Abstract Background Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. Objective To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. Methods This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. Results During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitations This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. Conclusion This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Abstract Background: Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives: To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods: Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results: A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations: Mean follow-up time of less than five years and sample size. Conclusions: The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

BACKGROUND:Cryosurgery is an efficient therapeutic technique used to treat benign and malignant cutaneous diseases. The primary active mechanism of cryosurgery is related to vascular effects on treated tissue. After a cryosurgical procedure, exuberant granulation tissue is formed at the injection site, probably as a result of angiogenic stimulation of the cryogen and inflammatory response, particularly in endothelial cells.OBJECTIVE:To evaluate the angiogenic effects of freezing, as part of the phenomenon of healing rat skin subjected to previous injury.METHODS:Two incisions were made in each of the twenty rats, which were divided randomly into two groups of ten. After 3 days, cryosurgery with liquid nitrogen was performed in one of incisions. The rats' samples were then collected, cut and stained to conduct histopathological examination, to assess the local angiogenesis in differing moments and situations.RESULTS:It was possible to demonstrate that cryosurgery, in spite of promoting cell death and accentuated local inflammation soon after its application, induces quicker cell proliferation in the affected tissue and maintenance of this rate in a second phase, than in tissue healing without this procedure.CONCLUSIONS:These findings, together with the knowledge that there is a direct relationship between mononuclear cells and neovascularization (the development of a rich system of new vessels in injury caused by cold), suggest that cryosurgery possesses angiogenic stimulus, even though complete healing takes longer to occur. The significance level for statistical tests was 5% (p<0,05).

Os distúrbios atróficos da pele abrangem inúmeras doenças, algumas idiopáticas e outras, inflamatórias, em que há perda do volume de segmentos do corpo. A esclerodermia localizada é uma dermatose inflamatória, rara, que pode manifestar-se com alterações atróficas da pele e tecido subcutâneo. A lipoatrofia pode ser herdada geneticamente ou adquirida relacionada a paniculites, infeccção pelo HIV, ou envelhecimento. Muitos tratamentos são propostos. Os resultados são variáveis na fase inflamatória aguda e apresentam pouca resposta quando a esclerose e atrofia já estão instaladas. Descreve-se o tratamento de quatro casos de esclerodermia localizada e um de lipoatrofia idiopática, na face, tratados com enxerto de fragmentos de lóbulos de gordura autóloga extraídos sem a utilização da cânula aspirativa, com resultados duradouros.

A large number of diseases may cause Atrophic skin disorders are caused by a large number of diseases, some of them idiopathic and others inflammatory, in which there is loss of volume of body segments. Localized scleroderma is a rare inflammatory dermatosis, manifested by atrophic skin and subcutaneous tissue alterations. Lipoatrophy may be genetically inherited or acquired as a result of panniculitis, HIV infections or aging. Many treatments have been proposed. Results vary in the acute inflammatory phase and are scarce when sclerosis and atrophy have already been established. This article describes four cases of localized facial scleroderma and one of facial idiopathic lipoatrophy treated with implantation of autologous fat globules extracted from the infragluteal groove, without utilization of cannula aspiration, with lasting results.

A intradermoterapia é um procedimento médico introduzido por Pistor, em 1958, e consiste na aplicação, diretamente na região a ser tratada, de injeções intradérmicas de substâncias farmacológicas muito diluídas. Esse método é capaz de estimular o tecido que recebe os medicamentos tanto pela ação da punctura quanto pela ação dos fármacos, e apregoa-se que sua vantagem é evitar o uso de medicação sistêmica. Há relatos da utilização da intradermoterapia para tratamento de doenças dolorosas, dermatoses e condições consideradas inestéticas. Atualmente, clínicas médicas oferecem esse tratamento, utilizando, porém, o nome mais popular para essa prática, mesoterapia. Há escassa informação científica sobre o tema publicada em periódicos indexados no MedLine e poucos estudos com metodologia mais rigorosa sobre a eficácia e o mecanismo de ação da via intradérmica. A maioria das publicações indexadas sobre esse tema versa sobre as complicações dessa técnica. As dermatoses inestéticas têm se tornado queixas frequentes nos consultórios dermatológicos, sendo necessário um embasamento científico para lidar com tais pacientes, os quais, muitas vezes, estão em busca das novidades mostradas através da mídia. Assim, há necessidade de estudos cientificamente bem conduzidos sobre essa técnica. Estes estudos deverão oferecer aos médicos elementos para esclarecer os pacientes sobre quais benefícios esperar e quais os riscos de tal abordagem. Desse modo, realizou-se uma revisão bibliográfica sobre o assunto e constatou-se a necessidade de novos estudos com metodologia adequada para a confirmação dos benefícios da intradermoterapia como ferramenta útil no tratamento dermatológico.

