ABSTRACT
A reconstrução com enxertia para defeitos resultantes de exérese de carcinoma espinocelular nos membros inferiores é um grande desafio para o cirurgião dermatológico, tendo em vista que uma pele muito fina para a área receptora, a não homogeneidade da vascularização local e a insuficiência venosa transitória dificultam a integração da pele enxertada nessas regiões. Para o sucesso desse tipo de procedimento, podem ser usadas algumas técnicas para reparar essas dificuldades, como um curativo compressivo elástico que utilizamos nos primeiros dias de pós-operatório de enxerto de pele total no pé e na perna, com bons resultados
Reconstruction with grafting for defects resulting from the removal of squamous cell carcinoma in the lower limbs is a great challenge for the dermatological surgeon. A very thin skin for the receiving area, the inhomogeneity of the local vascularization and the transient venous insufficiency make it difficult to integration of the grafted skin in these regions. For the success of this type of procedure, some techniques can be used to repair these difficulties, such as an elastic compressive dressing that we use in the first postoperative days of a total skin graft on the foot and leg, with good results
ABSTRACT
O carcinoma espinocelular (CEC) é o segundo câncer de pele mais comum. Quando localizado na região palpebral inferior, a reconstrução do defeito resultante pode se tornar um desafio para o cirurgião dermatológico devido à peculiaridade cosmética e funcional local. Relatamos a utilização de retalho de transposição da pálpebra superior para reconstrução palpebral inferior com resultado satisfatório, tanto pela estética, quanto pela funcionalidade resultante.
Squamous cell carcinoma (SCC) is the second most common skin cancer. When it is located in the lower eyelid region, the reconstruction of the resulting defect can be challenging for the dermatological surgeon, due to the local cosmetic and functional peculiarity. We report the use of an upper eyelid transposition flap for lower eyelid reconstruction with satisfactory results, both in terms of aesthetics and the resulting functionality
ABSTRACT
Abstract: Background: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. Objectives: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. Methods: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. Results: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. Study limitations: Retrospective nature of the study. Conclusion: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Skin Neoplasms/etiology , Surgical Flaps/adverse effects , Carcinoma, Basal Cell/etiology , Skin Transplantation/adverse effects , Neoplasm Recurrence, Local/etiology , Skin Neoplasms/surgery , Skin Neoplasms/epidemiology , Carcinoma, Basal Cell/surgery , Carcinoma, Basal Cell/epidemiology , Retrospective Studies , Follow-Up Studies , Sex Distribution , Margins of Excision , Neoplasm Recurrence, Local/epidemiologyABSTRACT
Abstract Nevus sebaceous is the most common type of organoid epidermal nevus, often located on the face, following the Blaschko's lines and with alterations in the ipsilateral central nervous system. Distinct disorders can be distinguished by the type of association with epidermal nevus. Schimmelpenning-Feuerstein-Mims syndrome is a rare multisystem disorder characterized by sebaceous nevus associated with extracutaneous abnormalities affecting the brain, eyes and bones. We report the case of an 8-year-old female patient with a yellowish verrucous plaque on the left temporal area extending ipsilaterally to the cervical region, combined with cicatricial alopecia, periocular nodule, and epibulbar tumors.
Subject(s)
Humans , Female , Child , Nevus, Sebaceous of Jadassohn/pathology , Visual Acuity , Arachnoid Cysts/complications , Arachnoid Cysts/diagnostic imaging , Diseases in Twins/complications , Nevus, Sebaceous of Jadassohn/complications , Cognitive Dysfunction/complicationsSubject(s)
Humans , Male , Adult , Sweat Gland Neoplasms/pathology , Tubular Sweat Gland Adenomas/pathology , Nipples/pathology , BiopsyABSTRACT
A região nasal é local frequente de tumores cutâneos, e reparar defeitos nessa região pode ser um grande desafio cirúrgico devido à necessidade do restabelecimento de suas propriedades estrutural, funcional e estética. Este estudo descreve a aplicação de um retalho A-T como opção para reconstrução de ferida operatória secundária à excisão de carcinoma basocelular na ponta nasal.
The nasal region is site of frequent cutaneous tumors and repair defects in this region can be a great surgical challenge due to the need of restoring their structural, functional and aesthetic properties. This study describes the implementation of an A-T flap as an option for reconstruction of surgical wound secondary to excision of basal cell carcinoma in the nasal tip.
Subject(s)
Surgical WoundABSTRACT
Abstract: Gastrointestinal stromal tumor is rare digestive tract mesenchymal tumor, most often in the wall of the stomach. It is a benign neoplasm, but it can become malignant if not treated. We report a case of gastrointestinal stromal tumor that was discovered after abdominal ultrasonography during staging of a patient with primary cutaneous amelanotic melanoma. Mutation in the tyrosine kinase receptor could explain the development of two types of tumors in the same patient.
