Carcinoma espinocelular avançado e imunoterápicos: novas perspectivas terapêuticas / Advanced squamous cell carcinoma and immunotherapy: new therapeutic perspectives

O carcinoma espinocelular (CEC) apresenta a segunda maior taxa de incidência entre os cânceres de pele não melanoma. Cerca de 5% desses casos evoluem para lesões localmente avançadas e/ou metastáticas, tornando a abordagem cirúrgica muitas vezes inviável. Com base nisso, foi realizada uma revisão na literatura sobre o uso de imunoterápicos no tratamento do CEC avançado. Observou-se, então, que a imunoterapia é uma potencial estratégia terapêutica devido à promoção da atividade antitumoral por meio da própria resposta imunológica individual, o que contribui para a redução dos efeitos colaterais de cirurgias, quimioterapias e radioterapias.

Squamous cell carcinoma (SCC) has the second highest incidence rate among non-melanoma skin cancers. About 5% of cases progress to locally advanced and/or metastatic lesions, making the surgical approach often unfeasible. Based on this, we performed a literature review on the use of immunotherapy drugs to treat advanced SCC. The results showed that immunotherapy is a potential therapeutic strategy due to the antitumor activity promotion through the individual immune response, reducing the adverse events of surgeries, chemotherapy, and radiotherapy

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection

Abstract: Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Macrophage subtypes in recurrent nodular basal cell carcinoma after Mohs micrographic surgery.

BACKGROUND: The macrophages associated with solid tumors are related to the progression or regression of tumors, depending on the differentiation in M1 or M2. M2 subtype promotes angiogenesis, remodeling, and tissue repair (tumor proliferation). In contrast, M1 produces toxic mediators and presents antigens, destroying microorganisms and tumor cells. The microenvironment of most aggressive forms of basal cell carcinoma (BCC) shows an increase in macrophages due to M2 phenotype compared to noninvasive forms. The treatment of nodular BCC by Mohs micrographic surgery (MMS) provides high cure rates, but relapses can occur. AIMS: To compare the total population of macrophages and their subpopulations M1 and M2 in cases of recurrent and nonrecurrent nodular BCC after excision by MMS. MATERIALS & METHODS: Histological sections obtained from paraffin blocks of nine cases of recurrent nodular BCC after MMS and 18 cases of nonrecurrent nodular BCC operated by MMS were immunostained for iNOS, CD204, CD163, and CD68. The expression of these markers was analyzed by image analysis. RESULTS: No significant differences were found between the groups in relation to the average percentage of M1 cells, M2 cells, and total cells. DISCUSSION AND CONCLUSION: A relationship was not seen between tumor-associated macrophages (TAM) and tumor recurrence.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection.

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Indication guidelines for Mohs micrographic surgery in skin tumors.

Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.

Indication guidelines for Mohs micrographic surgery in skin tumors

Abstract: Mohs micrographic surgery is a technique used to excise skin tumors based on comprehensive surgical mapping, in which the surgeon removes the tumor, followed by a complete histological evaluation of the tumor's margins. The correlation of the presence of a tumor in histological examinations and its precise location on the surgical map result in a complete removal of the tumor with maximum normal tissue preservation. The present article seeks to provide general practitioners and healthcare specialists with guidelines regarding recommendations for Mohs micrographic surgery to treat skin tumors, based on the most reliable evidence available in medical literature on the subject. This bibliographic review of scientific articles in this line of research was conducted based on data collected from MEDLINE/PubMed. The search strategy used in this study was based on structured questions in the Patient, Intervention, Control, and Outcome (PICO) format. MeSH terms were used as descriptors. The indications of this technique are related to recurrence, histology, size, definition of tumor margins, and location of tumors. These guidelines attempt to establish the indications of Mohs surgery for different types of skin tumors.

Reconstrução dos defeitos nasais após exérese de tumores pela cirurgia micrográfica de Mohs / Reconstruction of nasal defects after tumor excision through Mohs micrographic surgery

Introdução: A reconstrução dos defeitos cirúrgicos gerados pela excisão de tumores no nariz, por sua estrutura rígida e de pouca mobilidade, é um desafio para os cirurgiões dermatológicos. A técnica de cirurgia micrográfica de Mohs (CMM) permite poupar tecido saudável, produzindo ferida cirúrgica menor. Objetivo: Demonstrar as técnicas de correção dos defeitos cirúrgicos após remoção de tumores do nariz pela CMM, de acordo com a localização anatômica do tumor. Métodos: Estudo descritivo com pacientes operados pela CMM no período 1996 a 2010. Foram analisadas imagens pré, intra e pós-operatórias dos pacientes com o intuito de classificar a localização anatômica do defeito cirúrgico e o tipo de reconstrução adotada. Resultados: Foram incluídos no estudo 170 pacientes, totalizando 203 lesões. A localização mais comum dos tumores foi (em ordem decrescente): asa nasal, dorso, ponta e parede lateral. Nas lesões localizadas na parede lateral e asa nasal o tipo de reconstrução mais utilizado foi o retalho de avanço. Nas lesões localizadas na ponta nasal, o enxerto; no dorso, o enxerto e o retalho de avanço. Conclusões: Os parâmetros que nos orientam na escolha do melhor método de reconstrução devem levar em consideração o tamanho e a localização do defeito cirúrgico.

