Utilidad del HeberFERON® en pacientes con carcinoma basocelular / Usefulness of HeberFERON® in patients with basal cell carcinoma

Introducción: El carcinoma basocelular es el tumor epitelial maligno más frecuente, pues constituye 60-80 % de todos los cánceres cutáneos. Objetivo: Determinar la respuesta al HeberFERON® en pacientes con carcinoma basocelular. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal de 90 pacientes con carcinoma basocelular, a quienes se le administró HeberFERON® en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2017 hasta diciembre de 2019. Se analizaron variables demográficas, clínicas y de respuesta al tratamiento. Resultados: La edad promedio fue de 63 años; hubo una mayor incidencia del sexo masculino (58 para 64,4 %) y el fototipo cutáneo II (56 para 62,0 %), con lesiones localizadas en la nariz (42 para 46,7 %), así como un predominio del subtipo clínico nodular (41 para 45,6 %). Se logró el control de la enfermedad en 100,0 % de la casuística. Conclusiones: El HeberFERON® resultó de gran utilidad en los pacientes con carcinoma basocelular, puesto que en más de la mitad de ellos se obtuvo una respuesta completa, con un mínimo de eventos adversos, todos leves y moderados.

Introduction: The basal cell carcinoma is the most frequent epithelial neoplasm, because it constitutes 60-80 % of all the cutaneous cancers. Objective: To determine the answer to HeberFERON® in patients with basal cell carcinoma. Methods: An observational, descriptive and longitudinal study of 90 patients with basal cell carcinoma to whom HeberFERON® was administered was carried out at Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from January, 2017 to December, 2019. Some demographic, clinical variables that responded to the treatment were analyzed. Results: The average age was 63 years; there was a higher incidence of the male sex (58 for 64.4 %) and the cutaneous fototype II (56 for 62.0 %), with lesions located in the nose (42 for 46.7 %), as well as a prevalence of the nodular clinical subtype (41 for 45.6 %). The control of the disease was achieved in 100.0 % of the case material. Conclusions: The HeberFERON® was very useful in patients with basal cell carcinoma, since in more than a half of them a complete response was obtained, with a minimum of adverse events, all of them light and moderate.

HeberFERON en el carcinoma basocelular periocular. Serie de casos / HeberFERON in periocular basal cell carcinoma. Case series

RESUMEN Fundamento: El carcinoma basocelular periocular es una lesión tumoral que surge de las células basales de la epidermis y los folículos pilosos, con un alto potencial de destrucción local, pueden ser desfigurantes e invaden el tejido que los rodea dando lugar a deformidades o pérdida de la función del órgano afectado. En orden de aparición es más común en el párpado inferior, el canto medial, el párpado superior y el canto temporal. Objetivo: Describir los resultados de la aplicación del HeberFERON en una serie de casos con carcinoma basocelular periocular que acudieron a consulta de dermatología del Policlínico Centro, de enero de 2017 a diciembre del 2020. Metodología: Se realizó un estudio de serie de casos clínicos con carcinoma basocelular periocular que acudieron a la consulta de dermatología del Policlínico Centro. Se incluyeron 17 casos con diagnóstico clínico, dermatoscópico e histopatológico. Se realizó una evaluación inicial, durante y 16 semanas después del tratamiento; se administró 10.5 UI de HeberFERON 3 veces por semana perilesional e intradérmica hasta completar 9 dosis. Las variables principales fueron la respuesta al tratamiento y la presencia o no de eventos adversos. Resultados: Predominó el sexo masculino, el fototipocutáneo II, la localización en párpado inferior, el subtipo clínico nódulo ulcerativo y el histológico sólido, se logró respuesta completa en la mayoría de los pacientes. Como eventos adversos se presentaron dolor en el sitio de inyección, fiebre, mal estar general, edema y eritema perilesional. Conclusiones: La respuesta al tratamiento fue favorable en la mayoría de los pacientes tratados con HeberFERON.

