Dermoscopic Aspects of Traumatized Nevi After Dermabrasion.

BACKGROUND: Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma. OBJECTIVE: The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion. METHODS: Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion. RESULTS: The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures. CONCLUSION: Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.

Skin pigmentation polymorphisms associated with increased risk of melanoma in a case-control sample from southern Brazil.

BACKGROUND: Melanoma is the most aggressive type of skin cancer and is associated with environmental and genetic risk factors. It originates in melanocytes, the pigment-producing cells. Single nucleotide polymorphisms (SNPs) in pigmentation genes have been described in melanoma risk modulation, but knowledge in the field is still limited. METHODS: In a case-control approach (107 cases and 119 controls), we investigated the effect of four pigmentation gene SNPs (TYR rs1126809, HERC2 rs1129038, SLC24A5 rs1426654, and SLC45A2 rs16891982) on melanoma risk in individuals from southern Brazil using a multivariate logistic regression model and multifactor dimensionality reduction (MDR) analysis. RESULTS: Two SNPs were associated with an increased risk of melanoma in a dominant model: rs1129038AA and rs1426654AA [OR = 2.094 (95% CI: 1.106-3.966), P = 2.3 10- 2 and OR = 7.126 (95% CI: 1.873-27.110), P = 4.0 10- 3, respectively]. SNP rs16891982CC was associated with a lower risk to melanoma development in a log-additive model when the allele C was inherited [OR = 0.081 (95% CI: 0.008-0.782), P = 3 10- 2]. In addition, MDR analysis showed that the combination of the rs1426654AA and rs16891982GG genotypes was associated with a higher risk for melanoma (P = 3 10- 3), with a redundant effect. CONCLUSIONS: These results contribute to the current knowledge and indicate that epistatic interaction of these SNPs, with an additive or correlational effect, may be involved in modulating the risk of melanoma in individuals from a geographic region with a high incidence of the disease.

Polymorphisms in CYP19A1 and NFKB1 genes are associated with cutaneous melanoma risk in southern Brazilian patients.

BACKGROUND: Melanoma is the leading cause of death from skin cancers and its etiology is complex. Recent discoveries related to genetic risk factors are helping us to understand melanoma pathogenesis better. Nuclear factor-κB (NF-κB) has a critical role in immunity, inflammation, and tumor growth. The 94ins/del ATTG (rs28362491) polymorphism located in the NFKB1 gene has been associated to various cancers and the ATTG2/ATTG2 genotype was correlated to melanoma risk in Sweden. The CYP19A1 gene encodes the enzyme aromatase, which is active in malignant melanoma tissue. In addition, the CYP19A1 TCT insertion/deletion variant in intron 4 (rs11575899) has been associated with an increased incidence of cancer, albeit with conflicting results. The goal of this study was to investigate possible associations between these two gene variants and melanoma. METHODS: In this case-control study, we evaluated 117 cutaneous melanoma patients and 116 controls from southern Brazil. Genotyping of rs28362491 and rs11575899 was carried out by means of PCR amplification and capillary electrophoresis. Logistic regression was used to obtain odds ratios (ORs) of melanoma, according to genotypes. RESULTS: We identified an association between the ATTG2/ATTG2 and melanoma [OR=1.78; 95% confidence interval (CI): 1.06-3.00; P=0.03]. In addition, there was a dose effect: for each ins allele in the genotype, the risk for melanoma increased (OR=1.51; 95% CI: 1.08-2.11; P=0.017). As regards the CYP19A1 variant, genotype 11 (del/del) was more frequent in patients than in controls (OR=1.85; 95% CI 1.06-3.22; P=0.03). CONCLUSION: The NFKB1 ATTG2/ATTG2 and CYP19A1 del/del genotypes are significantly associated with melanoma and could be genetic markers of melanoma susceptibility in southern Brazilian population.

Occupational Exposure to Pesticides With Occupational Sun Exposure Increases the Risk for Cutaneous Melanoma.

OBJECTIVE: The objective of the study was to examine the association between occupational exposure to pesticides and cutaneous melanoma, controlling for all possible confounders. METHODS: A pooled analysis of two case-control studies was conducted in two different geographic areas (Italy and Brazil). Detailed pesticides exposure histories were obtained. RESULTS: Ever use of any pesticide was associated with a high risk of cutaneous melanoma (odds ratio 2.58; 95% confidence interval 1.18-5.65) in particular exposure to herbicides (glyphosate) and fungicides (mancozeb, maneb), after controlling for confounding factors. When subjects were exposed to both pesticides and occupational sun exposure, the risk increased even more (odds ratio 4.68; 95% confidence interval 1.29-17.0). CONCLUSIONS: The study suggests an augmented risk of cutaneous melanoma among subjects with exposure to pesticides, in particular among those exposed to occupational sun exposure.

Prevalence of dermatoses in dermatologic evaluation requests from patients admitted to a tertiary hospital for 10 years.

Skin diseases are common in hospitalized patients. However, there is a lack of data concerning their frequency. The objective of this study is to evaluate the prevalence of dermatological diagnoses in hospitalized patients after consultation requested by non-dermatologist physicians to the Department of Dermatology, Hospital de Clinicas de Porto Alegre period of 10 years. A total of 5685 patients were evaluated, representing an average of 48.2 patients per month. The five most frequent groups were infectious dermatoses(33.25%), eczematous dermatoses (11.49%), drug reactions (11.43%), vascular dermatoses (6.81%) and group of pruritus, prurigo nodularis and urticaria (hives) (4.71%).

Residential and occupational exposure to pesticides may increase risk for cutaneous melanoma: a case-control study conducted in the south of Brazil.

BACKGROUND: Incidences of primary cutaneous melanoma (CM) have risen over the last few decades, mainly among populations of White European extraction. Some risk factors for melanoma have been clearly established, but other potential risk factors, such as exposure to pesticides, are currently under study. METHODS: A case-control study on melanoma was conducted during 2012 and 2013 at three dermatological reference centers in Porto Alegre, Brazil. A total of 191 CM patients and sex- and age-matched control subjects were enrolled in the study. Data on domestic and occupational use of pesticides and the risk factors already established for CM were collected. Multivariate logistic regression was used to study the association between exposure to pesticides and melanoma risk. RESULTS: Subjects exposed to pesticides had twice the level of risk for melanoma (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.03-6.89). When pesticides were used indoors for >10 years, the risk for CM increased further (OR 2.84, 95% CI 1.56-5.33). A high frequency of indoor use of pesticides (four or more times per year) was associated with a 44% increase in the risk for melanoma (OR 1.44, 95% CI 1.11-3.49). The domestic use of pesticides outdoors was not associated with increased risk. Subjects exposed to pesticides at an occupational level were at four times greater risk than subjects who were not occupationally exposed (OR 4.23, 95% CI 1.94-6.31). CONCLUSIONS: These findings indicate that the general use of pesticides, particularly indoor domestic use, frequently and over a long period, may be an independent environmental risk factor for CM.

Correlation between Breslow thickness and Technetium-99m-sestamibi uptake in cutaneous melanoma.

BACKGROUND: Technetium-99m-sestamibi (MIBI) is a radiopharmaceutical that has well-known tumor-seeking properties. We evaluated the correlation between Breslow thickness and MIBI uptake by cutaneous melanoma (CM). MATERIAL AND METHODS: Patients with suspicious melanocytic lesions received intravenous injections of 740-1,110 Mbq of MIBI. Using a gamma probe, the number of radioactive counts in the skin was considered to determinate the MIBI uptake intensity. SPECT imaging of the lesion site and respective lymph node region was obtained. RESULTS: There was a strong positive correlation between MIBI uptake intensity and Breslow thickness (rs = 0.74, P = 0.003). There was a statistically significant difference (P <0.001) between lesions with Breslow thickness <1 mm (MIBI uptake intensity = 1.23 ± 0.28 radioactive counts) and Breslow thickness >1 mm (MIBI uptake intensity = 2.32 ± 0.32 radioactive counts). DISCUSSION: The possibility of correlating MIBI uptake intensity with Breslow categories may facilitate surgical procedures, reducing morbidity and costs.

A melanoma risk score in a Brazilian population.

BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.

A melanoma risk score in a Brazilian population / Um escore de risco para melanoma em uma população brasileira

BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM. .

FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenvolver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano) e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79). Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo. .

