Subungual Acral Lentiginous Melanoma of the Fifth Toe.

Acral lentiginous melanoma is rare in Caucasians, but it is the most common among individuals with a higher phototype, such as Blacks and Asians. It is usually presented under the palmoplantar and/or nail region. Subungual melanoma is an acral lentiginous melanoma subtype in which the initial diagnostic approach does not have a consensus. We report a case of a woman with tumoral melanocytic lesion on the fifth toenail, of insidious growth, where the amputation of the nail apparatus technique was used as an excisional biopsy for an extensive lesion. The patient is followed up in an outpatient clinic setting without lymph node or distance metastasis.

Congenital Curved Nail of the Fourth Toe Associated with Oral Disorders.

Congenital curved nail of the fourth toe represents an unusual deformity in which the nail of the fourth toe curves in a plantar direction. It is unknown why only this toe is affected; however, the initial descriptions suggest that this is a mesodermal defect. We describe a case of congenital curved nail of the fourth toe associated with bifid uvula. There are only 2 reports mentioning the association of this nail abnormality with cleft palate and/or lip. In our patient, there was an association with bifid uvula that is considered a minor form of palatine fissure. There seems to be an association of congenital curved nail of the fourth toe with cleft palate to different degrees; however, the pathogenesis of the deformity remains unknown.

Correção cirúrgica de rinofima grave / Surgical repair of severe rhinophyma

A rosácea pode manifestar-se com a formação de fima, que se caracteriza por hipertrofia de glândulas sebáceas e proliferação de tecido conectivo e vasos sanguíneos. Considerada complicação grave, a fima é mais comum em homens, e mais frequente no nariz, quando é denominada rinofima. Rosácea e rinofima podem trazer prejuízos funcionais e estéticos com piora da qualidade de vida dos pacientes. Nos estádios iniciais realizam-se terapêuticas farmacológicas, às quais, porém, a forma fimatosa responde pobremente. Relatamos um caso de correção cirúrgica de rinofima gigante pela técnica de shaving e eletrocoagulação, com excelente resultado cosmético e funcional.

Rosacea can develop into phyma, which is characterized by hypertrophy of sebaceous glands and proliferation of connective tissue and blood vessels. Regarded as a serious complication, phymas are more common in men, being more frequent in the nose ­ when it is called rhinophyma. Rosacea and rhinophyma can cause functional and aesthetic impairment, leading to a worsening in the patients' quality of life. Pharmacological and physical therapies are performed in initial stages, however phymatous variants of the condition respond poorly to the first. The authors of the present article report a case of surgical correction of a giant rhinophyma using the shaving and electrocoagulation techniques, with excellent aesthetic and functional outcomes.

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.

Onicomatricoma / Onychomatricoma

Onicomatricoma é neoplasia benigna específica do complexo ungueal descrita em 1992, sendo o único tumor em que a alteração da placa ungueal é produzida ativamente pela lesão. Encontra-se na matriz ungueal apresentando projeções digitiformes que ficam impressas na placa ungueal, resultando em espessamento, estrias longitudinais, coloração amarelada e hemorragias em estilhaço. Apesar de descrito como tumor raro acredita-se que seja subdiagnosticado. O objetivo deste artigo é revisar as características clínicas e os exames complementares subsidiários para o reconhecimento e diagnóstico desse tumor.

Onychomatricoma is a benign neoplasia that occurs pecifically in the nail apparatus. It was described in 1992, and is the only tumor in which the change of the nail plate is actively caused by the lesion. It lies in the nail matrix,and has fingerlike projections that are embedded in the nail plate, resulting in thickening, longitudinal grooves, yellow discoloration and splinter hemorrhages. Although described as a rare tumor, it is believed to be underdiagnosed. The present study is aimed at reviewing onychomatricoma's clinical features as well as the complementary examinations that are used to recognize and diagnose this tumor.