ABSTRACT Background: Periocular basal cell carcinoma is a tumor lesion arising from the epidermis and hair follicles basal cells, with a high potential local destruction, can be disfiguring and invade the surrounding tissue leading to deformities or loss of function of the affected organ. In order of appearance it is most common in the lower eyelid, medial edge, upper eyelid and temporal edge. Objective: To describe the results of the application of HeberFERON in a case series with periocular basal cell carcinoma who attended dermatology appointment at the Policlínico Centro, from January 2017 to December 2020. Methodology: A series study of clinical cases with periocular basal cell carcinoma who attended the dermatology appointment at the Policlínico Centro was conducted. 17 cases with clinical, dermatoscopic and histopathological diagnosis were included. A baseline evaluation was conducted, during and 16 weeks after treatment; 10.5 IU of HeberFERON was administered 3 times a week perilesional and intradermally until completing 9 doses. The main variables were the treatment response and the presence or absence of adverse events. Results: Male sex, phototypocutaneous II, lower eyelid location, clinical subtype ulcerative nodule and solid histological subtype predominated, complete response was achieved in most patients. Adverse events were pain at the injection site, fever, general malaise, edema and perilesional erythema. Conclusions: Treatment response was favorable in most patients treated with HeberFERON.

Respuesta clínica del tratamiento con HerberFERON( en pacientes con carcinoma basal palpebral / Clinical response to treatment with HerberFERON® in patients with basal palpebral carcinoma

Objetivo: Determinar la respuesta clínica en pacientes con carcinoma basal palpebral tratados con HeberFERON. Métodos: Se realizó un estudio descriptivo en pacientes con carcinoma basal palpebral, a quienes se les aplicó HeberFERON( perilesional en el Instituto Cubano de Oftalmología "Ramón Pando Ferer", de enero del año 2013 a enero de 2015. La muestra quedó constituida por 10 pacientes que cumplieron con los criterios de inclusión. Las variables del estudio fueron: edad, sexo, color de la piel, forma clínica, diámetro tumoral, subtipo histológico del tumor, así como la respuesta clínica después del tratamiento de los casos estudiados. Para todas las variables del estudio fueron calculadas las frecuencias absolutas y relativas. Resultados: Predominaron el género masculino y los sujetos de piel blanca. En los pacientes estudiados se presentaron la forma clínica nódulo ulcerativo, el subtipo histológico tumoral poco diferenciado y la respuesta clínica objetiva. Conclusiones: En la mayoría de los pacientes se logró una buena respuesta clínica al tratamiento con HeberFERON(, por lo que este tratamiento se convierte una nueva alternativa no quirúrgica(AU)

Objective: To determine the clinical response in patients with basal palpebral carcinoma treated with HeberFERON(. Methods: A descriptive study was carried out in patients with eyelid cell basal carcinoma tried with HeberFERON in the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" from January 2013 to January 2015. The sample consisted of 10 patients who fulfilled the inclusion criteria. The study variables were: age, sex, skin color, clinical form, tumor diameter, histological subtype of the tumor, as well as the clinical response after treatment of the cases studied. In all the variables, absolute and relative frequencies were calculated. Results: Male gender and white-skinned subjects predominated. The clinical form ulcerative nodule, poorly differentiated histological tumor subtype, and objective clinical response were present in the patients studied. Conclusions: In most of the patients a good clinical answer was achieved to the treatment with HeberFERON, which becomes a new non surgical alternative(AU)

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients.

BACKGROUND: The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined. OBJECTIVE: To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS). MATERIALS AND METHODS: A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described. RESULTS: The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS. CONCLUSIONS: This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.

Carcinoma basocelular. Un reto actual para el dermatólogo / Basal cell carcinoma. An actual challenge for the dermatologist

