This article presents practical guidelines for the synergistic use of HA and laser/energy-based technologies in facial rejuvenation. These recommendations originate from the collaborative interaction of a multidisciplinary group of physicians with experience in dermatology and plastic surgery, and can potentially be extended to treat other areas of the body, including neck and hands. The synergy between HA and lasers/intense pulsed light was recognized, emphasizing patient-tailored treatments and post-treatment care. These recommendations represent valuable guidelines, which can be adapted according to individual patient needs and to the continuous advancement of dermatological technologies.

Keywords: Lasers; Light; Rejuvenation; Hyaluronic Acid; Laser Therapy; Intense Pulsed Light Therapy.

We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) of cases of foreign body granuloma (FBG) induced by hyaluronic acid (HA). A total of 27 patients with HA filler-induced FBG reported in literature were included. The estimated incidence of HA-induced FBG is 0.02%-0.6%. Several factors are involved, including cross-linking agents and impurities. The most frequent clinical presentation is asymptomatic nodules, although other lesions may occur. Histopathological examination is the gold standard for diagnosis, but ultrasound is a promising tool. Treatment options include expectant management, hyaluronidase, corticosteroids, 5-fluorouracil, and surgery.

Keywords: Hyaluronic Acid; Dermal Fillers; Granuloma, Foreign-Body.

INTRODUCTION: Cutaneous malignant tumors are preventable and have a high cure rate when diagnosed early, resulting in reduced morbidity and mortality. Early-stage cancer detection allows for timely treatment, leading to a better prognosis.
OBJECTIVE: To evaluate the effectiveness of the "Skin Cancer Awareness Month" campaign in identifying potential cases of skin cancer and its resolution rate based on the time required for lesion treatment.
METHOD: A retrospective analytical cross-sectional study with descriptive-quantitative characteristics.
RESULTS: In 2022, the time between biopsy and curative surgery ranged from 94 to 218 days, with a median of 153 days. In 2023, the time between biopsy and curative surgery ranged from 12 to 249 days, with a median of 129 days. A statistically significant difference (p=0.04) was observed between the years 2022 and 2023 in the median time from biopsy to surgery.
CONCLUSION: Improved efficiency in performing biopsies and surgeries, as well as enhanced patient adherence to treatment, was necessary.

Keywords: Carcinoma; Carcinoma, Squamous Cell; Skin Neoplasms; Health Promotion; Time-to-Treatment.

INTRODUCTION: The eyelids have specific functions, such as eye protection. Aging can lead to excess upper eyelid skin (upper dermatochalasis), causing functional and aesthetic impairment. Subjective assessments of improvement pre- and post-blepharoplasty may be underestimated, since even small increases in palpebral fissure height (PFH) can improve the visual field.
OBJECTIVE: To measure PFH to check for improvements in dermatochalasis after upper blepharoplasty performed by dermatologists and compare the subjective assessments of independent dermatologists and patients.
METHODS: Medical record review of patients who underwent upper blepharoplasty. Photographs taken before and two months after the procedure were compared. Independent dermatologists evaluated the photographs (subjective assessment). Patients' subjective perception was also assessed. PFH before and after the procedure was calculated in millimeters (mm).
RESULTS: A total of 170 eyelids were analyzed. There were significant differences in mean PFH values before and after the procedure (7.088 vs. 8.618 mm; p < 0.001) and in patient self-assessment (p = 0.001), but no differences between the subjective assessments by independent dermatologists (p = 0.665).
CONCLUSION: There was an improvement in mean PFH after blepharoplasty, which probably resulted in improved visual field. Dermatology is a specialty qualified to perform the procedure.

Keywords: Blepharoplasty; Eyelids; Skin Aging; Eye.

INTRODUCTION: Acne is a prevalent chronic disease that can cause physical, emotional, and social effects. Isotretinoin and chemical peels are available as treatment, but their combination has historically been avoided due to reports of abnormal healing. Recent studies suggest that the combination with superficial or medium-depth peels is safe, but there are no studies considering the specific characteristics of the Brazilian population.
OBJECTIVE: To evaluate the safety and efficacy of combining isotretinoin and chemical peels in the treatment of acne scars.
METHODS: A clinical trial was conducted with patients aged 15 to 25 years undergoing acne treatment with isotretinoin. The intervention group underwent three Jessner's peels during isotretinoin use, while the control group underwent the same peels after treatment with isotretinoin was completed. Outcomes were assessed using the QGSGS and IGA scales by two blinded evaluators.
RESULTS: Peels performed concomitantly with isotretinoin did not result in worse outcomes on the QGSGS and IGA scales compared to the control group.
CONCLUSION: The combination of isotretinoin and chemical peels proved to be safe, but further studies with larger samples are needed to establish recommendations.