Acompanhamento a longo prazo de pacientes submetidos a cirurgia de paroníquia crônica / Long-term follow-up of patients who underwent surgery for chronic paronychia

Introdução: A paroníquia crônica é doença inflamatória da dobra ungueal proximal, geralmente presente por mais de seis semanas. O tratamento cirúrgico está indicado nos casos resistentes ao tratamento clínico e tem como objetivo a retirada da prega ungueal proximal. Objetivo: O objetivo deste trabalho foi analisar a manutenção da resposta ao tratamento cirúrgico da paroníquia crônica a longo prazo. Métodos: Estudo de coorte prospectivo no qual foram convocados 62 pacientes que haviam realizado tratamento cirúrgico para correção de paroníquia crônica no período de novembro de 2004 a abril de 2008. Os pacientes foram convocados a retornar ao serviço para reavaliação clínica e observação da presença ou não de sinais de paroníquia crônica e divididos em dois grupos: curados e não curados. Resultados: Dos pacientes convocados, 12 compareceram à reavaliação clínica, totalizando 31 procedimentos. A média de tempo do seguimento dos pacientes foi de cinco anos e dois meses e houve manutenção do resultado em 27 (87%) dos procedimentos realizados. Conclusões: A cirurgia de remoção da dobra ungueal proximal constitui boa opção para o tratamento de paroníquia crônica, sendo simples, eficaz e duradoura.

Introduction: Chronic paronychia is an inflammatory disease of the proximal nail fold that usually lasts for more than six weeks. Surgical of removal the proximal nail fold is recommended in cases that are resistant to clinical treatment. Objective: To analyze the long-term response to the surgical treatment of chronic paronychia. Methods: Prospective cohort study of 62 patients who had undergone surgical treatment to correct chronic paronychia from November 2004 to April 2008. The patients were asked to return for reassessment and clinical observation of the presence or absence of signs of chronic paronychia and were classified into two groups: cured and uncured. Results: Of the 62 patients, 12 attended the clinical reassessment, for a total of 31 procedures for analysis. The average length of patient follow-up was 5 years and 2 months. The results were maintained in 27 (87%) of the procedures performed. Conclusions: Surgical removal of the proximal nail fold is a good option for the treatment of chronic paronychia due to its simplicity, effectiveness, and long-lasting results.

Cross-sectional descriptive study of topical self-medication in a hospital dermatology department in the state of São Paulo.

Self-medication involves individuals or their carers administering a medical drug of their own choice for symptomatic relief and in the hope of a "cure", without seeking professional medical advice.The aim of this descriptive cross-sectional study conducted at the Dermatology Department of the Taubaté University Hospital was to identify the occurrence of self-medication for the topical treatment of skin diseases in young people under 18, and to analyze the difficulties encountered in the clinical diagnosis of these individuals.We examined 29 cases of self-medication (from a total of 480 attendances). Although self-medication is a common practice in Brazil our study showed that users were not significantly harmed by it.

Doença de Rosai-Dorfman cutânea: relato de caso e revisão de literatura / Cutaneous Rosai-Dorfman disease: case report and review of literature

Relata-se o caso de uma paciente com doença de Rosai-Dorfman cutânea que apresentava na região glútea direita uma placa eritemato-acastanhada infiltrada com áreas amareladas e pápulas eritemato-acastanhadas perilesionais. O exame anatomopatológico revelou infiltrado inflamatório predominantemente de linfócitos e histiócitos de citoplasma amplo, claro e contendo células inflamatórias íntegras (emperipolese). Nenhuma outra alteração ao exame físico e laboratorial foi encontrada. A doença de Rosai-Dorfman é uma forma rara de proliferação histiocitária e o acometimento estritamente cutâneo é ainda mais raro. Sua etiologia é desconhecida e a correlação clinicopatológica permitiu o diagnóstico dessa enfermidade.

We report a patient with cutaneous Rosai-Dorfman disease that presented on the right buttock, a red brown plaque with yellowish areas and red-brown satellite papulas. The histopathologic exam revealed inflammatory infiltrate predominantly of lymphocytes and histiocytes with wide and clear cytoplasm containing intact inflammatory cells (emperipolesis). Any other alteration in the physical exam and laboratorial was not found. The Rosai-Dorfman disease is a rare form of histiocytic proliferation and the strictly cutaneous form is still rarer. The aetiology is unknown and the clinical and histologic correlation enables the correct diagnosis.