RESUMEN El carcinoma basocelular es un tumor maligno de origen epitelial, su crecimiento es lento y rara vez metastiza. Este puede producir destrucción local y comprometer extensas áreas de tejido, cartílago y hueso. Existen variantes clínicas e histológicas y constituye el cáncer más frecuente en humanos y su incidencia está en aumento. Se realizó una revisión para exponer los aspectos esenciales sobre factores predisponentes, formas clínicas y diagnóstico, así como las opciones terapéuticas en esta entidad. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed y Google. Fueron revisados veinticinco trabajos científicos sin limitación de año y país, de los cuales quince pertenecen a los últimos 5 años. El carcinoma basocelular se considera de origen multifactorial, el carcinógeno más importante es la luz ultravioleta. La forma clínica más frecuente es la variedad nodular y la distribución es en cara y cuello. La elección del tratamiento dependerá del tamaño de la lesión, la localización, la edad y estado general del paciente. A pesar de tener baja malignidad y mortalidad, puede ocasionar destrucción y deformidad y repercutir en la vida de los pacientes. El dominio de los factores de riesgo, los elementos para el diagnóstico precoz y las opciones terapéuticas son indispensable para elegir la conducta adecuada frente a la enfermedad y promover cambios en el estilo de vida, que favorezcan la prevención y disminuyan la morbilidad por esta causa (AU).

ABSTRACT Basal cell Carcinoma (BCC) is an epidermal malignant tumor, it has a slow growth and seldom metastases. It can produce local destruction and compromise big tissue areas, cartilage and bone. There are clinical and histological presentations. It is one of the most common cancer in humans and its incidence is increasing. This project's goal is to expose the essential aspects about the predisposal factors, clinic presentations and diagnoses as well as this disorder's therapeutic options.This study was made from different bibliographical revisions. The research was developed on Infomed Database and Google. Twenty five Scientific studies were researched without country and/or timeline limit, from whom fifteen belongs to the last 5 years. BCC is considered to have a multifactorial origin, whose most important carcinogen is the ultraviolet light. The most frequent clinical presentation is the nodular and the most common distribution is face and neck. The treatment choice depends on the tumor size, its distribution and the patient's age and current state. Although it is a low malignancy and low-death rate neoplasia, it can cause tissue destruction and affect patient's social life. The management of the risk factors, the elements for the early diagnosis and the therapeutic options are indispensable to choose the adequate behavior for the disorder and promote life style changes that favor the prevention and lower the morbidity rate (AU).

Carcinoma basocelular. Un reto actual para el dermatólogo / Basal cell carcinoma. An actual challenge for the dermatologist

RESUMEN El carcinoma basocelular es un tumor maligno de origen epitelial, su crecimiento es lento y rara vez metastiza. Este puede producir destrucción local y comprometer extensas áreas de tejido, cartílago y hueso. Existen variantes clínicas e histológicas y constituye el cáncer más frecuente en humanos y su incidencia está en aumento. Se realizó una revisión para exponer los aspectos esenciales sobre factores predisponentes, formas clínicas y diagnóstico, así como las opciones terapéuticas en esta entidad. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed y Google. Fueron revisados veinticinco trabajos científicos sin limitación de año y país, de los cuales quince pertenecen a los últimos 5 años. El carcinoma basocelular se considera de origen multifactorial, el carcinógeno más importante es la luz ultravioleta. La forma clínica más frecuente es la variedad nodular y la distribución es en cara y cuello. La elección del tratamiento dependerá del tamaño de la lesión, la localización, la edad y estado general del paciente. A pesar de tener baja malignidad y mortalidad, puede ocasionar destrucción y deformidad y repercutir en la vida de los pacientes. El dominio de los factores de riesgo, los elementos para el diagnóstico precoz y las opciones terapéuticas son indispensable para elegir la conducta adecuada frente a la enfermedad y promover cambios en el estilo de vida, que favorezcan la prevención y disminuyan la morbilidad por esta causa (AU).

ABSTRACT Basal cell Carcinoma (BCC) is an epidermal malignant tumor, it has a slow growth and seldom metastases. It can produce local destruction and compromise big tissue areas, cartilage and bone. There are clinical and histological presentations. It is one of the most common cancer in humans and its incidence is increasing. This project’s goal is to expose the essential aspects about the predisposal factors, clinic presentations and diagnoses as well as this disorder’s therapeutic options.This study was made from different bibliographical revisions. The research was developed on Infomed Database and Google. Twenty five Scientific studies were researched without country and/or timeline limit, from whom fifteen belongs to the last 5 years. BCC is considered to have a multifactorial origin, whose most important carcinogen is the ultraviolet light. The most frequent clinical presentation is the nodular and the most common distribution is face and neck. The treatment choice depends on the tumor size, its distribution and the patient’s age and current state. Although it is a low malignancy and low-death rate neoplasia, it can cause tissue destruction and affect patient’s social life. The management of the risk factors, the elements for the early diagnosis and the therapeutic options are indispensable to choose the adequate behavior for the disorder and promote life style changes that favor the prevention and lower the morbidity rate (AU).

