Spray de barreira para prevenir o apagamento da marcação cirúrgica na cirurgia micrográfica de Mohs / Barrier spray to prevent surgical marking erasure in Mohs micrographic surgery

A preservação do desenho das margens cirúrgicas é essencial durante a realização da cirurgia micrográfica de Mohs. Contudo, a degermação cutânea no ato da antissepsia e o uso da gaze durante a anestesia local, com frequência, promovem a remoção dessas marcações. A utilização da película protetora Cavilon® 3M, ao fixar a tinta da caneta marcadora, mostrou-se eficaz na preservação do mapa cirúrgico, permitindo uma remoção precisa do espécime cirúrgico

The preservation of the surgical margins marking is essential during Mohs micrographic surgery. However, skin degermation during antisepsis and the use of gauze during local anesthesia often remove these markings. The use of the protective film Cavilon® 3M to fix the marking pen ink was effective in preserving the surgical map, allowing an accurate removal of the surgical specimen.

COVID-19 cutaneous manifestations in children and adolescents: a systematic review / Manifestações cutâneas da COVID-19 em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: The aim of this study was to evaluate the coronavirus disease 2019 (COVID-19) cutaneous manifestations described in pediatric patients and discuss their relevance for early diagnosis. Data source: The study consisted of a systematic review of original articles indexed in PubMed and Embase databases, as well as gray literature articles found through Google Scholar. A search strategy, based on PICO (Patient, Intervention, Comparison, Outcome) Tool, with the terms "child," "infant," "childhood," "adolescents," "teenagers," "COVID-19," "SARS-CoV-2," and "skin manifestations," was performed to optimize the findings. The study did not restrict any article regarding language. Data synthesis: Out of the 310 articles that initially met the inclusion criteria, 35 were selected for review, totalizing 369 patients. The most common COVID-19 cutaneous manifestations in children and adolescents were Chilblain-like lesions, presented in 67.5% of the cases, followed by erythema multiforme-like (31.7%) and varicella-like lesions (0.8%). The Chilblain-like lesions appeared 7.6 days (95%CI 7.4-7.8) after the viral infection and lasted for 17.5 days (95%CI 16.5-18.5), erythema multiforme-like lesions appeared in 9.5 days (95%CI 9-10) and lasted for 10.3 days (95%CI 9.1-11.5), and varicella-like lesions appeared in 12.3 days (95%CI 4-20.6) and lasted for 7 days. Conclusions: Knowledge of the different skin manifestations in children and adolescents with COVID-19 is essential for an early diagnosis and, consequently, the possibility of promptly care adoption as well as to interrupt the new coronavirus transmission chains in the current pandemic context.

RESUMO Objetivo: Avaliar as manifestações cutâneas da Doença de Coronavírus 2019 (COVID-19) descritas em pacientes pediátricos e discutir sua relevância para o diagnóstico precoce. Fontes de dados: O estudo consistiu em uma revisão sistemática de artigos originais indexados nas bases de dados PubMed e Embase, assim como na literatura cinzenta localizados via Google Scholar. Uma estratégia de busca, baseada na PICO (Patient, Intervention, Comparison, Outcome) Tool, com os termos "child", "infant", "childhood", "adolescents", "teenagers", "COVID-19", "SARS-CoV-2" e "skin manifestations" foi conduzida para otimizar os achados. Não houve restrições de idiomas. Síntese de dados: 35 dos 310 artigos que inicialmente cumpriram os critérios de inclusão foram selecionados para revisão, totalizando 369 pacientes. As manifestações cutâneas mais comuns de COVID-19 em crianças e adolescentes foram as lesões Chilblain-Like presentes em 67,5% dos casos, seguidas pelas lesões Eritema Multiforme-Like (31,7%) e Varicella-Like (0,8%). As lesões Chilblain-Like surgiram 7,6 dias (IC95% 7,4-7,8) após a infecção viral e tiveram duração de 17,5 dias (IC95% 16,5-18,5); as lesões Eritema Multiforme-Like surgiram em 9,5 dias (IC95% 9-10) e duraram 10,3 dias (IC95% 9,1-11,5) e as lesões Varicella-Like apareceram em 12,3 dias (IC95% 4-20,6) e duraram 7 dias. Conclusões: O conhecimento das diferentes manifestações cutâneas em crianças e adolescentes com COVID-19 é essencial para o diagnóstico precoce da doença, assim como possibilitar adoção de prontos cuidados e interromper cadeias de transmissão do novo coronavírus.