Tratamento de onicomicose dos háluces por dermatófito com laser Nd: YAG 1064nm / Treatment of dermatophyte onychomycosis of the haluces with 1064 Nd: YAG laser

A onicomicose é uma doença muito prevalente em nosso meio, cujos tratamentos atuais apresentam baixas taxas de cura, potenciais efeitos adversos e interações medicamentosas que limitam seu uso. Estudos recentes apresentam a laserterapia como uma nova opção terapêutica segura e eficaz. Foi realizado este tratamento em 12 pacientes, num total de 20 unhas acometidas, com 3 sessões de aplicação do laser Nd:YAG 1064nm pulso longo, com intervalo de duas semanas entre elas. Os resultados corroboram os dados atuais de boa resposta clínica e segurança deste novo método.

Onychomycosis is a very common condition in Brazil and one whose current treatments yield low cure rates, potential adverse effects, and drug interactions that limit their use. Recent studies have demonstrated laser therapy as a new, safe, and effective treatment option. This treatment was performed in 12 patients (with a total of 20 affected nails), with 3 application sessions of 1,064nm long pulse Nd:YAG laser, in two-week intervals. The results corroborate the current data of good clinical response and safety.

The CDKN2A p.A148T variant is associated with cutaneous melanoma in Southern Brazil.

Several germline mutations and sequence variants in cancer predisposition genes have been described. Among these, the CDKN2A p.A148T variant appears to be frequent in patients with melanoma, at least in certain ethnic groups. In this case-control study, we evaluated 127 patients with cutaneous melanoma and 128 controls from Southern Brazil, the region with the highest melanoma incidence rates in the country. Using PCR-RFLP, we demonstrate that CDKN2A p.A148T variant was significantly more frequent in patients with melanoma than in controls (12.6% vs 3.9%; P=0.009). There was no association between presence of the polymorphism and tumor thickness, site of the primary tumor, melanoma subtype, age at diagnosis, quantitative and qualitative number of nevi. Patients with a positive family of history for other cancers were particularly prone to carry the CDKN2A p.A148T allele. All patients with p.A148T-positive melanoma reported European ancestry, especially German, and this was confirmed using a panel of ancestry-informative INDELs. Our data suggest that CDKN2A p.A148T is a melanoma susceptibility allele in Southern Brazil and is particularly common in patients with melanoma of predominantly European ancestry.

Predictors of quality of life in patients with skin melanoma at the dermatology department of the Porto Alegre Teaching Hospital.

BACKGROUNDS: Some symptoms present in melanoma patients are directly related to psychological stress, which emphasizes the need to evaluate quality of life (QoL) in these patients at all the stages of their disease. OBJECTIVES: The objective of this study was to evaluate quality of life in a sample of patients diagnosed with melanoma, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. METHODS: A descriptive, cross sectional study was conducted between July and December, 2006 with all patients with skin melanoma receiving follow-up care at the Department of Dermatology of the Porto Alegre Teaching Hospital, Federal University of Rio Grande do Sul. RESULTS: Sixty patients were included in the study. Mean age was 55.6 years. Poor education level (primary school or less) was associated with a poorer FACT-G score. Patients with a family history of the disease had higher QoL scores in 3 of the 4 categories evaluated: physical, emotional and functional wellbeing (p<0.01). QoL scores were higher in married patients (82.42) compared to single patients (70.28) (p<0.01). Patients with metastases had lower scores in the functional wellbeing category and this difference was statistically significant. CONCLUSIONS: Factors related to the tumor, as well as gender, age and employment status, were not found to be predictive of quality of life in this sample. Quality of life scores were lower in the functional wellbeing domain in patients with metastases. Married patients are able to count on greater comfort and emotional support to help them deal with the diagnosis of melanoma. Patients with a family history of melanoma had significantly higher quality of life scores, while those with poor education levels had lower scores.

Preditores de qualidade de vida em pacientes com melanoma cutâneo no serviço de dermatologia do Hospital de Clínicas de Porto Alegre / Predictors of quality of life in patients with skin melanoma at the dermatology department of the Porto Alegre Teaching Hospital