Keywords: Acne Vulgaris; Isotretinoin; Chemexfoliation.

INTRODUCTION: Vitiligo is an autoimmune pigmentary disorder characterized by depigmented macules on the skin. It is associated with a range of autoimmune diseases. Antinuclear antibodies (ANA) are implicated in vitiligo, but their association with disease severity remains unclear.
OBJECTIVE: This study aims to assess antinuclear antibody (ANA) serum levels and evaluate their relationship with the severity and types of vitiligo.
METHODS AND PATIENTS: This is a retrospective study using preexisting patient records from the Pigmentary Disorders Unit of the Cairo Hospital of Dermatology and Venereology. The analysis included patients with complete medical records, including demographic data, clinical evaluation (VIDA and VASI scores), and laboratory results for ANA titer. Their correlation with disease severity and patient demographics was analyzed.
RESULTS: The study found that 462 patients (33%) were positive for ANA, with a higher prevalence in females (350 patients; 75.8%). A significant correlation was observed between ANA positivity and family history of vitiligo and systemic autoimmune diseases such as type 1 diabetes mellitus and thyroid disease. Weak positive correlations were found between ANA, different types of vitiligo, and disease severity scores.
CONCLUSION: Vitiligo is strongly associated with systemic autoimmune conditions. Routine monitoring of autoimmune markers in patients with vitiligo is recommended.

Keywords: Vitiligo; Antibodies, Antinuclear; Autoimmune Diseases.

INTRODUCTION: Melanoma is a type of skin cancer originating from melanocytes which may also affect mucous membranes, leptomeninges, and the uveal tract. Although less prevalent than other skin cancers, it has high lethality due to its aggressiveness, making it a significant public health problem in Brazil.
OBJECTIVE: The primary objective of this study was to assess the time elapsed between diagnosis and treatment initiation for patients with melanoma in different regions of the country in 2024. In addition, it sought to identify possible regional disparities in this interval, as well as to correlate this information with existing data in the literature.
METHODS: This cross-sectional study analyzed 4,405 cases of melanoma diagnosed in 2024, focusing on the diagnosis-to-treatment interval based on data from the Brazilian public health information systems (SISCAN, SIH, and SIA). The study assessed compliance with the 60-day legal maximum waiting time established by Law No. 12.732/2012 across the country's five macroregions.
RESULTS: Regional disparities were observed: the South Region had the best indicators (34.25% of cases treated within 30 days), while the North Region had the worst performance (22.41%). A high percentage of cases had no recorded treatment initiation dates (60.86% nationwide; 68.10% in the North), revealing weaknesses in health information systems and possibly in treatment delivery. Persistent delays and regional inequalities highlight structural deficiencies in the provision of oncology care.
CONCLUSION: The findings underscore the need to strengthen the regionalization of care, improve recordkeeping, and implement effective mechanisms to enforce legal time limits.

Keywords: Melanoma; Diagnosis; Brazil.

Large upper-third auricular defects present complex reconstructive challenges, requiring restoration of both form and function. We describe a single-stage technique combining an ipsilateral conchal cartilage graft for structural support with a tunnelized preauricular transposition flap for soft tissue coverage. This approach provides rigid support to enable the use of glasses and hearing aids, along with good color and texture match. In a 79-year-old patient with a 30 × 28 mm post-Mohs surgical defect, the method yielded a satisfactory outcome with preserved ear contour and function. Only minor issues, such as slight forward auricular displacement, were noted at 8-month follow-up.

Keywords: Mohs Surgery; Dermatologic Surgical Procedures; Carcinoma, Basal Cell

Not all surgical wounds are amenable to primary healing, particularly on the scalp where tissue inelasticity and lesion extent, such as in skin cancers, complicate the procedure. Grafts and flaps increase complexity, recovery time, and surgical costs. The Figueiredo technique reduces costs, protects the wound during its critical phase, maintains wound moisture, and promotes the effective development of granulation tissue. This previously unpublished report demonstrates the use of the technique on the scalp of an elderly patient with systemic scleroderma and a suspected squamous cell carcinoma lesion, showing good progress and satisfactory aesthetic results.

Keywords: Surgical Oncology; Skin Neoplasms; Wound Closure Techniques; Scalp.