Intradermotherapy is a medical procedure introduced by Pistor in 1958 that consists in the application of intradermal injections of diluted pharmacological substances that are given directly into the region to be treated. There are reports of the use of intradermotherapy to treat painful diseases, skin diseases and unaesthetic conditions. Medical clinics have been recently offering the treatment of intradermotherapy, using the more popular name for this practice - mesotherapy. There is only scant scientific information about this subject published in periodicals indexed on MedLine. Only a few states rigorously pursue this method. Most indexed publications about this subject deal with the complications of this technique. Unaesthetic dermatoses have been a common complaint in dermatologic clinics, and it has become necessary to have scientific evidence to give to patients. Therefore, well-researched scientific studies about this technique are necessary to offer data to medical professionals that will clearly explain to patients both the benefits and the risks of these procedures. A bibliographical review was conducted and we verified the need for new studies with adequate methods to confirm the benefits of intradermotherapy as used in dermatologic treatment.

FUNDAMENTOS - O DNA viral pode atuar como oncogene, favorecendo o desenvolvimento de neoplasias, como as linfoides e da pele. Entre esses vírus, encontram-se alguns herpes-vírus humanos. OBJETIVO - Identificar a presença de DNA do herpes-vírus humano tipo 1 em neoplasias epiteliais pré-malignas,malignas e pele normal de indivíduos controle, avaliando seu papel na carcinogênese. MÉTODOS - Identificação, por reação em cadeia da polimerase, do DNA viral do tumor e pele sã de 41 pacientes e comparação com grupo controle, sem neoplasia. Análise estatística: Testes de Fisher e de McNemar. RESULTADOS - O vírus foi identificado em 20 indivíduos sem e em 21 com neoplasia. Destes últimos, 11 o expessaram apenas nas células tumorais. A diferença, entretanto, não foi estatisticamente significante. CONCLUSÕES - Parece não haver relação direta entre o encontro do DNA viral na pele sã e na pele tumoral. Sua presença pode facilitar o desenvolvimento da neoplasia ou apenas coincidir de se localizar onde esta já ocorreu.

BACKGROUND - Viral DNA may act as an oncogene, especially in skin and lymphoid organs. This group includes some human herpes virus. OBJECTIVE - To identify human herpes virus type 1 DNA in pre-malignant and malignant skin samples of epithelial tumors comparing to normal skin to determine its role in carcinogenesis. METHODS - Forty-one patients with epithelial tumors were submitted to biopsies from tumor and normal skin. The control group comprised 41 biopsies from patients with other dermatoses than cancer. After DNA extraction, polymerase chain reaction was performed to identify 199-bp band. The results were statistically evaluated by Fisher and McNemar tests. RESULTS - The virus was identified in 20 subjects without cancer and in 21 with skin cancer. From these, 11 expressed it only in tumor cells. This difference was not significant. CONCLUSION - There seem to be no direct relation between viral findings in normal skin and skin cancer cells. It may act as a promoter or just coexist at the same site where a neoplastic transformation has already occurred.

A criocirurgia com nitrogênio líquido é recurso cirúrgico utilizado para o tratamento de várias lesões cutâneas, benignas, pré-malignas e malignas. Promove destruição dos tecidos acometidos por congelamento e alterações da resposta imunológica. Os autores enfocam a utilização da criocirurgia no tratamento das dermatoses infecciosas, principalmente as verrugas virais, leishmaniose e ccromoblastomicose. Discutem os resultados como tratamento primário ou coadjuvante. O artigo também apresenta os cuidados com os instrumentos no tratamento das doenças infecciosas.

Cryosurgery using liquid nitrogen is a surgical resource to treat several types of benign, pre-malignant and malignant skin lesions. It promotes the destruction of tissues and changes the immune response. The authors identify several uses of cryosurgery in treating skin disorders, particularly viral warts, chromoblastomycosis and leishmaniasis. The results of primary and adjuvant treatments are also discussed. The article focuses on precautions when using surgical instruments during treatment of infectious diseases.

FUNDAMENTOS: A observação de lesões cutâneas é freqüente pelos indivíduos que as têm e por seus familiares. A demanda de pacientes que buscam atenção médica com queixas cutâneas é significante. OBJETIVO: Determinar a freqüência das alterações dermatológicas em usuários do Sistema Único de Saúde de Campinas, Estado de São Paulo, Brasil. MÉTODOS: Cinco unidades básicas de saúde foram selecionadas pela Secretaria de Saúde da Prefeitura Municipal para participar da pesquisa. Todos os pacientes atendidos por profissionais de saúde dessas unidades, no período de 20 dias úteis, deveriam ser avaliados quanto à presença ou ausência de sintomas/sinais dermatológicos. RESULTADOS: Dos 1.491 pacientes avaliados, 358 (24,01%) apresentavam queixas e/ou achados dermatológicos, com maior prevalência nos mais jovens. De todos os usuários atendidos pelos profissionais de saúde que participaram do estudo e que tiveram as fichas preenchidas adequadamente, 9,98% procuraram a Unidade Básica de Saúde primariamente pela queixa dermatológica. CONCLUSÃO: Esses resultados, condizentes com estudos semelhantes realizados em outros países, mostram a importância da especialidade para o desempenho do médico não dermatologista, especialmente dos pediatras, e dão elementos para a discussão curricular sobre a suficiência do tempo destinado ao ensino da especialidade no curso médico.

BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

O ensino da dermatologia é pouco valorizado no currículo médico, e as doenças sexualmente transmissíveis, em geral, são apresentadas de forma não sistematizada. Em estudo sobre o ensino da dermatologia, de 83 médicos que participaram do projeto apenas 10 acertaram uma questão sobre sorologia de lues. Mais pesquisas sobre o ensino das doenças sexualmente transmissíveis são necessárias no Brasil, e os dermatologistas devem aproveitar a oportunidade, trazida pelas reformas curriculares, para reassumir a responsabilidade do ensino dessas doenças.

Teaching of Dermatology is little valorized in medical courses, and sexually transmitted diseases are generally presented to the students in a non-systematized way. In a study about the teaching of Dermatology, only ten out of 83 medical doctors taking part in the project correctly answered a question about syphilis serology. More research regarding the teaching of the sexually transmitted diseases is needed in our country. Moreover, dermatologists should take the opportunity brought about by the current discussion on the re-elaboration of medical course curricula to retake the responsibility on teaching about these diseases.

Várias dermatoses são consideradas idiopáticas. Muitas vezes, afecções como eritema nodoso ou eritema multiforme, por exemplo, não podem ter sua etiologia definida. A infecção humana por Bartonella spp. pode determinar várias expressões clínicas sindrômicas. A partir de um caso de angiomatose bacilar com documentação clínica, histológica e ultra-estrutural, foi feita a revisão da literatura médica para avaliar os critérios diagnósticos disponíveis para a infecção por esses agentes. Conclui-se que a avaliação histológica é, na prática, um importante e útil método diagnóstico, especialmente quando a sorologia não estiver disponível.

Several dermatoses are considered idiopathic diseases. Many times lesions such as erythema nodosum or erythema multiformis, for example, cannot have their etiology defined. Human infection caused by Bartonella spp. may determine several clinical syndromic expressions. Starting with a clinically, histologically and ultrastructurally documented bacillary angiomatosis case, a review of medical literature was undertaken to evaluate the available diagnostic criteria regarding infection caused by these agents. Histological evaluations were concluded to be, practically speaking, an important and useful diagnostic method, especially when serology is not available.

CONTEXTO: Vários estudos de perda de heterozigozidade na região 9p21-p22, que abriga os genes supressores tumorais CDKN2a/p16INK4a, p19ARF e p15INK4b, têm sido realizados em uma ampla série de tumores humanos, incluindo os melanomas familiares. Perdas e ganhos em outras regiões do cromossomo 9 também têm sido observados com freqüência e podem indicar mecanismos adicionais no processo de tumorigênese dos carcinomas basocelulares da pele. OBJETIVO: Investigar o equilíbrio alélico existente na região 9p21-p22 em carcinomas basocelulares. TIPO DE ESTUDO: Análise molecular de marcadores de microssatélites em tumores e controles. LOCAL: Dois serviços de dermatologia de atendimento terciário em universidades públicas de São Paulo e o Laboratório de Genética Molecular do Câncer da Universidade Estadual de Campinas (Unicamp), Brasil. PARTICIPANTES: Examinamos 13 casos benignos, incluindo 4 queratoses solares, 3 queratoacantomas, 3 nevos melanocíticos, 2 doenças de Bowen e 1 neurofibroma cutâneo, além de 58 tumores malignos da pele: 14 de células escamosas, 40 carcinomas basocelulares e 4 melanomas; em pacientes consecutivamente encaminhados à clínica de Dermatologia da Unicamp e que concordaram em participar do estudo. VARIÁVEIS ESTUDADAS: O tumor principal e uma porção normal de pele não-adjacente foram removidos cirurgicamente de pacientes que consecutivamente procuraram os ambulatórios de dermatologia da Universidade Estadual de Campinas (Unicamp) e da Universidade Estadual de São Paulo (Unesp), São Paulo, por causa de lesões cutâneas. Extraímos DNA tanto de tecido tumoral como do correspondente tecido normal de cada paciente. Para amplificar regiões de repetição polimórfica de microssatélites do cromossomo 9, foram utilizados quatro pares de primers, sendo dois deles destinados à região 9p21-p22. RESULTADOS: Identificamos oito casos (20%) de desequilíbrio alélico entre os carcinomas basocelulares, sendo dois casos de perda de heterozigozidade e seis casos de instabilidade de microssatélite na região 9p21-p22. Outros marcadores também mostravam anormalidades em três destes tumores, enquanto nenhuma alteração foi detectada entre os casos benignos e nos outros tumores malignos. CONCLUSÃO: Esta dependência fenotípica sugere que existem diferenças importantes no comportamento das formas mais comuns de tumores cutâneos não-melanocíticos em relação à sua tendência para instabilidade de microssatélite no cromossomo 9. Considerando-se que os genes CDKN2a/p16INK4a, p19ARF e p15INK4b não parecem responsáveis pelas anormalidades observadas, outros genes em 9p21-p22 podem estar envolvidos na etiopatogenia e na progressão dos carcinomas basocelulares.

