Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions

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.

Fatores de risco para complicações pósoperatórias da hidradenite supurativa: artigo de revisão / Risk factors for postoperative complications of Hidradenitis Suppurativa: a review article

Introdução: a hidradenite supurativa é uma doença inflamatória crônica e recidivante. Altas taxas de recorrência podem persistir mesmo após ampla excisão cirúrgica local. Objetivo: avaliar os principais fatores de risco para complicações pós-operatórias da hidradenite supurativa. Metodologia: foram utilizadas referências em artigos científicos nas bases de dados Google, PubMed, LILACS e SciELO nas línguas portuguesa e inglesa, no período de 2000 a 2021. Resultados: os principais fatores que influenciam os resultados pós-operatórios estão relacionados a técnica cirúrgica empregada, gravidade da doença, comorbidades dos pacientes e terapia clínica adjuvante

Introduction: Hidradenitis Suppurativa is a chronic inflamatory and relapsing disease. High levels of recurrence can persist even after wide local excision. Objective: Identify the main risk factors for postoperative complications of Hidradentis Suppurativa. Methods: We included journal articles with data from Google, Pubmed, Lilacs, and Scielo, in Portuguese and English, from 2000 to 2021. Results: The main risk factors that influence postoperative outcomes are related to surgical technique, disease severity, comorbidities, and adjuvant clinical therapy

Sunscreen lotions in the dermatological prescription: review of concepts and controversies

Abstract The skin is regularly exposed to several environmental aggressions, including solar radiation, whose biological effects can induce sunburn, dyschromia, skin aging and cancer. Among the photoprotection measures, sunscreens comprise a relevant part of the strategy aimed to prevent solar radiation damage and, for effective action, the patient must adhere to the product use and the latter, in turn, must follow technical parameters to promote adequate protection. This review article brings together the most current and relevant concepts about photoprotection for dermatological use, including the challenges for their formulation, the risks of certain photoprotective active substances for individual and environmental safety and the importance of stringency in determining the product efficacy, considering the regulatory aspects, highlighting relevant differences between Brazil and other countries. Thus, when assessing a sunscreen, not only the visual aspects and sensory perception will be immediately evaluated, but also the quality and suitability of the vehicle, the chemical composition of the formulation, the environmental risks, the photostability of the screening system, and the measurement of its protection spectrum. Technical knowledge of sunscreens can help dermatologists in this important role of educating patients about the best photoprotective strategies in each situation.

Acurácia da teledermatoscopia móvel na avaliação de lesões cutâneas pigmentadas / The accuracy of mobile teledermatoscopy in the assessment of pigmented skin lesions

Neste estudo transversal, comparamos o diagnóstico feito por meio da teledermatoscopia ao diagnóstico histopatológico. Fotos convencionais e dermatoscópicas de 31 lesões pigmentadas foram enviadas a um dermatologista experiente por meio do aplicativo WhatsApp® Messenger. Todas as lesões foram excisadas e examinadas por um dermatopatologista. A acurácia global da teledermatoscopia móvel foi de 90,32%. Em relação à capacidade de a teledermatoscopia definir malignidade da lesão pigmentada, a especificidade foi de 81,8% e a sensibilidade de 100%. Nossos resultados fornecem evidências adicionais sobre a confiabilidade da teledermatoscopia móvel, com alta sensibilidade e precisão.

In this cross-sectional study, we compared the diagnosis made through teledermatoscopy with histopathological diagnosis. Conventional and dermoscopic photos of 31 pigmented lesions were taken and sent to an experienced dermatologist using the WhatsApp® Messenger application. A dermatopathologist excised and examined all lesions. The global accuracy of mobile teledermatoscopy was 90.32%. Regarding the ability of teledermatoscopy to define malignancy of the pigmented lesion, the specificity was 81.8% and the sensitivity was 100%. Our results provide additional evidence of the reliability of mobile teledermatoscopy with high sensitivity and accuracy.

Cholestatic pruritus: a knowledge update

Abstract This review is focused on updating knowledge about cholestatic pruritus. It summarizes clinical-epidemiological characteristics, pathophysiology, diagnostic approach, and evidence-based therapeutic recommendations regarding this form of pruritus. Pruritus is a frequent symptom that accompanies several liver diseases, particularly cholestatic ones. The symptom may be mild and tolerable, but it can also dramatically reduce the quality of life. Although the exact pathophysiology of this form of pruritus remains unclear, current evidence supports a mixed origin. It is extremely important for dermatologists to have knowledge about cholestatic pruritus since they are usually the first physicians to be sought by the patient when they experience the symptom. In the absence of specific dermatological alterations, cholestasis must always be considered as a possible cause of pruritus. In addition to allowing an adequate diagnosis, a better pathophysiological understanding of hepatic pruritus provides the identification of new therapeutic targets and, consequently, optimization of the approach in patients with this condition.