Técnicas quirúrgicas estéticas en pacientes con defectos faciales por carcinoma basocelular / Cosmetic surgical techniques in patients with facial defects due to basal cell carcinoma

Uno de los agentes causales de las alteraciones de las estructuras y partes externas de la cara y el cuero cabelludo es el carcinoma basal o basocelular. Al respecto, los cirujanos maxilofaciales son capaces de reparar y reconstruir aquellas áreas del complejo bucomaxilofacial que se encuentren deformadas o que se han perdido parcial o totalmente; así, en este artículo se describen e ilustran algunas técnicas reparadoras de los defectos quirúrgicos por carcinoma basal, entre ellas: el colgajo bilobulado, el colgajo nasogeniano y una modificación del colgajo de Mustardé, con las cuales se observaron buenos resultados estéticos y funcionales, teniendo en cuenta la localización y extensión de las lesiones.

One of the causative agents of the disorders of structures and external parts of the face and scalp is the basal carcinoma or basal cell carcinoma. In this respect, maxillofacial surgeons are able to repair and reconstruct those areas of the oral maxillofacial complex that are deformed or that have been partially or totally lost; this way, in this work some reparative techniques of the surgical defects due to basal carcinoma are described and illustrated, among them: bilobed flap, nasogenien flap and a modification of the Mustardé flap, with which good cosmetic and functional results were observed, taking into account the localization and extension of the injuries.

Reconstrução nasal total: uso da "técnica em sanduíche" durante a residência / Total nasal reconstruction: use of the "sandwich technique" during residency

Introdução: Um dos locais mais comuns para o surgimento de câncer de pele é o nariz e, devido à sua distinta estruturação em três dimensões, a reconstrução do suporte da ponta nasal apresenta-se como um desafio para os cirurgiões plásticos. Métodos: Este artigo apresenta uma das opções de reconstrução nasal total utilizando como recursos o retalho frontal bilateral e o enxerto de cartilagem auricular bilateral em bloco. Apresentamos um relato do uso da "técnica em sanduíche", constituída por dois retalhos frontais intercalados pelas cartilagens auriculares. Enquanto o primeiro retalho origina o novo teto das fossas nasais, a cartilagem configura o formato tridimensional e garante o suporte da nova estrutura nasal. O segundo retalho fica, então, responsável pela cobertura exterior. Resultados: Neste caso comprovou-se tanto a mínima morbidade da área doadora quanto a excelente perfusão dos retalhos autonomizados, o que se considerou um resultado amplamente satisfatório. Conclusões: Embora a reconstrução nasal total seja um procedimento infrequente na vida do cirurgião plástico, a técnica aqui descrita mostra-se como uma opção atraente para estes casos.

Introduction: One of the most common sites of skin cancer is the nose, and because of its distinct three-dimensional structure, reconstruction of the nasal tip support is challenging for plastic surgeons. Methods: This article presents an alternative option for total nasal reconstruction using the bilateral frontal flap and the block bilateral auricular cartilage graft. We present an account of the use of the "sandwich technique", consisting of two frontal flaps interspersed by auricular cartilage. While the first flap gives rise to the new roof of the nasal fossa, the cartilage configures the threedimensional shape and provides support for the new nasal structure. The second flap is then responsible for the outer coverage. Results: In this case, both the minimal morbidity of the donor area and excellent perfusion of the autonomized flaps were verified, leading to a largely satisfactory result. Conclusions: Although total nasal reconstruction is an infrequent procedure in the career of a plastic surgeon, the technique described here is a viable option for these cases.

Carcinoma basocelular metastásico / Metastatic basal cell carcinoma

El carcinoma basocelular es la neoplasia con mayor incidencia a nivel mundial. Es de crecimiento lento y localmente agresiva pero posee un potencial metastásico extremadamente bajo, que se estima entre 0,0028% y 0,5%. El objetivo de este trabajo es mostrar la experiencia de una institución con el manejo de esta enfermedad metastásica. Estudio descriptivo retrospectivo de los pacientes con carcinoma basocelular metastásico tratados en el Instituto Nacional del Cáncer, entre julio 2004 y julio 2015. Se realizó una revisión de la literatura. Se evidenciaron 3 casos con esta enfermedad poco habitual en un plazo de 11 años. Un paciente falleció a los 42 meses de seguimiento. Hay 2 pacientes aún en control, uno de ellos lleva 29 meses de seguimiento y actualmente tiene enfermedad metastásica pulmonar, y el último paciente lleva 92 meses de seguimiento libre de enfermedad. El carcinoma basocelular metastásico, es una entidad poco frecuente por lo que todos los que nos vemos involucrado en su manejo debemos mantenernos alerta para una pesquisa oportuna. La cirugía asociada a la radioterapia siguen siendo los pilares del tratamiento. Esta patología debiera manejarse en centros de referencia a nivel nacional.

Basal cell carcinoma is the most frequent neoplasm worldwide. It's a slow growing and locally aggressive tumor, but it has a metastatic potential estimated between 0,0028 and 0,5%. The purpose of this study is to show the experience of a center in the management of this metastatic disease. Descriptive retrospective study of patients with metastatic basal cell carcinoma treated at the Instituto nacional del cancer from July2004 to July 2015. A revision of the literature was also made. 3 cases with this unusual disease during an 11 years period. The first one died at 42 months of follow up. There are 2 patients on follow up, 1 of them has lung metastatic disease after 29 months of follow up, and the last one is free of disease with 92 months of follow up. Metastatic basal cell carcinoma is an unusual entity, thus everyone that is involved in it's treatment, must be aware of this in order to do an early diagnosis. Surgery associated to radiotherapy are the mainstays of treatment. This disease should be managed on national referral centers.

Colgajo en filete como tratamiento de carcinoma basocelular recidivado / Fillet flap as treatment of recurrent basal cell carcinoma

El carcinoma basocelular (CBC) es el tumor maligno de piel con el que más frecuentemente se enfrenta el cirujano plástico, y los CBC recidivados se presentan como un reto en cuanto a su resolución. Por su parte, los queloides que resultan de un proceso patológico de cicatrización tienen múltiples alternativas para su tratamiento. Se describe la versatilidad del colgajo en filete como tratamiento de un CBC recidivado retroauricular, a través de la presentación de un caso clínico

Basal cell carcinoma ( BCC) is the malignant skin tumor which most frequently is a challenge to the plastic surgeon, and basically the recurrent BCC shows a challenge in terms of resolution. On the other hand, keloids are a consequence of a disease healing process. However, these have multiple choices for treatment. As the versatility of the fillet flap described as treatment of recurrent basal cell carcinoma BCC, by through the presentation of a case report.

Interferones una opción terapéutica moderna en el tratamiento de los carcinomas basocelulares / Interferons Modern Therapeutic Option in the Treatment of Basal Cell Carcinomas

El carcinoma basocelular es la neoplasia maligna de piel de mayor frecuencia que afecta mayoritariamente a las personas de la raza blanca. Se relaciona etiológicamente el potencial efecto carcinogénico a la explosión acumulativa de los rayos ultravioletas y con el deterioro de la capa de ozono este fenómeno tiende a aumentar en los últimos años, por tanto, la búsquedas de alternativas de tratamiento eficaces y seguros constituye una prioridad para los sistemas de salud como respuesta a este creciente problema de salud. Los interferones son productos biotecnológicos considerados modificadores de la respuesta biológica que por sus propiedades antiproliferativas y antiantigénicas se emplean en la terapéutica moderna del basotelioma. Se realizó una revisión en las principales base de datos, se seleccionaron 46 artículos que actualizan los aspectos, moleculares y estudios clínicos que justifican el empleo de la inmunoterapia y esencialmente los interferones como una estrategia eficaz y segura en el tratamiento de este tipo de neoplasia(AU)

Basocellular carcinoma is a skin malignant neoplasia that primarily affects white race people. Potential carcinogenic effect is etiologically related to the accumulative explosion of ultraviolet rays, with the deterioration of the ozone layer this phenomenon tends to increase in the last few years, thus the search of efficacious and safe alternative treatments constitutes a health system priority. Interferons are biotechnological products known to modify the biological response that, due to its antiproliferative and antiantigenic properties, are employed in modern therapy of basothelioma. A revision was carried out in the main databases, choosing 46 articles that update the molecular aspects and the clinical trials that justify the use of immune therapy, and essentially, the interferons, as a safe and efficacious strategy in the treatment of this type of neoplasia(AU)

Comparative analysis of basaloid and conventional squamous cell carcinomas of the esophagus: prognostic relevance of clinicopathological features and protein expression.