Introduction: The reconstruction of surgical defects resulting from the excision of tumors in the nose is a challenge for dermatologic surgeons due to its rigid structure and low mobility. The Mohs Micrographic Surgery technique allows the preservation of healthy tissue and leads to a smaller surgical wound. Objective: To demonstrate techniques for surgical correction of defects after removal of tumors of the nose through Mohs Micrographic Surgery, according to the anatomical location of the tumor. Methods: Descriptive study of patients operated on using Mohs Micrographic Surgery during the period 1996-2010. Patient images taken pre-, intra-, and post-operatively were analyzed with the aim of classifying the defect's anatomic location and the type of surgical reconstruction adopted. Results: 170 patients (totaling 203 lesions) were included in the study. The most common locations for tumors were (in descending order): nasal ala, dorsum, tip, and lateral wall. The advancement flap was the most common reconstruction type for lesions located in the lateral wall and in the nasal ala. Grafts were most often used in lesions located in the tip of the nose. Grafts and advancement flaps were more frequently used in the dorsum of the nose. Conclusions: The parameters that provide guidance on choosing the best reconstruction method must take into consideration the size and location of the surgical defect.

Tumores glômicos subungueais tratados pela cirurgia micrográfica de Mohs: índices de recidiva e revisão de literatura / Subungal glomus Tumors treated by the Mohs micrographic surgery: recurrence index and literature review

Introdução: O tumor glômico subungueal caracteriza-se por nódulo doloroso desencadeado por alteração térmica e tátil. A excisão completa da lesão é o tratamento de escolha, porém as recidivas são frequentes. Objetivo: Comparar as taxas de recidivas de cirurgias convencionais descritas na literatura com as taxas de recidiva da cirurgia micrográfi ca de Mohs (CMM). Material e Métodos: Foram incluídos 10 pacientes diagnosticados com tumor glômico subungueal, dos quais 9 eram do sexo feminino e 1 do sexo masculino, que foram submetidos à retirada dessas lesões pela técnica de Cirurgia Micrográfi ca de Mohs. Resultados: Dos 10 pacientes operados, 8 foram considerados curados após seguimento de 14 a 93 meses (média de 47,8 meses). Houve duas recidivas, que ocorreram após 47 e 51 meses, respectivamente. Um caso foi reoperado pela CMM, sem evidência de doença após 24 meses. Conclusão: Os resultados obtidos com o emprego da CMM em tumores glômicos subungueais foram semelhantes aos relatados na literatura com técnicas convencionais, geralmente com seguimentos mais limitados.

Introduction: The subungual glomus tumor is characterized by painful nodules triggered by thermal and tactile change. A complete lesion excision is the treatment of choice but relapses are frequent. Objective: To compare the rates of recurrence of conventional surgeries described in the literature with the ones we found after the Mohs micrographic surgery (MMS). Material and Methods: We included 10 patients diagnosed with subungual glomus tumor of which 9 were female and 1 male and who also underwent withdrawal of these lesions by the technique of Mohs micrographic surgery. Results: Of the 10 patients, eight were considered cured after following 14 to 93 months (around 47.8 months). There were two recurrences which occurred after 47 and 51 months, respectively. One case was reoperated by MMS without evidence of disease after 24 months. Conclusion: The results obtained with the use of MMS in subungual glomus tumors were similar to those reported in the literature with conventional techniques, usually with more limited follow-up.

Direct immunofluorescence in lupus erythematosus (LE)

One hundred and twenty-six patients with LE were studied. They were distributed as follows: 84 with DLE, 13 with SALE and 29 with SLE. Biopsies from the skin lesions were performed and submitted to DIF. Positive results were equal to 69,61.5 and 72.4 percent of the DLE,SALE and SLE cases, respectively. These data are in accordance with the literature. IgM was the most frequently found immunoglobulin, followed by the association IgM+C3.

Lúpus eritematoso sistêmico bolhoso: estudo de dois casos e revisäo da literatura / Bullous systemic Lupus erythematosus: study of 2 cases and literature review

Os autores apresentam dois casos de lúpus eritematoso sistêmico bolhoso confirmados clínica e laboratorialmente, juntamente com revisäo de literatura. Discutem a diagnose diferencial das dermatoses bolhosas juncionais associadas ao LES e caracterizam o LES bolhoso como entidade clínico-patológica