The nasal region is often affected by cutaneous neoplasm, especially in individuals of low phototypes, where the incidence of basal cell carcinoma is high. Surgical defects in the nasal wing and perinasal region constitute a challenge to its reconstruction since it involves several cosmetic units and preservation of the nasal groove. The preservation of the limits between these units is thus fundamental for good functional and aesthetic results. This article aims to show the application of the Shark Island Flap for the correction of defects in the nasal and perinasal regions.

Keywords: Nasal Surgical Procedures; Neoplasms, Basal Cell; Nose Neoplasms

Pilomatricoma is an uncommon benign neoplasm of hair follicles, most commonly seen in children. The tumor appears as a solitary and firm nodule, covered with normal epidermis. We report the case of a 26-year-old woman with a lesion in the temporal region. In histological sections, there was an expansive proliferation of islets of epithelial cells configured irregularly, showing the shadow of lost nuclei (ghost cells) in the central area. Pilomatricoma should be considered in the differential diagnosis of skin nodules, especially those of the head, neck, and upper limbs.

Keywords: Hair Follicle; Neoplasms; Pilomatricoma

Cysts are benign epithelial tumors widespread. The trichilemmal cysts, originating from the anagen’s isthmus, represent about 20% of the cysts and are located more frequently in the scalp (90%). Several methods can be used for the removal of the cysts. The choice of technique depends on its characteristics, such as size, mobility, consistency, quiescence, inflammation, and quantity. However, they may grow again if the capsule is incomplete removed. The authors present a simple variant of the marsupialization technique that allows its complete removal.

Keywords: Ambulatory Surgical Procedures; Cysts; Scalp Dermatoses

Muscle, mucosae, and skin anatomically compose the lips. Neoplasms, congenital malformations, or local trauma can cause lesions on the lips. The surgical reconstruction of lip defects may need flaps, grafts, or microsurgery. The following case report describes the ambulatory surgical correction of a lower lip complex scar, using local skin flaps, with satisfactory aesthetic and functional outcomes.

Keywords: Ambulatory Surgical Procedures; Surgery, Plastic; Face; Surgical Flaps

INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is a local aggressive sarcoma that presents 60% of recurrences. Rarely it presents lung metastasis too.
METHODS: 41 years old man presented a soft tumor in his right hallux for two years. Histopathology has shown spindle-shaped cells arranged in a storiform manner, and immunohistochemistry was CD34 positive.
DISCUSSION: The literature describes some clinical types of DFSP. The most common are: confluent nodules forming a plaque, sometimes similar to keloids, tumoral lesions, and atrophic plaques.
CONCLUSION: DFSP cases simulating a subcutaneous cyst have been described in the literature; nevertheless, it is an unusual presentation of this tumor.

Keywords: Dermatofibrosarcoma; Sarcoma; Surgical Procedures, Minor

The giant BCC is a rare variant, and the repair of large defects in the scalp, generated after oncologic resection, is a surgical challenge. We report the case of a patient submitted to late scalp reconstruction after oncologic resection of giant BCC in the scalp with the association of techniques. Reconstruction of scalp lesions depends on a comprehensive understanding of the anatomy of this site, knowledge of the arsenal of surgical techniques, and a detailed assessment of patient factors and expectations, given the impact on the quality of life and morbidity related to each therapeutic option.

Keywords: Carcinoma, Basal Cell; Reconstructive Surgical Procedures; Scalp Dermatoses

Dermatofibrosarcoma protuberans is a locally aggressive sarcoma of intermediate malignancy that predominates in the range of young adults to middle age. Congenital or childhood lesions are rare but have been reported. It can be misdiagnosed and incompletely excised in the early stages, which increases the risk of recurrence. The present article reports the case of a 24-year-old male patient presenting a hyperchromic macula in the abdominal region from birth that evolved into a tumor after several surgical approaches. Biopsy and immunohistochemistry confirmed the diagnosis of dermatofibrosarcoma protuberans, and the lesion was excised with a 3 cm margin.

Keywords: Dermatofibrosarcoma; Neoplasms, Fibrous Tissue; Sarcoma

Dowling-Degos disease (DDD) is a rare genodermatosis. Progressive reticular hyperpigmentation of flexural areas mainly characterizes the disease, which may be associated with a large spectrum of benign lesions and cutaneous neoplasms. It may cause psychosocial impairment due to the deformity caused by the lesions with significant aesthetic damage. We present two cases of male patients with hyperchromic macules, multiple comedones, epidermal cysts, cribriform scars on the face, cervical region, dorsum, anterior thorax, armpits, genital region, and disfiguring tumors, characteristic of DDD.