CONTEXT: Loss of heterozygosity in the 9p21-p22 region, has been frequently described in a wide range of human malignancies, including familial melanomas. Also, losses and gains in other regions of chromosome 9 have frequently been observed and may indicate additional mechanisms for basal cell tumorigenesis. OBJECTIVE: To investigate allelic imbalance in the 9p21-p22 region, among basal cell carcinomas. TYPE OF STUDY: Microsatellite analysis. SETTING: Two dermatology services of public universities in São Paulo and the Laboratory of Cancer Molecular Genetics of Universidade Estadual de Campinas (Unicamp). PARTICIPANTS: 13 patients with benign skin lesions consecutively referred to the outpatient dermatology clinics of Unicamp and Universidade Estadual de São Paulo (Unesp) and 58 with malignant skin tumours. MEAN MEASUREMENTS: We examined 13 benign cases including four of solar keratosis, three keratoachanthomas, three melanocytic nevi, two of Bowen's disease and one of neurofibroma, and 58 malignant skin tumors: 14 of squamous cell, 40 basal cell carcinomas and four melanomas. Participating patients had the main tumor and a normal portion of non-adjacent skin surgically removed. DNA was extracted from the tumor and matching normal tissue. We used four sets of primers to amplify polymorphic microsatellite repeats on chromosome 9, two of them targeting the 9p21-p22 region. RESULTS: We identified eight cases (20%) of allelic imbalance among basal cell carcinomas, two cases of loss of heterozygosity and six cases of microsatellite instability in the 9p21-p22 region. Additional markers were also involved in three of these tumors. No events were detected among the benign or the other malignant cases. CONCLUSION: This phenotype dependency suggests that there is a major distinction between the two most important forms of nonmelanoma skin cancers in their tendency to present microsatellite instability in chromosome 9. Since the CDKN2a/p16INK4a, p19ARF and p15INK4b tumor suppressor genes do not appear to be responsible for the observed abnormalities, other genes at 9p21-p22 may be involved in the pathogenesis and progression pathway of basal cell carcinomas.

A angiomatose bacilar é uma das bartoneloses humanas. É doença sistêmica de manifestação cutânea freqüente. Caracteriza-se por lesões angioproliferativas causadas pela Bartonella henselae e pela B. quintana, que comprometem especialmente indivíduos imunodeficientes. Deve ser bem conhecida pelos dermatologistas, pois é potencialmente fatal, mas responsiva à antibioterapia. Para estabelecer o diagnóstico nosológico eles deverão sugeri-lo ao anatomopatologista, facilitando a diferenciação histológica, sobretudo, com o granuloma piogênico e o sarcoma de Kaposi. O presente artigo apresenta revisão da literatura e fotografias clínicas, de microscopia de luz e eletrônica de transmissão.

Bacillary angiomatosis is one of the human bartoneloses. It is a systemic disease usually affecting the skin. Its angioproliferative lesions are caused by B. henselae and by B. quintana. Such lesions are more frequent in immunodeficient hosts. Dermatologists must be well aware of this disease because it is potentially fatal, though it is treatable with antibiotic therapy. To establish a nosologic diagnosis, dermatologists should refer patients to a pathologist. In so doing, they will facilitate histologic differentiation especially from pyogenic granuloma and Kaposi's sarcoma. This paper presents a literature review of the disease, and includes clinical, light and transmission electron microscope photographs.

É apresentado um caso de infestação maciça por Ancylostoma sp. em paciente que recebeu terapia sistêmica com corticosteroide. O que chama a atenção neste caso é a exuberância e a raridade da manifestação clínica. Com base na literatura pertinente, discutimos os mecanismos da infecção parasitária, a história natural da doença e seu tratamento.

A case of massive Ancylostoma sp. larval infestation is presented in a patient who had received systemic corticosteroid therapy. What attracts attention in this case is the exuberance and rarity of clinical manifestation. Based on the pertinent literature, we discuss the mechanisms of parasital infection, the natural history of the disease and its treatment.

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella spp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases.