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Despite being an integral part of dermatologic surgery, nail surgery is infrequently performed in daily practice. Indeed, it is frequently considered difficult, time-consuming, and the results take a long time to be observed. Nonetheless, nail pathology is a frequent cause of dermatology consultation, so dermatologists should be familiar with its diagnosis and therapeutic approach, which often involves surgical procedures. This article provides a review of nail surgery, focusing on the anatomy of this region, anesthesia of the ungual apparatus, common surgical techniques, reconstruction of defects in these locations, and a general approach to the most frequently encountered conditions in clinical practice.
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Abstract Background: Cutaneous leiomyosarcoma is a rare malignant neoplasm with muscular origin, representing 2%-3% of all cutaneous soft tissue sarcomas. Objectives: The aim of this study was to characterize clinicopathological features of patients diagnosed with cutaneous leiomyosarcoma in our center over the last 20-years. Methods: A retrospective study of patients with a histopathological diagnosis of leiomyosarcoma between 1999 and 2018 was conducted. Results: Eleven patients were diagnosed with cutaneous leiomyosarcoma during this period. Most cases occurred in men (n = 7). Age at presentation ranged from 47 to 92 years (mean 64.9 years). Head and neck were the most frequently involved locations (n = 5). Ten leiomyosarcoma were dermal, with one cutaneous metastasis. Immunohistochemical staining was available for 7 patients, demonstrating positivity for smooth muscle actin in all of them. All neoplasms were treated surgically. Mean survival was 32.2-months. Study limitations: This was a retrospective study based on medical and pathological records. Conclusions: Histopathology is essential for the diagnosis of leiomyosarcoma, usually revealing a dermal or subcutaneous lesion composed of intertwined fascicles of smooth muscle fibers. Immunohistochemistry is then used to adequately differentiate leiomyosarcoma from other spindle cell tumors. When dealing with cutaneous leiomyosarcoma, it is advisable to carefully evaluate the depth of subcutaneous extension, since even minimal subcutaneous involvement may be associated with a poorer prognosis.
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Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Neoplasias Cutâneas , Leiomiossarcoma/diagnóstico , Imuno-Histoquímica , Estudos Retrospectivos , Tela Subcutânea , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Cutaneous leiomyosarcoma is a rare malignant neoplasm with muscular origin, representing 2%-3% of all cutaneous soft tissue sarcomas. OBJECTIVES: The aim of this study was to characterize clinicopathological features of patients diagnosed with cutaneous leiomyosarcoma in our center over the last 20-years. METHODS: A retrospective study of patients with a histopathological diagnosis of leiomyosarcoma between 1999 and 2018 was conducted. RESULTS: Eleven patients were diagnosed with cutaneous leiomyosarcoma during this period. Most cases occurred in men (nâ¯=â¯7). Age at presentation ranged from 47 to 92 years (mean 64.9 years). Head and neck were the most frequently involved locations (nâ¯=â¯5). Ten leiomyosarcoma were dermal, with one cutaneous metastasis. Immunohistochemical staining was available for 7 patients, demonstrating positivity for smooth muscle actin in all of them. All neoplasms were treated surgically. Mean survival was 32.2-months. STUDY LIMITATIONS: This was a retrospective study based on medical and pathological records. CONCLUSIONS: Histopathology is essential for the diagnosis of leiomyosarcoma, usually revealing a dermal or subcutaneous lesion composed of intertwined fascicles of smooth muscle fibers. Immunohistochemistry is then used to adequately differentiate leiomyosarcoma from other spindle cell tumors. When dealing with cutaneous leiomyosarcoma, it is advisable to carefully evaluate the depth of subcutaneous extension, since even minimal subcutaneous involvement may be associated with a poorer prognosis.
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Leiomiossarcoma , Neoplasias Cutâneas , Idoso , Idoso de 80 Anos ou mais , Humanos , Imuno-Histoquímica , Leiomiossarcoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tela SubcutâneaRESUMO
Abstract Biological therapies, including anti-TNF agents, are important in the treatment of various chronic inflammatory diseases, including psoriasis, rheumatoid arthritis or inflammatory bowel disease. The increased use of these drugs translates into an increasing awareness of its adverse effects, which include malignancy. In this paper, we describe the case of a 28-year-old woman who developed a spitzoid melanocytic tumor after starting infliximab therapy for ulcerative colitis. The evidence for causality between anti-TNF and melanocytic proliferations is still sparse; nonetheless, treatment-associated immunosuppression seems to play a key role in this phenomenon. Therefore, a regular follow-up with a rigorous skin examination is essential in these patients. Noninvasive techniques such as dermoscopy or reflectance confocal microscopy are particularly useful diagnostic tools in these circumstances.
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Humanos , Feminino , Adulto , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Nevo de Células Epitelioides e Fusiformes/induzido quimicamente , Fator de Necrose Tumoral alfa , Diagnóstico Diferencial , Infliximab/efeitos adversosRESUMO
Biological therapies, including anti-TNF agents, are important in the treatment of various chronic inflammatory diseases, including psoriasis, rheumatoid arthritis or inflammatory bowel disease. The increased use of these drugs translates into an increasing awareness of its adverse effects, which include malignancy. In this paper, we describe the case of a 28-year-old woman who developed a spitzoid melanocytic tumor after starting infliximab therapy for ulcerative colitis. The evidence for causality between anti-TNF and melanocytic proliferations is still sparse; nonetheless, treatment-associated immunosuppression seems to play a key role in this phenomenon. Therefore, a regular follow-up with a rigorous skin examination is essential in these patients. Noninvasive techniques such as dermoscopy or reflectance confocal microscopy are particularly useful diagnostic tools in these circumstances.
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Nevo de Células Epitelioides e Fusiformes , Neoplasias Cutâneas , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Infliximab/efeitos adversos , Nevo de Células Epitelioides e Fusiformes/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Fator de Necrose Tumoral alfaRESUMO
Photodynamic therapy (PDT) has long been used in dermatology as a therapeutic strategy for several malignant and premalignant conditions. Currently, it is approved in Europe for the treatment of actinic keratosis, squamous cell carcinoma in situ, and some forms of basal cell carcinoma, with favorable clearance rates associated with satisfying aesthetic results. Nonetheless, in the past few years, PDT has also demonstrated efficacy in many other conditions, including inflammatory and infectious dermatoses. These results, probably explained by its immunomodulatory, anti-inflammatory, and bactericidal effects, may lead to an expansion of PDT indications in the upcoming years. In this article, conditions where PDT may be useful are reviewed, thus highlighting the potential of this therapeutic modality for the dermatologist.
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Carcinoma Basocelular , Dermatologia , Ceratose Actínica , Fotoquimioterapia , Neoplasias Cutâneas , Ácido Aminolevulínico/uso terapêutico , Carcinoma Basocelular/tratamento farmacológico , Humanos , Ceratose Actínica/diagnóstico , Ceratose Actínica/tratamento farmacológico , Fármacos Fotossensibilizantes/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
Granulomatous skin diseases comprise an extensive group of pathologies whose diagnosis usually requires a histopathological examination. At this level, various types of granulomas can be distinguished, namely tuberculoid, sarcoid, necrobiotic, suppurative, xanthogranuloma, and foreign-body granulomas. This study aimed to determine the frequency and pattern of different granulomatous skin lesions in the Dermatopathology Department of Hospital de Santa Maria (Lisboa, Portugal). A retrospective study of all skin biopsies with granulomatous lesions received during a period of 10 years (2008-2017) was performed. Clinical and histopathological characteristics of the selected cases were analyzed, and the lesions were categorized according to histological type of granuloma and etiology. Foreign-body granulomas secondary to ruptured cyst, folliculitis, or suture material were excluded. From a total of 48,253 cutaneous biopsies performed in this period, 461 (1%) granulomatous lesions were included in our study. In the analysis according to type of granuloma, necrobiotic granulomas were the most frequent (N = 111; 27.0%), followed by sarcoidal (N = 72; 17.5%), tuberculoid (N = 51; 12.4%), suppurative (N = 45; 10.9%), foreign body (N = 40; 9.7%), and xanthogranulomas (N = 26; 6.3%). The remaining 20% corresponded to granulomas of other types. During these 10 years, the most frequent etiology was granuloma annulare (N = 98; 88.3%), followed by sarcoidosis (N = 47; 65.3%). Histopathology is a fundamental tool in the diagnosis of granulomatous skin diseases, allowing for the categorization of various types of granulomas and often guiding further investigation of these patients. The geographical area has an influence on the types of granulomas observed, as evidenced by comparing this study with others previously published.
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Granuloma/patologia , Dermatopatias/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Granuloma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Estudos Retrospectivos , Dermatopatias/etiologia , Centros de Atenção Terciária , Adulto JovemRESUMO
BACKGROUND: Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. METHODS: Retrospective study of all patients diagnosed with an APD over a 10-year period (2009-2018) at a tertiary teaching hospital in Lisbon, Portugal. RESULTS: Fifty-seven patients with APD were identified. Thirty-five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty-six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. CONCLUSION: Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases.
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Dermatopatias/diagnóstico , Pele/patologia , Acitretina/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Diabetes Mellitus/epidemiologia , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Hospitais de Ensino/estatística & dados numéricos , Humanos , Extremidade Inferior , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Fototerapia , Portugal/epidemiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Dermatopatias/etiologia , Dermatopatias/patologia , Dermatopatias/terapia , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Viroses/complicações , Viroses/epidemiologiaRESUMO
Over the last few decades, behavioral changes in sexual practices have made oral transmission of traditional sexually transmissible infections increasingly recognized. Patients harboring a sexually transmissible infection may first present lesions on the oral cavity, as these may be visible and interfere with basic functions such as speech or swallowing. Moreover, the oral cavity may function as a reservoir for future spread of these infections. In order to successfully control this problem, a greater focus on oral sex should be persued, along with promotion of the use of condom and education on safe oral sex practices. Furthermore, examination of the oral cavity should is essential when evaluating any patient suspected of harboring a sexually transmissible infection. In this article, oral transmission of several viral and bacterial infections is reviewed, including human papillomavirus infection, genital herpes, syphilis and gonorrhea, among others.
Com as alterações comportamentais nas práticas sexuais verificadas nas últimas décadas, a transmissão oral de infeções sexualmente transmissíveis tem vindo a ser progressivamente mais reconhecida. As lesões na cavidade oral podem ser visíveis ou interferir com funções básicas como a fala ou deglutição, sendo por isso o motivo de apresentação de muitos destes doentes. Além disso, a cavidade oral pode funcionar como um reservatório para a disseminação futura dessas infecções. Para um controlo adequado deste problema, deve ser prestada uma maior atenção às práticas de sexo oral, à promoção do uso do preservativo e à educação relativamente a práticas sexuais seguras. Por outro lado, o exame da cavidade oral deve ser parte integrante da avaliação de qualquer indivíduo com suspeita de uma infecção sexualmente transmissível. Neste artigo, a transmissão oral de várias infeções virais e bacterianas é revista, nomeadamente a infeção pelo vírus do papiloma humano, herpes genital, sífilis e gonorreia, entre outras.
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Doenças da Boca/complicações , Sexo Seguro , Comportamento Sexual , Infecções Sexualmente Transmissíveis/transmissão , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/transmissão , Chlamydia trachomatis , Gonorreia/diagnóstico , Gonorreia/transmissão , Infecções por HIV/diagnóstico , Infecções por HIV/patologia , Infecções por HIV/transmissão , Herpes Simples/diagnóstico , Herpes Simples/transmissão , Humanos , Doenças da Boca/diagnóstico , Doenças da Boca/patologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/transmissão , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/patologia , Sífilis/diagnóstico , Sífilis/patologia , Sífilis/transmissãoRESUMO
Excessive solar exposure presents well-recognized risks and side effects, solar radiation being the most important environmental factor concerning skin cancer. In the last few years, several connections between solar exposure and prevention and/or treatment of several diseases have been discussed, with studies suggesting that regular solar exposure may be beneficial for conditions such as colorectal, breast, prostate, and pancreatic cancer; non-Hodgkin lymphoma; arterial hypertension; obesity; type 2 diabetes mellitus and metabolic syndrome; nonalcoholic hepatic steatosis; multiple sclerosis; Alzheimer disease; and several psychiatric disturbances. In most cases, UV radiation's beneficial effects are mediated through vitamin D; however, studies show that in other instances other mediators are responsible for these associations, specifically nitric oxide. Moderation is therefore essential, as a strict strategy of total sun avoidance may be inadequate.
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Dermatofibromas are common and asymptomatic benign histiocytic tumors. The occurrence in a small number (up to 5 lesions) is frequent. However, the expression "multiple eruptive dermatofibromas" is reserved for the appearance of more than 5 lesions in less than four months. Multiple eruptive dermatofibromas are rare and usually associated with an underlying systemic condition, the most common being autoimmune diseases or HIV infection. Herein we report multiple eruptive dermatofibromas developing in an otherwise healthy pregnant woman. Although the pathogenesis of this condition remains unknown, it is believed to be related to immunological alterations, given the strong association with states of immunosuppression or, in the case of pregnancy, with a state of immunotolerance.