Mohs micrographic surgery: a review of indications, technique, outcomes, and considerations

Abstract Mohs micrographic surgery is a specialized form of skin cancer surgery that has the highest cure rates for several cutaneous malignancies. Certain skin cancers can have small extensions or "roots" that may be missed if an excised tumor is serially cross-sectioned in a "bread-loaf" fashion, commonly performed on excision specimens. The method of Mohs micrographic surgery is unique in that the dermatologist (Mohs surgeon) acts as both surgeon and pathologist, from the preoperative considerations until the reconstruction. Since Dr. Mohs's initial work in the 1930s, the practice of Mohs micrographic surgery has become increasingly widespread among the dermatologic surgery community worldwide and is considered the treatment of choice for many common and uncommon cutaneous neoplasms. Mohs micrographic surgery spares the maximal amount of normal tissue and is a safe procedure with very few complications, most of them managed by Mohs surgeons in their offices. Mohs micrographic surgery is the standard of care for high risks basal cell carcinomas and cutaneous squamous cell carcinoma and is commonly and increasingly used for melanoma and other rare tumors with superior cure rates. This review better familiarizes the dermatologists with the technique, explains the difference between Mohs micrographic surgery and wide local excision, and discusses its main indications.

Reconstrução perioral após cirurgia micrográfica de Mohs: análise de 108 casos / Perioral reconstruction after Mohs micrographic surgery: analysis of 108 cases

Introdução: a região perioral é comumente acometida por câncer de pele não melanoma. A cirurgia micrográfica de Mohs é o tratamento de escolha nessa área, com as maiores taxas de cura e preservação de tecido sadio. Há inúmeros métodos de reconstrução da região perioral, sendo sua escolha influenciada por características da ferida operatória e preferência do cirurgião. Objetivos: descrever a experiência dos autores na reconstrução perioral após cirurgia micrográfica de Mohs e analisar os métodos de reconstrução mais utilizados. Métodos: estudo retrospectivo de casos de reconstrução perioral submetidos à cirurgia de Mohs. Resultados: foram incluídos 103 pacientes, totalizando 108 casos. O número médio de estágios da cirurgia micrográfica de Mohs foi de 1,4, e o tamanho médio dos defeitos, de 16mm. O fechamento primário foi a técnica mais empregada para reconstrução, seguido por retalhos, principalmente V-Y avanço simples e rotação. A associação entre métodos de reparo foi utilizada em 28,7%. Quatro pacientes tiveram complicações (necrose e infecção do enxerto, trapdoor e deiscência parcial de sutura). Conclusões: fechamento primário foi o método mais frequente de reparo, seguido pelos retalhos. Conhecer as estratégias de reconstrução e possibilidades de associações é fundamental para a adequada restauração da região perioral, mantendo-se funcionalidade, sensibilidade e estética do local.

Introduction: The perioral region is commonly affected by non-melanoma skin cancer. Mohs micrographic surgery is the treatment of choice in this area because it has the highest cure rate and preserves healthy tissue. Several methods are available for restoring the perioral region, and their selection is influenced by the surgical wound characteristics and the surgeon's preference. Objective: Describe the authors' experience in perioral reconstruction after Mohs micrographic surgery and analyze the repair methods most frequently performed. Methods: Retrospective study of consecutive cases submitted to Mohs surgery and perioral reconstruction. Results: The study included 108 cases from 103 patients. The mean number of Mohs surgery stages was 1.4, and the mean defect size was 16 mm. Primary closure was the most used technique for reconstruction, followed by flaps (mainly V-Y, single advancement, and rotation). The association of repair methods was used in 28.7% of cases, mostly combined with flaps. Four patients had complications (necrosis and graft infection, trapdoor effect, and partial wound dehiscence). Conclusion: Primary closure was the most frequent repair method, followed by flaps. Knowing reconstruction strategies and possibilities of associations is essential for proper restoration of the perioral region, maintaining its functionality, sensitivity and aesthetics.