Subject(s)
Humans , Male , Middle Aged , Skin Neoplasms/diagnosis , Melanoma, Amelanotic/diagnosis , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Biopsy , Immunohistochemistry , Tomography, X-RayABSTRACT
A ressecção oncológica auricular pode criar defeitos parciais da pele e/ou da cartilagem que tornam difícil e desafiadora a reconstrução desse local. Várias técnicas têm sido descritas, porém poucos casos de cirurgias para defeitos na cauda da hélice têm sido relatados. Os autores descrevem um retalho de interpolação nessa localização anatômica para correção de defeito secundário à excisão de carcinoma basocelular.
Oncologic ear resection can create partial skin and / or cartilage defects that make reconstruction of this site difficult and challenging. Several techniques have been described, however few cases of surgery for defects in the cauda helicis have been reported. The authors describe an interpolation flap in this anatomical location for the correction of a defect secondary to the excision of a basal cell carcinoma.
Subject(s)
Humans , Male , Middle Aged , Soft Tissue Neoplasms/pathology , Hallux/pathology , Giant Cell Tumors/pathology , Tendons/pathology , Tumor BurdenABSTRACT
Criar curativos compressivos que evitem hematomas no pós-operatório de cirurgias no couro cabeludo é um desafio. Tais curativos podem ser especialmente de problemática realização na região do vértex, pela dificuldade de adesão da fita hipoalergênica no local. Os autores apresentam uma boa opção de curativos compressivos para uso após cirurgias no couro cabeludo.
To make compressive dressings that are capable of preventing hematoma during the recovery period, after surgery on the scalp is a challenge. These dressings can be especially problematic to perform in the vertex region, due to the difficult adhesion of the hypoallergenic tape in that site. The authors introduce a good option for compressive dressings for use after surgeries on the scalp.
ABSTRACT
Proliferating pilomatricoma is proliferative, rare tumor variant of pilomatricoma. It is a benign neoplasm of hair matrix that can have potentially involve local recurrence. We report the case of a 60-year-old man who presented an asymptomatic nodule on the scalp. Histological exam demonstrated a basaloid epithelium at the periphery, filled with eosinophilic cornified material containing shadow cells. The tumor was excised and there was no evidence of recurrence one year later.
.Subject(s)
Humans , Male , Middle Aged , Hair Diseases/pathology , Pilomatrixoma/pathology , Skin Neoplasms/pathology , Skin/pathology , Treatment Outcome , Tumor BurdenABSTRACT
Subcutaneous phaeohyphomycosis is an infection caused by dematiaceous fungi which mainly affects immunosuppressed patients. We report a case of subcutaneous phaeohyphomycosis on the back of the left hand in a kidney transplant patient who had been taking prednisone, tacrolimus, and azathioprine daily for 3 years.
Subject(s)
Humans , Female , Middle Aged , Phaeohyphomycosis/pathology , Hand Dermatoses/pathology , Biopsy , Immunosuppression Therapy/adverse effects , Kidney Transplantation , Immunocompromised Host , Phaeohyphomycosis/surgery , Hand Dermatoses/surgeryABSTRACT
Impetigo herpetiformis is a rare dermatosis of pregnancy with typical onset during the last trimester of pregnancy and rapid resolution in the postpartum period. Clinically and histologically, it is consistent with pustular psoriasis. This similarity has led some authors to name the disease "the pustular psoriasis of pregnancy". We report the case of a patient who developed impetigo herpetiformis in two sucessive pregnancies.
Impetigo herpetiforme é uma dermatose gestacional rara que se inicia tipicamente durante o último trimestre e evolui com rápida resolução no período pós-parto. Clinica e histologicamente é consistente com psoríase pustulosa. Essa similaridade tem levado alguns autores a nomearem a doença como "psoríase pustulosa da gestação". Relatamos o caso de uma paciente que apresentou impetigo herpetiforme em duas gestações subsequentes.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Dermatitis Herpetiformis/pathology , Impetigo/pathology , Pregnancy Complications, Infectious/pathology , Psoriasis/pathology , Biopsy , Dermatitis Herpetiformis/drug therapy , Impetigo/drug therapy , Pregnancy Outcome , Pregnancy Complications, Infectious/drug therapy , Psoriasis/drug therapy , Treatment OutcomeABSTRACT
Pyoderma gangrenosum is a rare dermatosis of unknown etiology and variable clinical presentation. The disease is challenging for the medical staff, from the frequent diagnostic difficulties to the lack of scientific evidence with a good level to support the management of extensive and refractory cases. Our patient is a 50 year-old man with an extensive and deep ulcer on the left leg, which exemplifies the therapeutic difficulties inherent to the disease and who, fortunately, has progressed with excellent result after association of hyperbaric oxygen therapy and skin grafting to the immunosuppression therapy initially proposed.
Pioderma gangrenoso é dermatose rara de etiologia não completamente compreendida e apresentação clínica variável. A doença apresenta muitos desafios à equipe médica, desde a freqüente dificuldade diagnóstica até a inexistência de evidências científicas com bom nível para condução de casos extensos e refratários. Apresentamos o caso de um paciente masculino, 50 anos, com úlcera extensa e profunda em perna esquerda, que exemplifica bem a dificuldade terapêutica e que, felizmente, evoluiu com excelente resultado após associação de oxigenoterapia hiperbárica e enxertia de pele ao tratamento imunossupressor inicialmente proposto.