Basaloid squamous cell carcinoma (BSCC), a variant of squamous cell carcinoma (SCC), is a rare and aggressive epithelial malignancy which has been reported in only 0.1-11 % of primary esophageal carcinomas. In this study, a comparison of clinicopathological features and protein expression between esophageal BSCC (EBSCC) and conventional esophageal SCC (ESCC) cases from Brazil was performed in order to find factors that can be relevant to better characterize EBSCC. The expression of HER2, epidermal growth factor receptor (EGFR), Ki-67, and cyclins (A, B1, and D1) in 111 cases (95 ESCC and 16 EBSCC) was evaluated by immunohistochemistry using tissue microarray. When the clinicopathological data were compared, no significant difference was found between the two histological types. Although the difference is not significant (p = 0.055), the EGFR expression was more frequent in the conventional ESCC than in the EBSCC group. Our results indicate that the clinicopathological profiles of conventional ESCC and EBSCC are similar and provide no indicators for differences in prognosis between these two groups.

Cicatrização por segunda intenção no tratamento de carcinoma basocelular nasal / Second intention healing in the treatment of nasal basal cell carcinoma

INTRODUÇÃO: A busca por melhores alternativas para o tratamento do carcinoma basocelular (CBC) nasal é referida por diversos autores há anos. Os enxertos e os retalhos cutâneos apresentam problemas, como o risco de não integração ou de necroses; e ainda determinam a formação de cicatrizes que, muitas vezes, são extensas ou inestéticas. Além disso, eles demandam um tempo operatório maior, sendo realizados em centro cirúrgico. A exérese simples do CBC nasal, seguida da cicatrização por segunda intenção e de cuidados cosmiátricos simples no pós-operatório, ressurge como alternativa válida para o tratamento destes tumores. MÉTODOS: Os autores vêm apresentar sua experiência com a técnica, discutindo as vantagens do método. No período de 4 anos, todos os pacientes submetidos à técnica foram acompanhados prospectivamente. RESULTADOS: Dos 23 pacientes operados, 12 foram acompanhados por 2 anos e incluídos na avaliação. O procedimento cirúrgico teve duração média de 21 minutos (+6) e foi realizado sem dificuldades. A evolução pós-operatória se deu sem intercorrências ou recidivas tumorais. CONCLUSÃO: A técnica empregada coloca-se como uma alternativa simples, segura e com excelentes resultados para o tratamento dos CBC nasais.

INTRODUCTION: The search for better alternatives for the treatment of nasal basal cell carcinoma (BCC) has been reported by several authors. The complications associated with grafts and skin flaps include the risk of non-integration or necrosis, and the formation of scars that are often large or unaesthetic. In addition, these procedures require longer operative times, which implies the need for a surgical center. The simple removal of nasal BCC, followed by second intention healing and simple postoperative cosmetic care, has reemerged as a valid alternative for the treatment of these tumors. METHODS: In this study, the authors describe their experience with the technique, and report the advantages of the method. All patients submitted to this procedure were followed-up prospectively for a period of 4 years. RESULTS: Of 23 patients, 12 were monitored for 2 years and were included in the study. The surgical procedure was performed without difficulty in an average of 21 minutes (+6). Postoperative evolution was uncomplicated and without tumor recurrence. CONCLUSION: This technique is a simple and safe alternative, providing excellent results for the treatment of nasal BCC.