Reconstrução nasal após cirurgia micrográfica de Mohs: análise de 208 casos / Nasal reconstruction after Mohs micrographic surgery: analysis of 208 cases

Introdução: O nariz é frequentemente acometido por carcinomas cutâneos. Devido à importância funcional e estética, tem como primeira indicação a cirurgia micrográfica de Mohs, método com a maior taxa de cura. Para reparo das feridas operatórias, inúmeras opções estão disponíveis incluindo cicatrização por segunda intenção, fechamento primário, enxertos cutâneos e retalhos. Em certos casos, deve-se considerar a combinação de métodos. Objetivo: Descrever a experiência dos autores na reconstrução nasal após cirurgia de Mohs e avaliar se o número de subunidades anatômicas acometidas influenciou no uso de métodos combinados de reparo. Métodos: Estudo retrospectivo de casos consecutivos submetidos à cirurgia de Mohs e à reconstrução nasal por um dos autores, num período de três anos. Resultados: Foram incluídos 208 casos e o método de reparo mais comum foram os retalhos (n=82). A combinação de métodos foi utilizada em 44/154 (29%) casos com acometimento de apenas uma subunidade anatômica nasal e em 29/54 (54%) casos com múltiplas subunidades nasais envolvidas. Conclusões: O cirurgião dermatológico deve se familiarizar com as diferentes opções de reconstrução nasal. A combinação de métodos de reparo foi frequentemente utilizada, principalmente para feridas com acometimento de mais do que uma subunidade nasal.

Introduction: The nose is frequently affected by cutaneous carcinomas. Due to its functional and cosmetic importance, tumors on this location are preferably treated by Mohs micrographic surgery, which provides the highest cure rates. For repairing of surgical wounds, several options are available, including healing by second intention, primary closure, skin grafts, and flaps. In certain cases, one should consider a combination of methods. Objective: To describe the authors' experience in nasal reconstruction after Mohs surgery and to assess if the number of involved subunits influenced the use of combined repairs. Methods: Retrospective study of consecutive cases submitted to Mohs surgery and nasal reconstruction by one of the authors during a 3-year period. Results: 208 cases were included, and the most common repair method were flaps (n = 82). Combined methods were performed in 44/154 (29%) cases with involvement of only one nasal anatomical subunit and 29/54 (54%) cases with multiple nasal subunits involved. Conclusions: The dermatologic surgeon should be familiar with different options for nasal reconstruction. The combination of repair methods was often performed, mainly for wounds that affected more than one nasal subunit

Versatility of advancement flaps for nasal reconstruction following Mohs` micrographic surgery

Abstract: Advancement flaps are important reconstructive options after skin cancer removal on the nose. Donor areas vary according to defect location and size. The objective of this article is to illustrate the versatility of advancement flaps in nasal reconstruction. Five patients were selected. All cases were treated with Mohs' micrographic surgery prior to reconstruction to ensure that 100% of the surgical margins were free of cancer. Advancement flaps can be used to repair a wide variety of surgical defects on the nose with good matching of skin color, texture, and thickness. With careful planning, resulting scars can be camouflaged in natural boundary lines, leading to good functional and cosmetic outcomes.

Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis

Abstract: Wet wrap dressings provide an ancillary treatment option for erythrodermic patients. Wet wrap therapy consists of the application of topical corticosteroids on all affected surfaces, followed by the application of a warm moist cotton cloth with a dry cotton cloth on top. The advantages of this procedure include its safety, as well as the prompt and marked improvement of the erythroderma. For erythrodermic psoriasis, wet wrap dressings can serve as an important rescue therapy option. The purpose of this study is to report a case series of seven patients with erythrodermic psoriasis that responded promptly to wet wrap therapy prior to the initiation of systemic treatment.

Sutura purse-string combinada com cicatrização por segunda intenção para reparo de defeito cirúrgico temporal / Purse string-suture combined with second intention healing for temporal region repair

A sutura purse-string é uma das várias técnicas de reparo em cirurgia dermatológica. Suas principais indicações são feridas com formato oval ou redondo localizadas em tronco e membros. Os autor es descrevem a combinação da sutura purse-string com cicatrização por segunda intenção para reparo de defeito cirúrgico em região temporal, após remoção de carcinoma basocelular. A sutura purse-string é capaz de produzir resultados estéticos favoráveis em casos selecionados. Apesar de mais indicada no tronco e nos membros, pode ser indicada na região temporal quando se deseja evitar métodos de reparo mais complexos.

The purse-string suture is one of the several repair options in dermatologic surgery. Its main indications are round or oval wounds on the trunk and limbs. The authors describe the combination of purse string suture and second intention healing for a surgical defect after removal of a basal cell carcinoma on the temple. The purse-string suture is an important closure method that may yield good results in selected cases. Although it is more often indicated on the trunk and limbs, it may be performed on the temple to avoid more complex repair.