Keywords: Carcinoma; Genetics; Hidradenitis; Hidradenitis Suppurativa; Skin Pigmentation

Nodular fasciitis is a benign tumor resulting from the reactive proliferation of fibroblastic or myofibroblastic cells presenting rapid growth and rich cellularity. In adults, the extremities’ involvement is more frequent; however, other regions can be affected. In this report, we present the case of a 40-year-old woman with a nodular lesion on the forehead. The histopathology confirmed the diagnosis of nodular fasciitis. The reported case highlights its rare location and alerts the clinical dermatologist in its inclusion among the differential diagnoses of tumor lesions on the face.

Keywords: Facial Dermatoses; Fasciitis; Forehead

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

The trilobate flap can be used for the reconstruction of mid-size defects of the lower nasal portion. The third lobe determines the rotational arch’s increase, reducing the flap tension and improving the final aesthetics. We report the case of a patient submitted to the procedure with good aesthetic and functional results.

Keywords: Dermatologic Surgical Procedures; Mohs Surgery; Surgical Flaps

Facial surgeries are often challenging for surgeons due to their complex anatomy, aesthetic and functional importance. Interventions in the cosmetic subunit that comprises the eyebrows can be particularly difficult. This case report aims to demonstrate the use of island flap in this region. We performed the excision of melanocytic nevus, with a good outcome and absence of postoperative complications. This technique is commonly used for facial reconstruction; however, the literature describes only a few cases using this method for eyebrow reconstruction.

Keywords: Eyebrows; Reconstruction; Surgical Flaps

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

Proliferating Trichilemmal Tumor (PTT) is an uncommon benign neoplasm that usually affects adult women over 60 years old, preferably as a solitary nodule in the scalp. We report a case of PTT in a young woman presenting exuberant, asymptomatic scalp tumors 7 years ago, which recurred after surgical exeresis. The histopathology confirmed the diagnosis, and surgical excisions and clinical follow-up were performed. PTT appears to originate from the wall of trichilemmal cysts, from the isthmus of the hair follicle’s outer root sheath. Usually, it has benign biological potential with a low risk of malignancy and high recurrence. The therapy of choice is surgery.

Keywords: Cysts; Neoplasms; Scalp

The digital myxoid cyst is a benign lesion of controversial origin, usually in the distal phalanx, close to the posterior nail fold. Clinical picture or imaging techniques, such as ultrasound and magnetic resonance imaging, can help diagnose the condition. It may present with discomfort to patients because it is often painful. There are several possible treatments, such as surgical excision and suturing, with or without grafting, cryotherapy, electrocoagulation, and curettage. However, it presents high recurrence rates. In this paper, we propose a simple, fast, and low-cost method for treating digital myxoid cyst, so far with low recurrence rates.

Keywords: Ambulatory Surgical Procedures; Dermatology; Nails

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

Although several techniques have been described for upper lip reconstruction, functional reconstruction of total upper lip defects remains a challenge. We report a case of a significant size squamous cell carcinoma excised in the upper lip region using the double-advancement technique, with positive functional and aesthetic results.

Keywords: Carcinoma, Squamous Cell; Lip Neoplasms; Surgical Flaps

Onychomatricoma is a rare tumor of the nail complex of unknown etiology. It has a higher incidence in women in the 5th decade of life. However, this occurrence may be mistaken due to data and information that have not yet been fully elucidated. This study aims to review the literature and report two cases of onychomatricoma. We included two male patients with different age ranges and different tumor presentations. This study shows that the rarity and incidence reported in the literature are questionable and that the onychomatricoma can be underdiagnosed.

Keywords: Dermoscopy; Onychomycosis; Pathology, Clinical

Koenen tumors are nail fibromas included among the main diagnostic criteria of tuberous sclerosis. Elongated and thin papules, firm, with smooth surface and broad base characterize these lesions, which are slightly erythematous and present varying sizes. Koenen tumors commonly affect toenails and result in aesthetic and functional concerns associated with deformities, pain, and bleeding. Several therapeutic options are described for Koenen tumors; however, there is a lack of consensus in the literature regarding standard treatment. We report the case of a patient who underwent surgery with excellent outcomes. Additionally, we discuss the advantages and disadvantages of each therapeutic modality.

Keywords: Dermatologic Surgical Procedures; Fibroma; Nails; Tuberous Sclerosis

Undifferentiated sarcomas are neoplasms of soft tissues derived from the mesoderm. We report a case of undifferentiated pleomorphic sarcoma, its dermoscopy, staging, and therapeutic approach.

