Abstract Although subungual squamous cell carcinoma is rare, it is the most common primary malignant neoplasms in this location. The higher incidence occurs in the fingernails, but involvement of the toenails is also possible. Subungual squamous cell carcinoma often looks like other more common benign lesions, such as fungal infection, onychomycosis, or viral wart. These factors, together with a general lack of awareness of this disease among physicians, often result in delayed diagnosis. Therefore, it is underdiagnosed, with few reports in the literature. The authors present a case of a man with a diagnosis of subungual squamous cell carcinoma in the hallux, without bone involvement, which was submitted to the appropriate surgical treatment.

Abstract In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.

Abstract Pemphigus vulgaris is an autoimmune disease characterized by suprabasal blisters with acantholysis, which has a fatal course in a large number of untreated patients. Systemic corticosteroid therapy is considered first-line therapy. Adjuvant treatment with the goal of sparing corticosteroids include, among others, dapsone. This drug is not without side effects and its use requires clinical and laboratory control. We present a patient with PV initially managed with suboptimal dose of prednisone, evolving into drug-induced hepatitis after introduction of dapsone.

We report the case of a three-year-old child who, following long term treatment with topical corticosteroids and their associations for a case of ringworm on the face developed a form of folliculitis known as Majocchi's Granuloma. Treatment with oral Griseofulvin was successful.

Acroangiodermatitis is an angioproliferative disease usually related to chronic venous insufficiency, and it is considered a clinical and histological simulator of Kaposi's sarcoma (KS). Immunohistochemistry is the suitable method to differentiate between these two entities. It reveals the following immunostaining profile: immunopositivity with anti-CD34 antibody is restricted to the vascular endothelium in acroangiodermatitis, and diffuse in the KS (endothelial cells and perivascular spindle cells); immunopositivity with anti-HHV-8 only in KS cases. We report the case of an HIV seropositive patient without apparent vascular disease, who presented violaceous and brownish erythematous lesions on the feet, and whose histopathology and immunohistochemistry indicated the diagnosis of acroangiodermatitis.

Confluent and reticulated papillomatosis of Gougerot and Carteaud is a dermatosis that despite showing characteristic clinical signs is often poorly recognized and diagnosed. The authors present a case with extensive skin involvement, discuss its association with obesity and describe dermoscopic findings making the histopathological correlation.

Over the last few centuries, the expansion of urbanization brought bats closer to urbanized areas, increasing the risk of accidents by bat bites. The morphology of bat bites can be varied, usually having an elliptical shape, about 0.5 cm along its greatest length, and the characteristic corkscrew bite pattern. The authors present the case of a patient who was repeatedly bitten by vampire bats for two months. A polymerase chain reaction was performed in the cutaneous nerves at the base of the hair follicles which showed negativity towards the rabies virus. The authors highlight the public health importance of this case, and discuss the morphological characteristics of these hematophagous bat bites.

O carcinoma sebáceo é um tumor cutâneo raro e agressivo. Pode localizar-se em qualquer área do corpo sendo a região periorbital a mais comumente envolvida. Ele não tem uma apresentação clínica típica, o que explica o diagnóstico frequentemente tardio. O objetivo deste relato é apresentar a raridade da doença e uma descrição clínica atípica, uma vez que, até a presente data, não foi relatada úlcera inguinal como manifestação clínica. Apresentamos e discutimos um caso de carcinoma sebáceo, com uma apresentação clínica incomum em um paciente idoso do sexo masculino. A abordagem de úlceras genitais, como mostrado no presente caso, é um desafio diagnóstico que requer uma grande quantidade de esforço por parte do clínico.

Sebaceous carcinoma is a rare and aggressive skin tumor. It can be located in any area of the body, the most commonly involved area being the periorbital region. It does not entail a typical clinical presentation, which explains the often late diagnosis. The aim of this report is to outline the rarity of the disease and its atypical clinical description, since to this day, inguinal ulcers with clinical manifestation have not been reported. We present and discuss a case of sebaceous carcinoma with an unusual clinical presentation, in an elderly male patient. The precise approach to genital ulcers, as shown in this case, is a diagnostic challenge that requires a great deal of effort on the part of the clinician.