Estudio del ángulo del cuello del fémur en cadáveres del departamento de anatomía de la Facultad de Medicina - PUC-SP / Study of the collo-diaphyseal angle of the femur of corpses in the Anatomy Department of the PUC-SP Medical School

In Brazilian literature the works are scarce on the collo-diaphyseal angle (CDA) in Brazilians, as well as, in relation to the other measures that can be acquired in the proximal portion of the femur, as the femur axle length (FAL), femur neck width (FNW), and the femur head diameter (FHD).This study had the purpose of enlarging the data on the Brazilian people, providing anatomic fundamentals that allow a better comprehension of clinical and pathological states involving the hip joint. All these measures were gotten in millimeters (mm) through a paquimeter and a goniometer for the same researcher. Eighty-seven bones were analyzed, being 40 (46 percent) right femurs and 47 (56 percent) left femurs. The bones were in their complete form and they were from adult corpse. For the analysis of measures were used Friedman's analysis of variance to compare, separately, for the sides right and left, the values of the five measures effected by the researchers; the test of Student for two not independent samples, with the objective to compare, for each corpse, the values of the observed angle in the right and left side. The results were: right-CDA 128.23° +/- 4.43 and left-CDA 128.04° +/- 4.36, right-FAL 90.14mm +/- 5.53 and left-FAL 91.08mm +/- 5.48, right-FNW 28.69mm +/- 2.58 and left-FNW 28.81mm +/- 3.28, andright-FHD 41.80mm +/- 3.10 andleft-FHD 42.11 +/- 3.42. In conclusion, it is necessary to emphasize the importance of femoral geometry data of Brazilian bones in this study which could be compared to values carried out in other Brazilian states since the Brazil continental size causes variations in the population. Also it is imperative to emphasize the future possibility of applying this knowledge in clinical practice, especially in relation to the risk of bone fracture.

En la literatura brasileña los trabajos sobre el ángulo del cuello del fémur (CDA) son escasos, así como de las otras medidas que pueden adquirirse en la porción proximal del hueso, como la longitud del cuello del fémur (FAL), anchura de cuello del fémur (FNW), y el diámetro de la cabeza del fémur (FHD). Este estudio tiene el propósito de aumentar los datos de individuos brasileños, proporcionando principios anatómicos que permitan una mejor comprensión de estados clínicos y patológicos que involucran la articulación de la cadera. Todas estas medidas se consiguieron en milímetros (mm) a través de un paquímetro y un goniómetro, por un mismo investigador. Se analizaron 87 huesos, siendo 40 (46 por ciento) fémures derechos y 47 (56 por ciento) fémures. Los huesos estaban enteros y eran de individuos adultos. Para analizar las medidas se usó Análisis de Varianza de Friedman para comparar, separadamente, los lados derecho y izquierdo, los valores de las cinco medidas efectuados por los mismos investigadores; la prueba t-Student para las muestras independientes, con el objetivo de comparar, para cada cadáver, los valores del ángulo observado en los lados derecho e izquierdo. Los resultados fueram: derecho-CDA 128.23° +/- 4.43 e izquierdo-CDA 128.04° +/- 4.36, derecho-FAL 90.14mm +/- 5.53 e izquierdo-FAL 91.08mm +/- 5.48, derecho-FNW 28.69mm +/- 2.58 e izquierdo-FNW 28.81mm +/- 3.28, y derecho-FHD 41.80mm +/- 3.10 e izquierdo-FHD 42.11 +/- 3.42. En conclusión, son importantes los datos de geometría femoral de huesos brasileños obtenidos en este estudio, para poder compararlos con valores obtenidos en individuos de otros estados brasileños, debido el tamaño continental de Brasil, que causa variaciones en su población. También es importante la posibilidad de aplicar en el futuro geometría de la porción proximal del fémur en la práctica médica, sobre todo cuando existe riesgo de fractura del hueso.