Retalho de rotação para reconstrução de lábio cutâneo superior após cirurgia micrográfica de Mohs / Rotation flap for the reconstruction of the cutaneous upper lip after Mohs micrographic surgery

Introdução: O lábio cutâneo superior é frequentemente acometido por neoplasias malignas da pele. O tratamento cirúrgico é o preferível para a maioria das lesões nesse local. Sempre que disponível, a cirurgia micrográfica de Mohs deve ser considerada para essa área. Relato de caso: Descreve-se aplicação de retalho de rotação para lábio cutâneo superior em paciente submetido à cirurgia micrográfica de Mohs. Discussão: Há diferentes opções para restaurar defeitos cirúrgicos no lábio cutâneo superior. Quando fechamento primário não é possível, o retalho de rotação pode ser considerado. Ele permite camuflar o arco da rotação no sulco nasogeniano e as demais incisões nas rítides periorais.

Introduction: The cutaneous upper lip is often affected by malignant skin neoplasms. Surgical treatment is preferred for most lesions in this site. Whenever available, tumors in the perioral area should be managed with Mohs micrographic surgery. Case report: The author of the present article describes the implementation of a rotation flap in the cutaneous upper lip of a patient who underwent Mohs micrographic surgery. Discussion: There are a number of options for repairing surgical defects in the cutaneous upper lip. When primary closure is not possible, rotation flaps are considered because they allow camouflaging of the rotation arc in the nasolabial fold, and the other incisions in the perioral rhytids.

Usefulness of the subunit principle in nasal reconstruction

Abstract The subunit principle in nasal reconstruction proposed the concept of reconstructing the specific topographic subunits that were identified as dorsum, tip, columella, the paired alae, sidewalls, and soft triangles. In patients with more than 50% of subunit loss, removing the remaining portion of the subunit and reconstructing the entire subunit may yield better results. The placement of incisions along the borders of the subunits minimizes scar lines. Furthermore, as trapdoor contraction occurs, the entire restored subunit bulges in a way that mimics the normal contour of a nasal tip, dorsum or ala. Two cases of nasal reconstruction that followed this important principle are described.

Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery

Abstract Staged retroauricular flap is a great option for full-thickness defects along the helical rim and antihelix. Donor site consists of the posterior ear, postauricular sulcus and mastoid area. The advantages of this flap include hidden donor scar, donor tissue similarity and rich vascularity. We present a case of collision tumor on the left helix treated with Mohs micrographic surgery and the resulting full-thickness defect repaired with a staged retroauricular flap. This flap is an effective technique for full-thickness helical defect repair with relatively little operative morbidity. High esthetic and functional results may be obtained restoring the ear size and shape.

Paramedian forehead flap combined with hinge flap for nasal tip reconstruction

Abstract The paramedian forehead flap is a great option for restoration of complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. We present a patient with a basal cell carcinoma on the distal nose treated by Mohs micrographic surgery, and a resulting full-thickness defect repaired with paramedian forehead flap combined with a hinge flap. For optimal results with the paramedian forehead flap, adequate surgical planning, patient orientation and meticulous surgical technique are imperative.

Tratamento do vitiligo em progressão com minipulso oral de dexametasona / Treatment of developing vitiligo with oral mini-pulse of dexamethasone

Introdução: Foram analisados retrospectivamente dados de 26 pacientes com vitiligo em progressão, submetidos a protocolo de tratamento com minipulso oral de dexametasona. A resposta clínica e os efeitos colaterais foram avaliados em intervalos mensais. Dos 26 pacientes incluídos no protocolo de estudo, 12 (46,2%) apresentaram repigmentação das lesões, 11 (42,3%) estabilização, e três (11,5%) progressão da doença. Dez pacientes (38,5%) apresentaram efeitos colaterais, sendo o aumento de peso a reação adversa mais comum. Houve associação entre tempo de tratamento e frequência dos efeitos colaterais.

Introduction: The authors have carried out a retrospective analysis of data from 26 patients with developing vitiligo who were treated with oral mini-pulse of dexamethasone. Clinical response and side effects were evaluated at monthly intervals. Of the 26 patients included in the study, 12 (46.2%) presented a repigmentation of lesions, 11 (42.3%) stabilized, and 3 (11.5%) experienced a worsening of the condition. Ten patients (38.5%) had side effects, the most common of which was weight gain. There was a correlation between the duration of the treatment and the frequency of side effects.