O Angioma em tufo é considerado um raro tumor vascular cutâneo adquirido. Caracteriza-se por máculas purpúrico-violáceas, dolorosas que podem evoluir para placas com pápulas angiomatosas. Tem natureza benigna, mas o envolvimento extenso é comum, gerando alteração funcional do membro afetado em caso de dor. Os autores relatam um caso de angioma em tufo associado à síndrome dolorosa miofascial, em que o elemento predisponente foi a presença deste tumor desde a infância. A dor local prejudicou a utilização da musculatura e possibilitou o surgimento da síndrome relatada. A realização de bloqueio anestésico de pontos-gatilhos no membro afetado, levou à melhora total dos sintomas.

Tufted angioma is a rare acquired vascular tumor. It is characterized by painful purplish macules that may progress to plaques containing angiomatous papules. The condition is benign; however, it often affects extensive areas of the skin, leading to functional disability of the affected limb if painful. The present report describes a case of a tufted angioma associated with myofascial pain syndrome in which the predisposing element was the presence of this tumor since childhood. Pain at the site of the lesion affected muscle use and led to the onset of the associated syndrome. Complete relief from symptoms was achieved by blocking the trigger points of the affected limb with anesthesia.

O melanoma do aparelho ungueal é apresentação relativamente rara dessa neoplasia, muitas vezes diagnosticada como nevo juncional, hematoma subungueal ou mesmo onicomicose. Esse fato leva a um atraso no diagnóstico e, conseqüentemente, na instituição da terapêutica específica, contribuindo para agravar o prognóstico de uma doença que por si só já é muito agressiva. Os autores relatam um caso de melanoma no primeiro quirodáctilo esquerdo de uma paciente negra com evolução de um ano, ressaltando a importância de avaliar certos critérios clínicos para obter o diagnóstico em fases mais precoces da doença.

Nail apparatus melanoma is a rare presentation of melanoma and may be misdiagnosed as junctional nevus, subungual hematoma or onychomycosis. This fact often leads initially to inappropriate treatment and significant delays in appropriately managing such an aggressive disease. The authors report a case of melanoma on the left thumb of a black patient evolving for a year. Emphasis was placed on the importance of assessing certain clinical characteristics in order to reach an early diagnosis.

Acroangiodermatite é enfermidade rara, caracterizada por lesões eritêmato-violáceas bem delimitadas que acometem pernas e pés com aspecto semelhante ao do sarcoma de Kaposi. É relatado o caso de paciente do sexo feminino, de 57 anos, com início súbito de lesões eritêmato-violáceas nas pernas sem outras alterações. O caso acrescenta aprendizado por sua dificuldade diagnóstica e reafirma a importância da imuno-histoquímica. Trata-se da publicação do primeiro caso brasileiro.

Acroangiodermatitis is a very rare disease. It is characterized by erythematous violaceous cutaneous lesions, localized mainly in the legs and feet, resembling Kaposi's Sarcoma. A case is presented of a female, 57 years old presenting erythematous-violaceous lesions in both legs. She also presented varices, reticularis livedo and venous stasis. The clinical and histopathological lesions resembled Kaposi's Sarcoma. The immunohistochemistry (CD-34) confirmed the diagnosis. This is the first case observed in Brazil.

A epidermólise bolhosa albopapulóide é doença rara, de caráter autossômico dominante, também conhecida como epidermólise bolhosa distrófica albopapulóide de Pasini. Os autores relatam o caso de uma paciente de 37 anos de idade, com início do quadro aos sete anos, com lesões bolhosas e milia nas áreas de traumatismo, além de máculas hipocrômicas e atróficas (lesões albopapulóides) no corpo. A paciente também apresenta pele apergaminhada, xerótica, e distrofia ungueal dos pés. A histopatologia da lesão bolhosa revelou clivagem subepidérmica, compatível com o diagnóstico clínico.

Albopapuloid epidermolysis bullosa (Pasini's variant) is a rare, autosomal dominant inherited disorder. The authors report the case of a 37-year-old female patient with blisters on trauma areas, atrophic macules (albopapuloid lesions) and milia, with onset of disease at age seven. The histopathological exam of the blister reveals a subepidermal cleavage.