Total body mapping in the follow-up of melanocytic lesions: recommendations of the Brazilian Society of Dermatology

Abstract Total body mapping comprises photographic documentation of the entire body surface followed by digital dermatoscopy of selected melanocytic lesions, aiming to compare their evolution over time and identify new lesions. As this is an exam based on comparative analysis of serial dermoscopic body images, standardization of the technique for performing total body mapping is essential. Prepared by specialists from the Brazilian Society of Dermatology, using the modified Delphi method, this article provides recommendations for carrying out total body mapping in Brazil, regarding its indications, technical aspects, and the issuing of the report.

Nevo dividido na região genital: relato de seis casos / Divided nevus in the genital region, report of six cases

Os nevos divididos ocorrem em áreas contíguas da pele e, em sua grande maioria, são lesões benignas. Relatamos seis casos de nevo dividido no pênis e seus respectivos padrões dermatoscópicos. Levando em consideração a localização dessas lesões, o acompanhamento clínico foi a melhor opção terapêutica para este grupo de pacientes

The divided nevi occur in contiguous areas of the skin that are mostly benign lesions. We report six cases of nevus divided on the penis and its dermoscopic patterns. Clinical follow-up was the best therapeutic option for this group of patients, considering the location of these lesions.

Opções de reconstrução para fechamento de defeitos cirúrgicos nasais / Reconstruction options for the closure of nasal surgical defects

O carcinoma basocelular é o câncer de pele não melanoma mais comum, sendo o nariz o local de maior ocorrência. O tratamento de primeira escolha é a excisão cirúrgica. Defeitos nasais são um desafio para os cirurgiões devido à dificuldade para manter a funcionalidade e o bom resultado estético. Ao planejar a reconstrução, deve-se considerar as características anatômicas do nariz e individualidades do paciente. Relatamos quatro casos com defeitos cirúrgicos localizados em topografias semelhantes, abordados com técnicas de fechamento diferentes - fechamento primário, retalho, enxerto e segunda intenção - com resultados igualmente satisfatórios dos pontos de vista estético e funcional

Basal cell carcinoma is the most common type of nonmelanoma skin cancer, and the nose is the most common site. The treatment of choice, surgical excision, may cause nasal defects, which may be challenging for surgeons for maintaining functionality and aesthetics. When planning the reconstruction, one should carefully consider the nose's anatomical features and the patient's individual characteristics. We report four cases of nasal defects due to surgical excision of basal cell carcinoma approached with different closure techniques (primary closure, flap, graft, and second-intention healing), achieving equally satisfactory esthetic and functional results..

Combined high-frequency and Doppler ultrasound in early diagnosis of atrophoderma of Pasini and Pierini

Abstract: Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Descriptive dermoscopy terminology in Portuguese language in Brazil: a reproducibility analysis of the 3rd consensus of the International Dermoscopy Society

Abstract: Background: Dermoscopy is a noninvasive complementary diagnostic method largely used in dermatology. Feasibility, accuracy, and reproducibility are key elements for a diagnostic method to be useful, hence the importance of the terminology used to describe dermoscopic criteria. Objective: To evaluate the reproducibility of the English descriptive terminology proposed for dermoscopic criteria at the 3rd Consensus Meeting of the International Dermoscopy Society in Brazilian Portuguese. Methods: Nine Brazilian dermatologists independently analyzed the translation of sixty dermoscopic descriptive terms proposed at the 3rd Consensus Conference of the International Society of Dermoscopy. Interobserver agreement index was analyzed using the Fleiss' kappa test. Results: The interobserver agreement of the descriptive terminology in Brazilian Portuguese was considered weak (κ = 0.373; p < 0.05). The interobserver agreement of the descriptive terminology used to describe morphology and arrangement of vascular structures was considered moderate (κ = 0.43; p < 0.05). Study limitations: Our study limitations include the small number of participants and limited regional representation (only 2 out of 5 Brazilian regions were represented). Conclusions: The descriptive English terminology proposed at the 3rd Consensus Conference of the International Dermoscopy Society revealed weak reproducibility and the morphology and arrangement of vascular structures presented moderate reproducibility in Brazilian Portuguese. Despite small regional differences, metaphoric terminology in dermoscopy seems to be the most useful and reproducible system to be adopted in Brazilian Portuguese.

