 5-FU was more effective in the treatment of solar leukoderma. The use of a smaller quantity of medication is the great advantage of the MMP + 5-FU technique. Further studies are needed to standardize these techniques.

Keywords: Drug delivery systems; Fluorouracil; Hypopigmentation; Skin aging

Diagnosing basal cell carcinomas, both clinically and dermoscopically, is part of most dermatologists' daily routine. However, tumors of this lineage, when densely pigmented, can be a challenge for the physician and surgeon. Dermoscopic features typical of melanocytic lesions may be present in these carcinomas, and the similarity with melanoma results in a real dilemma. More in-depth knowledge on this topic can make a difference in the management of these cases.

Keywords: Carcinoma, Basal cell; Dermoscopia; Diagnosis; Melanoma

The COVID-19 pandemic represents an unprecedented healthy global threat, leading dermatologist surgeons/aestheticians to interrupt or alter clinical practice and adjust to the necessary precautionary methods. This article aims to prepare dermatologists for the upcoming difficulties and precautions for conducting procedures in the midst of coronavirus pandemics, focusing on recommendations and best practices for reopening aesthetic practice while mitigating risks to practitioners, patients, staff, and the general public.

Keywords: COVID-19; Dermatology; Pandemic; Physicians’ office, SARS-CoV-2.

Hair transplant has become one of the most performed cosmetic procedures worldwide, and the follicular unit excision (FUE) method is progressively growing. FUE can be used to treat not only androgenic alopecia, but also eyebrows and beard area. For the eyebrow, follicular unit transplantation (FUT) is considered the gold standard for keeping the hair longer, facilitating the visualization of their direction during the implant. We describe a case of long hair FUE, where this technique was used without shaving the donor area, maintaining the length of the strands, and with no linear scar.

Keywords: Eyebrows; Hair Follicle; Transplantation

Pincer nail is an acquired or hereditary nail deformity, which manifests as a transverse hypercurvature of the nail plate, especially in its distal portion, causing compression of the nail bed, which can provoke pain with functional disability, as well as secondary infections. Conservative treatment is associated with high recurrence rates, so surgical reconstruction is generally necessary. Four exemplary clinical cases of different corrective options of the pincer nail are described.

Keywords: Ambulatory surgical procedures; Nail diseases; Nails malformed

INTRODUCTION: Squamous cell carcinoma (SCC) is the second most frequent malignant tumor of the epidermis. When located in the labial region, it can present a great challenge for the reconstruction, since it’s located in the center of the inferior third of the face, causing scars and distortions that negatively affect the quality of life.
OBJECTIVE AND METHODS: We report two cases of SCC in the lower lip reconstructed with Gilles fan flap associated with zetaplasty.
RESULTS AND CONCLUSIONS: In both cases, the result was satisfactory, with tumor resolution, absence of microstomia, preservation of the functionality, and good aesthetic acceptance.

Keywords: Carcinoma Squamous Cell; Case Reports; Lip; Surgical Flaps