Horizontal histological sections in the preliminary evaluation of basal cell carcinoma submitted to Mohs micrographic surgery

Abstract Background: Mohs micrographic surgery is a surgical technique for the treatment of nonmelanoma skin cancer. Surgery begins by removing the visible tumor before excision of the tissue specimens for evaluation of the tumor margins. Objectives: To present a new way to evaluate the material obtained from debulking, by horizontal histological analysis of the fragment. Methods: Descriptive retrospective cross-sectional study based on the medical records and histological lamellae of patients with primary basal cell carcinomas smaller than 1.5 cm submitted to Mohs micrographic surgery and who had the visible tumor analyzed by horizontal histological sections. Results: The sample evaluated included 16 patients with lesions located on the face. Comparing the histopathological examinations of incisional biopsy in vertical sections and debulking in horizontal sections, there was agreement in seven cases. The histological analysis performed in horizontal sections allowed identification of the tumor site in 13 cases, and the relation between tumor and margin showed that in 11 cases, the lateral margin was compromised.Study limitations: The technique was better-applied in lesions smaller than 2 cm. Conclusion: Horizontal histological analysis of debulking has advantages for Mohs surgery, since it allows visualization of almost all tumor extension in the same view plane of the dermatoscopy, allowing better definition of the histological subtype, tumor site, and tumor/margin of lesions less than 1.5 cm.

Reflectance confocal microscopy as a tool for screening surgical margins of basal cell carcinoma

Abstract: Surgical excision of basal cell carcinoma with minimum margins requires serial assessment of layers by frozen histopathology in the case of Mohs micrographic surgery. Evaluation of presurgical tumor margins by in vivo reflectance confocal microscopy is a potential alternative. We selected 12 basal cell carcinoma lesions that were analyzed by confocal microscopy to define margins. The lesions were excised by Mohs surgery. Six tumors showed negative margins in the first phase of Mohs micrographic surgery. We concluded that reflectance confocal microscopy can be useful in the preoperative definition of basal cell carcinoma margins.

Aplicação de toxina botulínica na cicatrização por segunda intenção / Botulinum toxin application in the secondary intention healing

O uso da toxina botulínica tipo A em feridas de primeira intenção tem sido bastante adotado com a finalidade de inibir a formação de cicatrizes hipertróficas. Neste relato demonstramos o uso da toxina em uma ferida operatória deixada cicatrizar por segunda intenção, após a remoção de um carcinoma espinocelular in situ por cirurgia micrográfica de Mohs, na região supralabial, com bom resultado estético. A toxina botulínica age inibindo a proliferação de fibroblastos, na diferenciação em miofibroblastos e na produção de colágeno tipo I, que são os principais fatores responsáveis para a boa qualidade do processo de cicatrização.

Use of botulinum toxin type A in first intention healing wounds has been widely adopted in order to inhibit the formation of hypertrophic scars. In this report we demonstrate the use of the toxin in a surgical wound left to heal by secondary intention, after the removal of a squamous cell carcinoma in situ by Mohs micrographic surgery in supralabial region, with good cosmetic result. Botulinum toxin acts by inhibiting the proliferation of fibroblasts, by differentiating fibroblasts and by producing type I collagen, which are the main factors responsible for the good quality of the healing process.

Granuloma faciale: a rare disease from a dermoscopy perspective / Granuloma facial: uma doenca rara sob uma perspectiva dermatoscopica

The granuloma faciale is a rare and benign skin disease of unknown etiology, characterized by chronic leukocitoclastic vasculitis. It is characterized by skin lesions predominantly facial whose course is chronic and slowly progressive. The diagnosis is based on clinical features, histopathology and, more recently, in dermoscopy. We describe the case of a male patient, 40 years old, with a sarcoid lesion on the malar site, whose histopathological examination revealed a mixed inflammatory infiltrate with presence of Grenz zone. Dermoscopy revealed a pink background with white striations. The definitive diagnosis is made by histopathologic evaluation, and dermatoscopy can be helpful. It is known to be resistant to therapy, oral medications, intralesional and surgical procedures are options.

O granuloma facial é doença cutânea rara e benigna, de etiologia desconhecida, caracterizado por vasculite leucocitoclástica crônica. Caracteriza-se por lesões cutâneas predominantemente faciais, tem curso crônico e lentamente progressivo. O diagnóstico é baseado na clínica, histopatologia e, mais recentemente, na dermatoscopia. Relatamos o quadro de um paciente masculino, 40 anos de idade, com lesão sarcoídea na face malar, cujo exame histopatológico revelou infiltrado inflamatório misto com presença de zona de Grenz. A dermatoscopia revelou um fundo rosado com estrias brancas. O diagnóstico definitivo é feito pela avaliação histopatológica, sendo que a dermatoscopia pode ser útil. É conhecida por ser resistente à terapêutica, sendo propostas medicações orais, intralesionais e procedimentos cirúrgicos.

Proteína C-reativa: associação entre inflamação e complicações pós-infarto agudo do miocárdio em idosos / C-reactive protein: association between inflammation and complication after acute myocardial infarction in the elderly

JUSTIFICATIVA E OBJETIVOS: O infarto agudo do miocárdio (IAM) está associado com extensa resposta inflamatória sistêmica e miocárdica. A proteína C-reativa (PCR) é uma proteína de fase aguda que está sendo considerada como marcador padrão-ouro para inflamação e para doença de artéria coronária. A PCR também pode refletir o grau de resposta inflamatória oculta, bem como uma medida útil para a lesão imune tecidual e indicar aterosclerose; entretanto, a correlação entre a área enfartada e os níveis de PCR não está bem definida. O objetivo deste estudo foi discutir as correlações entre os níveis de PCR e as complicações do IAM. CONTEÚDO: A PCR tem alta sensibilidade para predição de risco cardiovascular. Observou-se aumento da taxa de eventos cardíacos maiores após IAM e aumento significativo (p < 0,0001) da incidência de fibrilação atrial (FA) à medida que se aumenta a concentração de PCR. CONCLUSÃO: A maioria das FA ocorreu na fase aguda da resposta ao infarto. Observou-se que os níveis de PCR pós-infarto maiores que 2,55 mg/dL identificaram pacientes de alto risco para evento isquêmico e que a PCR elevada está associada com grande aumento do risco de insuficiência cardíaca e morte durante o primeiro ano pós-infarto.

BACKGROUND AND OBJECTIVES: Acute myocardial infarction (AMI) is associated with an extended myocardial and systemic inflammatory response. C-reactive protein (CRP) is an acute phase protein that has been shown to be the gold standard marker for inflammation and coronary artery disease. The CRP may also reflect the degree of underlying inflammatory response, provide a useful measurement of immune injury to tissues and indicate atherosclerosis; however, the relation between the infarct area and CRP levels is not well defined. The objective of this study was to discuss the correlation between CRP levels and AMI complications. CONTENTS: CRP is highly sensitive in predicting cardiovascular risk. An increased rate of cardiac events after AMI and significantly (p < 0.0001) increased frequency of atrial fibrillation (AF) have been noted as the concentration of CRP increases. CONCLUSION: Most atrial fibrillation happens during the acute phase response to infarction. It has been noted that there is a high risk of an ischemic event among patients with post-infarction CRP levels above 2.55 mg/dL and that increased CRP is associated with a large increase in the risk of heart failure and death during the first year after infarction.