Abstract Background: Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. Objective: To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. Methods: 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. Results: The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. Study limitations: The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). Conclusion: This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.

Pontos vermelhos foliculares foram descritos como achado tricoscópico de lupus eritematoso discóide do couro cabeludo em atividade e a presença destes associado a melhor prognóstico. Relatamos cinco pacientes com distúrbios da pigmentação nos quais pontos vermelhos foliculares foram detectados ao exame do couro cabeludo. Sugerimos que este padrão está provavelmente relacionado à rica vascularização que naturalmente envolve o folículo piloso normal. As possíveis implicações desta suposição nos casos de lupus eritematoso discóide e outras doenças do couro cabeludo também são discutidas.

Follicular red dots have been described as a trichoscopic feature of active discoid lupus erythematosus of the scalp and its presence associated with a better prognosis. We report five patients with pigmentary disorders in whom follicular red dots were detected during scalp examination. We suggest that this pattern is probably related to the rich vasculature that naturally envelops the normal hair follicle. The possible implications of such proposition in cases of discoid lupus erythematosus and other scalp disorders are also discussed.

Os melanomas desmoplásicos apresentam-se como pápulas amelanóticas firmes; à microscopia exibem proliferação de células fusiformes na derme e variável deposição de colágeno, além de proliferação melanocítica lentiginosa, intraepidérmica, na maioria dos casos. Realizada biópsia de pele de paciente masculino, 61 anos, branco, com diagnóstico de lentigo maligno na face, há 10 anos. O exame histopatológico revela proliferação dérmica de células fusiformes pigmentadas e deposição de colágeno, invadindo até a profundidade da derme reticular, associado a componente lentiginoso; presença de positividade imuno-histoquímica com S-100, Melan-A e WT1, e marcação fraca com HMB45. Diagnóstico de melanoma desmoplásico, associado a lentigo maligno. Existe divergência quanto à origem do melanoma desmoplásico, a partir do componente lentiginoso ou "de novo", na ausência de lentigo associado. O melanoma desmoplásico representa uma minoria dos casos de melanoma cutâneo primário (menos de 4%). A presença de lentigo maligno pode servir de sinal de alerta para possível relação com melanoma desmoplásico.

Desmoplastic melanoma tends to present as firm, amelanotic papules. Microscopically, it reveals a proliferation of fusiform cells in the dermis and variable collagen deposition, as well as intraepidermal melanocytic proliferation of lentiginous type in most cases. Biopsy in a 61-year-old white male patient, who had received a diagnosis of lentigo maligna on his face 10 years before, revealed a proliferation of dermal pigmented spindle cells and collagen deposition, reaching the deep reticular dermis, with a lentiginous component. Immunohistochemistry with S-100, Melan-A and WT1 showed positivity, but it was weak with HMB45. Desmoplastic melanoma associated with lentigo maligna was diagnosed. Several authors discuss whether desmoplastic melanoma represents a progression from the lentiginous component or arises "de novo". Desmoplastic melanoma represents a minority of cases of primary cutaneous melanoma (less than 4%). Identification of lentigo maligna indicates that desmoplastic melanoma should be carefully investigated.

O melanoma cutâneo é um problema de saúde pública a nível mundial. Sua incidência tem aumentado, de forma marcante, nos últimos anos, e o diagnóstico e excisão precoces são essenciais para o bom prognóstico dos pacientes. Neste contexto, a dermatoscopia ganhou grande importância, nas últimas duas décadas, melhorando, de forma significativa, a acurácia do diagnóstico do melanoma, em estágios iniciais. Porém, existem algumas lesões benignas que apresentam dermatoscopia duvidosa, levando à realização de cirurgias desnecessárias. Mais recentemente, a microscopia confocal reflectante vem sendo introduzida como método diagnóstico auxiliar promissor, por ser um exame não-invasivo, realizado in vivo, de forma simples, indolor e de rápida execução. É a única técnica capaz de identificar estruturas celulares e examinar a epiderme e a derme papilar, com resolução semelhante à da histopatologia, com uma sensibilidade de 97,3%, e especificidade de 72,3% para o diagnóstico do melanoma cutâneo. É uma importante ferramenta diagnóstica, visto que não substitui o exame histopatológico realizado no pós-operatório, mas permite a abordagem racional das lesões com dermatoscopia duvidosa, evitando procedimentos cirúrgicos desnecessários.

Skin melanoma is an international public health issue, with a considerable increase in frequency over the past few years. Early diagnosis and excision are essential for good patient prognosis. Over the past two decades dermoscopy has gained significance due to a major improvement in the accuracy of skin melanoma diagnosis in its early stage. However, there are some benign lesions of questionable dermoscopy, which may lead to the performance of unnecessary surgery. Recently, reflectance confocal microscopy has been introduced as a promising supplementary diagnostic method. It is a noninvasive, in vivo, simple, painless and quick exam. It is the only technique capable of identifying cellular structures and to examine the epidermis and papillary dermis with a resolution similar to that of histopathology, with a sensitivity of 97.3% and specificity of 72.3 % in the diagnosis of cutaneous melanoma. This is an important diagnostic tool, because it does not substitute post-surgical histopathological examination and allows for the rational assessment of lesions of questionable dermoscopy, thus avoiding unnecessary surgical procedures.