Subject(s)
Humans , Male , Middle Aged , Hyperbaric Oxygenation/methods , Pyoderma Gangrenosum/therapy , Skin Transplantation/methods , Adrenal Cortex Hormones/therapeutic use , Pyoderma Gangrenosum/pathology , Treatment Outcome , Wound HealingABSTRACT
Drug-induced acne is a common skin condition whose classic symptoms can be similar to a rose pearl, as in the case of a male patient presenting with this condition after excessive use of a cream containing corticosteroids.
A acne medicamentosa é uma dermatose comum, que pode apresentar no seu quadro clássico semelhanças à pérola rosa, como no caso apresentado de um paciente do sexo masculino cujo quadro surgiu após uso intempestivo de creme contendo corticoesteróide.
Subject(s)
Humans , Male , Acne Vulgaris/chemically induced , Acne Vulgaris/diagnosis , Adrenal Cortex Hormones/adverse effects , Drug Eruptions/diagnosis , Diagnosis, Differential , Skin Cream/adverse effectsABSTRACT
Os sarcomas cutâneos são tumores raros, altamente agressivos e de diagnóstico muitas vezes difícil para o dermatologista. Apresentamos o caso de uma mulher branca, de 78 anos, com nódulo eritêmato-violáceo de crescimento rápido em ombro esquerdo, descrito inicialmente como melanoma amelanótico à histologia, conduzida como tal e, após estudo imuno-histoquímico, ausência de marcadores para lesões melanocíticas e expressão de CD45RB (antígeno leucocitário humano) e CD68 (proteína lisossomal) possibilitaram diagnóstico final de sarcoma histiocítico.
ABSTRACT
Noonan Syndrome is one of the most common genetic syndromes and also an important differential diagnosis in children presenting with syndromic facies similar to Turner's syndrome phenotype. This syndrome is characterized by facial dysmorphism, congenital heart defects, short stature and also a wide phenotypic variation. This article discusses the case of a 10 year-old patient with Noonan syndrome that presented typical facies, cardiac defects (pulmonary dilatation and mitral regurgitation), dental malocclusion, micrognatism, short stature and a certain degree of learning disability.
Síndrome de Noonan é uma das mais frequentes síndromes genéticas e importante diagnóstico diferencial em crianças com fácies sindrômica similar ao fenótipo da síndrome de Turner. É caracterizada por dismorfismo facial, defeitos cardíacos congênitos, baixa estatura e uma ampla variação fenotípica. Esse artigo apresenta um caso de uma paciente de 10 anos de idade com síndrome de Noonan que apresentava fácies tiípica além de defeitos cardíacos (dilatação de artéria pulmonar e insufiência mitral), má oclusão dentária, micrognatismo, baixa estatura e dificuldade de aprendizado.
Subject(s)
Child , Female , Humans , Noonan Syndrome/pathology , Abnormalities, Multiple/pathology , Diagnosis, Differential , Darier Disease/pathology , Eyebrows/abnormalities , Eyebrows/pathologyABSTRACT
O dorso das mãos é sede de tumores que muitas vezes necessitam de abordagem cirúrgica. Devido à limitada mobilidade cutânea, feridas cirúrgicas amplas tornam-se um desafio ao cirurgião dermatológico. Relatamos o caso de paciente apresentando tumor em região dorsal de mão esquerda que, após retirada com margem de segurança, apresentou ferida cirúrgica ampla, tendo sido feita a opção por reconstrução com retalho A-T. Seis meses após, o paciente apresenta-se curado, com preservação total da mobilidade da mão e ótimo resultado estético. Reforça-se o conceito da utilização de retalhos, sempre que possível, para o fechamento de feridas cirúrgicas amplas.
The dorsum of the hand is home to tumors that often require a surgical approach. Due to limited cutaneous mobility, wide surgical wounds become a challenge to dermatologic surgeons. The authors report the case of a patient with a tumor in the dorsal region of the left hand that, after removal with a safety margin, resulted in a wide surgical wound, and in the choice of reconstruction with an A-T flap. Six months later, the patient was cured, with total preservation of the hand's mobility and excellent aesthetic results. The concept of using flaps for closing wide surgical wounds, whenever possible, is reinforced.
ABSTRACT
O retalho de interpolação é um bom método para reconstruir um defeito amplo e profundo quando o tecido adjacente não permite um fechamento direto. Esses retalhos usam tecidos de área não adjacente com pedículo vascular para suprir o retalho até que uma neovascularização tenha sido estabelecida entre o retalho e o leito receptor. Esse estudo descreve a aplicação de um retalho de interpolação para fechar um defeito secundário à excisão de dois carcinomas basocelulares na face anterior do lóbulo de orelha.
An interpolation flap is an effective method for reconstructing large and deep defects when the surrounding tissue does not allow direct closure. These flaps use tissue from non-adjacent areas with a vascular pedicle that supplies the flap until neovascularization between the flap and the recipient area occurs. This study describes the use of an interpolation flap to close a defect in the anterior ear lobe that resulted from the excision of two basal cell carcinomas.