Ultrassonografia de alta frequência (22MHz) na identificação e remoção de ferrão de arraia / High-frequency ultrasonography (22MHz) for identification and removal of a rayfish stinger

A presença de corpos estranhos localizados na pele, sua dimensão, constituição e exata localização muitas vezes não são perceptíveis ao exame clínico dermatológico. Apesar de seu caráter benigno, a existência de corpos estranhos à pele provocam alta morbidade. A ultrassonografia de alta frequência tem sido amplamente utilizada nas diferentes áreas da Dermatologia. O avanço tecnológico com a introdução de aparelhos de alta frequência e resolução torna esse método útil na identificação e orientação da remoção de corpos estranhos localizados na pele. Apresentamos caso em que a ultrassonografia de alta frequência foi utilizada na identificação e retirada de um ferrão de arraia.

The presence of foreign bodies located on the skin, their size, constitution and precise location are often not perceptible on dermatological clinical examination. Despite their benign nature, the presence of foreign bodies in the skin is associated to high morbidity. High frequency ultrasonography has been widely used in different areas of Dermatology. Technological development and the introduction of devices offering high frequency and high resolution makes this method useful in identifying and guiding the removal of foreign bodies located in the skin. The authors describe a case where high frequency ultrasonography was used to identify and remove a rayfish stinger.

Multiple cutaneous melanomas associated with gastric and brain metastases

Abstract The occurrence of multiple primary melanomas in a single individual is rare. Most commonly, malignant melanocytic lesions subsequent to the initial diagnosis of melanoma are secondary cutaneous metastases. We report a patient with gastrointestinal bleeding from gastric metastasis of cutaneous melanoma. During clinical evaluation and staging, we discovered a brain metastasis associated with 3 synchronous primary cutaneous melanomas. We suggest the research on the mutation in the cyclin-dependent kinase inhibitor 2A (CDKN2A) (INK4a) in such cases. We also emphasize the importance of clinical examination and dermoscopy of the entire tegument, even after a malignant melanocytic lesion is identified.

Lichen sclerosus associated with localized scleroderma: dermoscopy contribution

Abstract: Lichen sclerosus is an uncommon inflammatory dermatosis with preferential involvement of the urogenital region. The extragenital involvement is uncommon and is characterized by small rounded macules or papules, pearly white in color. The coexistence of lichen sclerosus and scleroderma plaques in most cases with extragenital location has been reported in the literature. We report a case of lichen sclerosus associated with scleroderma in children, highlighting the importance of dermoscopy in diagnosis.

High frequency ultrasound with color Doppler in dermatology

Abstract: Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation / Estudo da anatomia cutânea com ultrassom de alta frequência (22 MHz) e sua correlação histológica

AbstractThe present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

ResumoO objetivo deste trabalho é familiarizar o radiologista com a estrutura histológica cutânea, o que torna possível uma melhor correlação dos achados ultrassonográficos da pele. Para o exame radiológico foi utilizado aparelho de ultrassom de alta frequência (22 MHz). O exame histológico foi realizado após fixação do material em formol, inclusão em parafina e coloração com hematoxilina-eosina. Os autores fazem uma revisão da literatura, demonstram a relação dos achados ultrassonográficos e histológicos do tecido cutâneo normal e discutem a técnica para o melhor aproveitamento do exame ultrassonográfico da pele. O ultrassom de alta frequência representa uma excelente ferramenta no diagnóstico das diferentes alterações cutâneas. Como o método é operador-dependente, é crucial o perfeito entendimento da pele normal e sua equivalência histológica/ultrassonográfica.

Collision of malignant neoplasms of the skin: basosquamous cell carcinoma associated with melanoma

Collision tumors are characterized by the coexistence of two cancers in the same anatomical site and its pathogenesis remains controversial. Although uncommon, the association of basal cell carcinoma and melanocytic nevus is the most common among combinations of skin tumors. Even rarer is the association of two malignant tumors. We report a case of tumor collision representing melanoma and basosquamous cell carcinoma, a combination not previously described in the literature, since there are no reported cases of melanoma with this type of basal cell carcinoma.

Contoured technique for lentigo maligna

The surgical approach to lentigo maligna is a challenge to dermatologists, given the difficulty of clinical delimitation of borders. We report here a case of a 69-year-old female patient presenting with brownish macules on her face, since 10 years ago, with histopathological diagnosis of lentigo maligna. The surgical management employed was excision of visible borders with the contoured technique and immediate submission of these borders for histopathological analysis before complete excision of the tumor. This technique is a variant of staged excision, with lower rates of recurrence and acceptable aesthetic results.