Tratamento cirúrgico do câncer de pele pelo cirurgião plástico / Surgical treatment of skin cancer by the plastic surgeon

Introdução: O câncer de pele é a neoplasia mais frequente no Brasil e corresponde a 25% de todos os tumores malignos. O melhor tratamento é a ressecção cirúrgica em fases iniciais. O cirurgião plástico, juntamente com uma equipe multiprofissional, participa no tratamento desta doença. O objetivo é analisar a eficácia dos procedimentos cirúrgicos realizados pelo cirurgião plástico no tratamento do câncer de pele. Método: Foram analisados 404 prontuários de pacientes operados no período de fevereiro de 2009 a dezembro de 2012 e analisados gênero, idade, diagnóstico, localização e evolução. Resultados: Faixa etária com média de 62 anos. 53% de casos de carcinoma basocelular, 25,5% melanoma e 15,1% carcinoma espinocelular. Houve predomínio de mulheres nos carcinomas basocelulares (56%) e no melanoma (54%) e de homens nos carcinomas espinocelulares (61%). Os carcinomas basocelulares (92,99%) e espinocelulares (72,13%) tiveram sua predominância na região de cabeça e pescoço; enquanto o melanoma predominou em região de tronco (36,89%) e membros inferiores (24,27%). Foram realizadas 67 cirurgias com pesquisa de linfonodo sentinela, com positividade em 14,93%. 7,76% dos pacientes de melanoma apresentaram metástases e 2,91% vieram a óbito. Conclusão: O cirurgião plástico é um dos profissionais importantes para o tratamento do câncer de pele, sendo o mais apto para realizar as reconstruções após as ressecções tumorais, pois tem em sua formação os conceitos de reparação, utilizando-se de enxertos e retalhos e considerando o aspecto estético dos pacientes. Cabe-lhe também a realização da cirurgia de pesquisa de linfonodo sentinela e o seguimento dos pacientes com câncer de pele.

Introduction: Skin cancer is the most common neoplasm in Brazil and it corresponds to 25% of all diagnosed malignant tumors. The best treatment is surgical resection in early stages. The disease is treated by a plastic surgeon along with a multidisciplinary team. The objective is to assess the effectiveness of surgical procedures performed by plastic surgeons to treat skin cancer. Methods: We analyzed medical records of 404 patients operated on between February 2009 and December 2012. Data analyzed included gender, age, diagnosis, localization and evolution. Results: Patients' mean age was 62 years. A total of 53% of patients had basal cell carcinoma, 25.5% melanoma and 15.1% squamous cell carcinoma. There was a predominance of women in basal cell carcinomas (56%) and melanoma (54%) and predominance of men in squamous cell carcinomas (61%). Basal cell carcinomas (92.99%) and squamous (72.13%) were predominant in the head and neck, melanoma predominated in the trunk region (36.89%) and in lower limbs (24.27%). We performed 67 surgeries with sentinel lymph node, with positivity in 14.93%. Patients with melanoma who had metastasis accounted for 7.76% and 2.91% patients died. Conclusion: Plastic surgeons are one of the important professionals for skin cancer treatment. These professionals are the most skilled one to perform reconstructions after tumor resections, because during education they learn repair concepts using grafts and flaps especially focused on aesthetic appearance of patients. They can also perform surgery for sentinel lymph node and offer follow-up to patients with skin cancer.

Análise retrospectiva de conduta para carcinoma basocelular e espinocelular em cabeça e pescoço / Retrospective analysis of treatment approaches used for basal and squamous cell carcinoma in the head and neck