Mulheres adultas com acne apresentam maior risco de elevação de triglicerídeos ao uso de isotretinoína oral / Adult women with acne have a higher risk of elevated triglyceride levels with the use of oral isotretinoin

A isotretinoína apresenta restrições relacionadas a efeitos no perfil lipídico. Revisaram-se 90 pacientes tratados, em busca de fatores predisponentes a essas alterações. Houve elevação significativa do colesterol e triglicerídeos. Os pacientes em que estes últimos mostraram essa alteração foram, em sua maioria, do sexo feminino, predileção que não ocorria com as alterações iniciais. Mulheres com acne persistente talvez representem população de risco para tais efeitos colaterais.

There are restrictions associated with the use of isotretinoin because of its effects on the lipid profile. The records of ninety patients treated with this medication were reviewed to identify factors that would predispose patients to these abnormalities. A significant increase in cholesterol and triglyceride levels occurred. Patients in whom triglyceride levels increased were more likely to be female, although this difference was not present at baseline. Women with persistent acne may constitute a risk population for these side effects.

Armadillo meat intake was not associated with leprosy in a case control study, Curitiba (Brazil)

Leprosy's progression and its maintained endemic status, despite the availability of effective treatments, are not fully understood and recent studies have highlighted the possibility of involved Mycobacterium leprae ambient reservoirs. Wild armadillos can carry leprosy and, because their meat is eaten by humans, development of the disease among armadillo meat consumers has been investigated. This study evaluated the frequency of armadillo meat intake among leprosy patients as well as age and gender matched controls with other skin diseases from a dermatological unit. Armadillo meat consumption among both groups was adjusted by demographic and socioeconomic covariates based on a conditional multiple logistic regression model. One hundred twenty-one cases and 242 controls were evaluated; they differed in socioeconomic variables such as family income, hometown population and access to treated water. The multivariate analysis did not show an association between the intake of armadillo meat and leprosy (odds ratio = 1.07; CI 95 percent 0.56-2.04), even when only cases with no known contacts were analyzed. We conclude that leprosy is not associated with the intake of armadillo meat in these patients.

Avaliação do padrão de uso de protetor solar em pacientes com vitiligo / Evaluation of sunscreen use patterns in vitiligo patients

Fundamentos: Acredita-se que pacientes com vitiligo pertençam a um grupo mais susceptível para o desenvolvimento de neoplasias malignas da pele devido à ausência de melanina na pele afetada. Por isso, o uso de protetor solar é fundamental nesses pacientes. Objetivo: Avaliar o padrão de uso de protetor solar em pacientes com vitiligo. Métodos: Foi desenvolvido estudo transversal através de questionário e exame físico em pacientes com vitiligo, de agosto de 2009 a abril 2010, tendo sido analisadas as variáveis: dados demográficos; características clínicas do vitiligo; uso de protetor solar e hábitos de exposição solar. Resultados: Participaram do estudo 121 pacientes, dos quais 43 usavam diariamenteprotetor solar, em sua maioria com FPS 30. As variáveis associadas ao uso diário foram sexo feminino (P = 0.001,OR = 4,76; 95% IC = 1,80-12,59) e recomendação pelo dermatologista na primeira consulta (P = 0.047, OR = 2,28; 95% IC = 1,01-5,28). Conclusão: Foi determinado um padrão de uso de protetor solar em pacientes com vitiligo.Além disso, foi identificado que o aconselhamento do dermatologista teve significância estatística no uso de protetor solar por esses indivíduos (P = 0.047, OR = 2,28; 95% IC = 1,01-5,28).

Introduction: Since patients with vitiligo are believed to be more susceptible to developing malignant neoplasias due to the lack of melanin in the affected skin, the use of sunscreens is critically important. Objective:To evaluate the pattern of sunscreen usage in vitiligo patients. Methods: A transverse study of vitiligo patients was conducted from August 2009 to April 2010. The following variables were studied using a questionnaire and physical examination: demographic data (gender, age, education level, and phototype); clinical characteristics of the condition (age at diagnosis, affected areas of the body, and clinical type); sunscreen use (frequency, protection factor, and duration of use); and habits of sun exposure. Results: Of the 121 study subjects, 43 used sunscreen – mainly with sun protection factor 30 – on a daily basis.The variables associated with daily use were female gender (p = 0.001, OR = 4.76, 95% CI = 1.80-12.59) and recommendation by a dermatologist in the first medical visit (p = 0.047, OR=2.28, 95% CI = 1.01-5.28). Conclusion: A pattern of sunscreen usage was determined for patients with vitiligo. In addition, it was verified that a dermatologist's recommendation to wear sunscreen had a statistically significant impact (p = 0.047, OR=2.28, 95% CI = 1.01-5.28).