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.

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.

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.

Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases.

BACKGROUND: The ear is a region that has a high prevalence of cutaneous carcinomas and several guidelines indicate Mohs micrographic surgery as the first-choice treatment in such cases. Although the technique allows maximum preservation of healthy tissue, many auricular surgical wounds constitute a challenge due to the peculiar local anatomy, with evident curves and reliefs. Auricular reconstruction should prioritize function before aesthetics, but without leaving the latter aside, since postoperative distortions can have a significant psychological impact. OBJECTIVE: To describe the authors' experience in auricular reconstruction after Mohs surgery and to evaluate the most frequently used repair methods. METHODS: Retrospective study of consecutive cases submitted to Mohs surgery and auricular reconstruction, over a period of 3 years. RESULTS: One hundred and one cases were included and the most common repair method was primary closure (n = 35), followed by full-thickness skin graft (n = 30) and flaps (n = 24). In thirty cases, reconstruction methods were associated. Seven patients had complications (partial graft necrosis, postoperative bleeding or infection). STUDY LIMITATIONS: Retrospective design and the absence of long-term follow-up of some cases. CONCLUSIONS: The dermatologic surgeon should be familiarized with different options for auricular reconstruction. Primary closure and skin grafts were the most frequently used repair methods.

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.

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

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.

Comparison of basal cell carcinoma subtypes observed in preoperative biopsy and Mohs micrographic surgery.

BACKGROUND: The treatment of basal cell carcinoma depends on its histological subtype. Therefore, a biopsy should be performed before definitive treatment. However, as the biopsy is only a sample of the tumor, it does not always shows every histological subtype present in the neoplasm. Few studies have compared the histological findings of biopsies with the findings of Mohs micrographic surgery. By evaluating the totality of the peripheral margins, in addition to sampling large tumor areas, this technique provides a more representative amount of tissue than preoperative biopsy. OBJECTIVES: a) Determine the agreement between the histological subtype of basal cell carcinoma from punch biopsy and the findings of Mohs surgery; b) To assess, among the discordant cases, the prevalence of non-aggressive tumors in the preoperative biopsy that were reclassified as aggressive by Mohs surgery. METHODS: Retrospective analysis of 79 cases of basal cell carcinomas submitted to punch biopsy and subsequent Mohs surgery. RESULTS: The agreement between the classification of the subtypes in the biopsy and in Mohs surgery was 40.5%. Punch biopsy was able to predict the most aggressive basal cell carcinoma growth pattern in 83% of cases. STUDY LIMITATIONS: Retrospective nature, sample size, and biopsies performed by different professionals. CONCLUSIONS: The agreement between the histopathological subtypes of basal cell carcinoma as seen in preoperative biopsy and Mohs surgery was low. However, preoperative biopsy presented good accuracy (83%) in detecting aggressive histopathological subtypes.

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.

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

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.

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.

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.

Usefulness of the subunit principle in nasal reconstruction.

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.

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.