Introdução: O câncer de pele em cabeça e pescoço tem incidência crescente no mundo, sendo o carcinoma basocelular e espinocelular os tipos mais frequentes. Não existe consenso absoluto para todas as situações tumorais conforme tipo histológico, tamanho, profundidade e localização da lesão. O objetivo é analisar a conduta abordada nessas neoplasias de pele em cabeça e pescoço, com ênfase nos tratamentos efetuados, recidivas e seguimento. Método: Foram analisados 69 pacientes com carcinoma basocelular ou de células escamosas tratados por cirurgia com congelação da lesão no intraoperatório, crioterapia ou Imiquimod 5% por 6 semanas. Com 36 meses de seguimento, observou-se a eficácia do tratamento escolhido, recidiva, intercorrências, complicações e satisfação estética do paciente. A análise estatística utilizou o teste exato de Fischer. Resultados: O tipo de reconstrução mais frequente foi o fechamento primário (71%). Não existem associações estatisticamente relevantes relacionando idade, sexo, classificação de Fitzpatrick, local/ tamanho da lesão, métodos de tratamento e recidiva. As principais complicações resultaram das cirurgias: um caso de necrose de retalho frontal, lesão parcial de nervo bucinador, estenose narinária. A recidiva tumoral nos casos operados foi de 4%. A crioterapia e uso do Imiquimod 5% causaram seis casos de reações locais leves com mais recidiva descritiva no tratamento de carcinoma basocelular (CBC) superficial (não estatisticamente relevante). Conclusões: Os CBC não superficiais e carcinoma espinocelular devem ser tratados cirurgicamente. Os CBC superficiais podem ser tratados com crioterapia e uso do Imiquimod 5% com menos complicações e melhor resultado estético, mas a recidiva tumoral é maior.

Introduction: The incidence of skin cancer on the head and neck is increasing worldwide, and basal and squamous cell carcinomas represent the most frequent types. There is no unanimous consensus for all tumor cases, based on the histological type, size, depth, and location of the lesion. The objective is to analyzed the approach used in skin neoplasias in the head and neck, focusing on the treatments performed, recurrence, and follow-up. Methods: Sixty-nine patients with basal or squamous cell carcinoma who were treated with surgery, cryotherapy, freezing of lesions in the intraoperative period, or 5% imiquimod were analyzed for 6 weeks. During 36 months of follow-up, the efficacy of the chosen treatment, recurrence, side effects, complications, and esthetic satisfaction of patients were observed. Statistical analysis was performed using the Fisher's exact test. Results: The most frequent type of reconstruction was primary closure (71%). There were no statistically significant correlations between age, sex, Fitzpatrick classification, location/size of lesion, method of treatment, or recurrence. The main complications resulting from surgery were: a case of a frontal flap necrosis, a partial lesion of the buccinator nerve, and nasal stenosis. There was a 4% tumor recurrence in patients treated with surgery. The cryotherapy and 5% imiquimod treatments resulted in six cases of mild local reactions with a more pronounced recurrence in a patient with superficial basal cell carcinoma (BCC) (not statistically significant). Conclusions: Non-superficial BCC and squamous cell carcinomas should be treated with surgery. Superficial BCCs may be treated with cryotherapy and 5% imiquimod with fewer complications and better aesthetic results, but this results in higher tumor recurrence.

[Bazex-Dupré-Christol syndrome: Case series]. / Síndrome Bazex-Dupré-Christol: serie de casos.

Bazex-Dupré-Christol syndrome is an X-linked dominantly inherited disorder characterized by congenital hypotrichosis, hypohidrosis, follicular atrophoderma, multiple milia and basal cell carcinomas. We present a girl and her family with this syndrome. Our patient, her 5 month old brother and her 17 year old brother had multiple milia and scalp and eyebrows hypotrichosis. Her 8 year old brother had multiple milia and follicular atrophoderma. Her mother had hypohidrosis and congenital scalp and eyebrows hypotrichosis, as well as a right paranasal lesion suggestive of basal cell carcinoma. We emphasize the importance of precise diagnosis and clinical follow up of these patients due to the possibility of developing basal cell carcinomas.

Management of high-risk and advanced basal cell carcinoma.

Despite that basal cell carcinoma (BCC) is curative in the vast majority of cases, some patients are at high risk of recurrence and, in a few patients, lesions can progress to a point unsuitable for local therapy and prognosis is quite poor. The aim of the present work is to review clinical and pathologic characteristics as well as classical and new treatment options for high-risk, metastatic and locally advanced BCC. Surgery and radiotherapy remain the selected treatments for the majority of high-risk lesions. However, some patients are located on a blurry clinical boundary between high-risk and locally advanced BCC. Treatment of these patients is challenging and need an individualized and highly specialized approach. The treatment of locally advanced BCC, in which surgery or radiotherapy is unfeasible, inappropriate or contraindicated, and metastatic BCC has changed with new Hedgehog pathway inhibitors of which vismodegib is the first drug approved by FDA and EMA.