Keywords: Dermoscopy; Sarcoma; Soft Tissue Neoplasms

Squamous cell carcinoma (SCC) represents the second most common type of skin cancer. SCC originates from the atypical proliferation of the cells of the epidermis's spinous layer and is more frequent in men over 50 years of age, with a low skin phototype and history of sun exposure. We describe the case of a 61-year-old man, previously healthy, with a lesion presenting fast and exuberant growth on the face. The anatomopathological and immunohistochemical exams confirmed the diagnosis of moderately differentiated SCC.

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

DNA-virus, which belongs to the papillomavirus group, causes Condylomata acuminata. In children under 3 years of age, transmission tends not to be due to sexual abuse but rather vertically. There is no consensus for the treatment of anogenital warts in children. The chosen method is individualized for each patient, preferring less traumatic treatments, with fewer sequelae. Although there are still some restrictions on the imiquimod use in children under 12, studies have already shown this therapy’s success in this age group. We report a case treated with 5% imiquimod cream with the resolution of pre-existing lesions.

Keywords: Condylomata Acuminata; Papilloma; Warts

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

Wearable technology has come to change the way people see and experience the world. Google Glass is one of these technologies created by Google Inc., Mountain View, California. This device has many uses, including in the medical field. One of these uses is the possibility of providing viewers with the surgeon's view during surgery. Surgeries with a small operative field, like cleft lip surgery, or cheiloplasty, should benefit from Google Glass. In our institution, we recorded the first cleft lip surgery using Google Glass to give our impression of the Glass.

Keywords: Education, Medical; Innovation; Technology

Necrobiosis Lipoidica (NL) is a granulomatous dermatosis, mainly affecting people with diabetes due to collagen degeneration. Although there are different treatments, all have little response. Among the options, the Intense Pulsed Light (IPL) and the Laser Erbium-YAG enhance the production and remodeling of the collagen treating the atrophy, besides reducing the erythema by the coagulation of blood vessels. We report a case of a 24-year-old woman with type I Diabetes Mellitus who underwent NL treatment on her left forearm in seven sessions with the association of IPL and 2940 nm Erbium-YAG laser. We observed improvement in central atrophy and erythema.

Keywords: Necrobiosis lipoidica; Diabetes mellitus; Lasers; Laser therapy; Intense pulsed light therapy; Collagen

We report the case of a 13-year-old girl with a diagnosis of extra-abdominal desmoid fibromatosis, a neoplasm of benign origin but uncommon in the soft tissues. This study aims to expose the rarity of the tumor and its challenging therapeutic approach due to its high frequent local recurrence rates. For the treatment, Mohs micrographic surgery was performed in two stages to obtain a free margin.

Keywords: Fibromatosis, Aggressive; Mohs Surgery; Neoplasms

Vitiligo is an acquired dyschromia that affects 0,1-3% of the world population and can cause significant psychosocial distress in patients. Surgical management became essential in the last years. Mini-punch grafting is one of the cheapest and most straightforward approaches to all surgical treatments available. A limitation of this technique is the possibility of cobblestone-like repigmentation. We describe a new technique with a dermoepidermal grafting obtained by shave excision of papule formed post punch grafting in vitiligo. It could improve the cobblestone pattern in the donor site and the repigmentation in both donor and recipient areas.

Keywords: Dermatology; Hypopigmentation; Vitiligo

Q-switched lasers are widely used for tattoo removal. A 48-year-old-woman with a black tattoo on the left thigh was submitted to ten sessions of Q-switched Nd:YAG 1064nm laser associated with fractional CO2 laser, performed every two months. Six months after treatment end, we observed almost complete tattoo removal, besides improvement in skin texture. Q-switched lasers promote tattoo removal by a photoacoustic phenomenon. The association with fractional ablative lasers is an option for intensely pigmented tattoos or for tattoos with several colors, which are hard to remove.

Keywords: Laser Therapy; Lasers; Tattooing

Rhinophyma is a disfiguring and progressive disease of the nose with high prevalence. Despite being considered a benign condition, many patients have sought curative treatments due to aesthetic deformity and social stigmatization. There are several surgical techniques described in the treatment of this disease. This report aims to present a case that required an unusual therapeutic approach for the treatment of rhinophyma, given the patient's multiple comorbidities. The procedure was performed with no complications in the intra and postoperative period. The patient maintains an outpatient follow-up with a good long-term aesthetic result.

Keywords: Dermatologic Surgical Procedures; Rhinophyma; Rosacea