Onychomatricomas are rare and benign tumors of the nail apparatus. Clinical findings, dermoscopic features and possibly imaging and histopathology exams confirm the diagnosis. We report the case of a 15-year-old male patient who had undergone multiple previous treatments for other diagnoses with no response. The transverse hypercurvature and digitiform projections on the nail plate, complemented by histopathological analysis, confirmed the hypothesis of onychomatricoma. The relevance of proper diagnosis and therapeutic management in these cases spares the patient and optimizes the use of public resources that would otherwise be spent on countless consultations and the long period until diagnosis.

Keywords: Neoplasms, Adnexal and Skin Appendage; Nails; Onychomycosis; Nails, Malformed.

Earlobe stretching dates back to various ancient cultures, symbolizing social status, cultural identity, and spirituality. Since the 1970s, it has gained popularity in the West as a form of self-expression. However, the use of gauges can lead to deformities requiring surgical correction. Numerous techniques have been developed over the past century to address this issue. This case report describes the use of the inverted "snail" technique, which employs two flaps, folding the medial flap into a spiral, and allows for a harmonious and symmetrical adjustment. It can be a viable alternative for correcting extensive deformities and asymmetries.

Keywords: Body modification, non-therapeutic; Ear deformities, acquired; Esthetics; Plastic surgery procedures.

Pemphigus vegetans is a rare clinical form of pemphigus vulgaris, and scalp involvement is even rarer. Treatment can be challenging, often requiring systemic immunosuppression. Botulinum toxin can be an effective and low-risk alternative for the treatment of pemphigus vegetans unresponsive to conventional treatments. We report an unprecedented case in the literature of successful treatment of scalp lesions through the application of botulinum toxin type A.

Keywords: Pemphigus; Scalp; Botulinum Toxins, Type A

We report a case involving a 71-year-old male with a history of kidney transplant on immunosuppressive therapy and non-melanoma skin cancers who developed persistent lesions on the cheek and forehead after multiple skin cancer treatments. Biopsies identified poorly differentiated cutaneous squamous cell carcinoma. The patient underwent excisional salvage therapy with flap reconstruction, complicated by infection requiring debridement. He subsequently presented with in-transit dermal metastases and began treatment with cemiplimab. Unfortunately, after two cycles, he faced graft rejection and transitioned to hemodialysis. A recent PET-CT revealed no evaluable disease, and there were no clinical signs of recurrence at his last follow-up.

Keywords: Programmed Cell Death 1 Receptor; Carcinoma, Squamous Cell; Graft Rejection; Kidney Diseases.

Basal cell carcinoma is the most common skin cancer, most often found in the head and neck region. We present the case of a 47-year-old male patient with pigmented basal cell carcinoma in the right medial malar region. After confirmatory biopsy, the lesion was excised with a 5 mm safety margin, extending to the lower eyelid. Reconstruction was performed using the McGregor flap, a technique that enables effective tissue advancement with minimal tension, minimizing the risk of complications. The patient had an uncomplicated recovery with satisfactory oncologic, aesthetic, and functional outcomes, demonstrating the technique's efficacy in complex periocular reconstructions.

Keywords: Carcinoma, Basal Cell; Surgical Flaps; Dermatology; Surgical Oncology; Face; Skin Neoplasms

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous areas of the body, characterized by painful nodules, abscesses, sinusoidal tracts, and fistulas. Surgery is crucial for treatment, being potentially curative and achieving high satisfaction levels. Pre-surgical evaluations are often limited by the difficulty of detecting fistulous tracts and deep nodules. Ultrasound has emerged as a staging, follow-up, treatment response evaluation, and preoperative management method for HS. It enables accurate localization of subclinical lesions and optimizes surgical results. This report presents two representative cases of pre-surgical ultrasound evaluation in HS.

Keywords: Hidradenitis Suppurativa; Ultrasonography, Doppler; Outpatient Surgical Procedures

Acquired digital fibrokeratoma is a rare, benign, fibroepithelial tumor, which commonly presents as a finger-shaped normochromic nodule, typically located at the extremities. When affecting the nails, it usually emanates from the proximal nail fold, rarely arising from the matrix or nail bed. In this report, we describe an unusual case of acquired digital fibrokeratoma located under the nail plate of the right thumb. We describe the clinical, dermoscopic, and histopathological aspects of the lesion, as well as the surgical treatment used, and present a brief literature review on the subject.

Keywords: Nail Diseases; Fibroma; Nails; Skin Neoplasms