FUNDAMENTOS: Alguns sintomas presentes nos pacientes com melanoma estão diretamente relacionados à tensão psicológ ica, o que reforça a necessidade de avaliar a qualidade de vida em todas as fases da doença. OBJETIVOS: Avaliar a qualidade de vida dos pacientes diagnosticados com melanoma por meio do questionário Fact-G. MÉTODOS: Estudo descritivo transversal que incluiu todos os pacientes em seguimento no serviço de dermatologia do Hospital de Clínicas de Porto Alegre entre julho e dezembro de 2006. RESULTADOS: Sessenta pacientes foram incluídos. A idade média foi de 55,6 anos. O nível de escolaridade até primeiro grau foi correlacionado a escores mais baixos no Fact-G. Os pacientes com história familiar apresentaram maiores escores de QoL em três das quatro categorias avaliadas: bem-estar físico, emocional e funcional (P < 0,01). Pacientes casados mostraram melhor qualidade de vida (82,42) que os solteiros (70,28; P < 0,01). Os pacientes com metástase obtiveram uma menor pontuação no questionário no domínio bem-estar funcional. CONCLUSÕES: Os fatores relacionados ao tumor, assim como o sexo, a idade e a situação de emprego, não foram preditores de qualidade de vida. Pacientes com metástases apresentaram pior qualidade de vida no domínio bem-estar funcional. Pacientes casados têm mais conforto e apoio emocional para lidar com o diagnóstico do tumor. Os pacientes com história familiar de melanoma tiveram melhor qualidade de vida e os com baixa escolaridade, uma pior qualidade de vida.

BACKGROUNDS: Some symptoms present in melanoma patients are directly related to psychological stress, which emphasizes the need to evaluate quality of life (QoL) in these patients at all the stages of their disease. OBJECTIVES: The objective of this study was to evaluate quality of life in a sample of patients diagnosed with melanoma, using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. METHODS: A descriptive, cross sectional study was conducted between July and December, 2006 with all patients with skin melanoma receiving follow-up care at the Department of Dermatology of the Porto Alegre Teaching Hospital, Federal University of Rio Grande do Sul. RESULTS: Sixty patients were included in the study. Mean age was 55.6 years. Poor education level (primary school or less) was associated with a poorer FACT-G score. Patients with a family history of the disease had higher QoL scores in 3 of the 4 categories evaluated: physical, emotional and functional wellbeing (p<0.01). QoL scores were higher in married patients (82.42) compared to single patients (70.28) (p<0.01). Patients with metastases had lower scores in the functional wellbeing category and this difference was statistically significant. CONCLUSIONS: Factors related to the tumor, as well as gender, age and employment status, were not found to be predictive of quality of life in this sample. Quality of life scores were lower in the functional wellbeing domain in patients with metastases. Married patients are able to count on greater comfort and emotional support to help them deal with the diagnosis of melanoma. Patients with a family history of melanoma had significantly higher quality of life scores, while those with poor education levels had lower scores.

Dermabrasion in acquired melanocytic nevi: a histopathological and immunohistochemical study.

INTRODUCTION: When subjected to trauma, acquired melanocytic nevi may present atypical histological features similar to alterations that occur after exposure to ultraviolet radiation. These persist for up to 3 weeks. To date, no study has evaluated the alterations that occur after dermabrasion in acquired melanocytic nevi. OBJECTIVE: To evaluate the histopathological and immunohistochemical alterations those occur in acquired melanocytic nevi, 4 weeks after dermabrasion. MATERIALS AND METHODS: This study evaluated 50 acquired melanocytic nevi, in which half of each lesion was submitted to dermabrasion, leaving the other half intact, and compared the histopathological and immunohistochemical findings from the 2 sides 4 weeks after the procedure. RESULTS: Five acquired melanocytic nevi were from male and 45 from female patients. The age of the patients varied from 15 to 69 years. On the dermabraded side, there was a greater frequency of atypical melanocytes (P = 0.015), increase in relation to nucleus/cytoplasm of the melanocytes (P = 0.034); inflammatory infiltrate (P = 0.007); and neovascularization (P = 0.004). In the immunohistochemical evaluation, there was a significantly higher percentage of immunoreactive melanocytes on this side for the HMB-45 only in the junctional component (P = 0.001) and for Ki-67, at a low rate, in the dermis (P = 0.03). CONCLUSIONS: Four weeks after the dermabrasion, atypical features, such as melanocytic atypia and pagetoid spread remained. Although these alterations may simulate melanoma in situ, the association with features of histopathological tissue repair (inflammatory infiltrate and neovascularization), together with immunohistochemical findings that are uncharacteristic of malignancy, favors a diagnosis of a benign lesion. These atypical alterations persist longer than those found after ultraviolet radiation.

Identifying individuals at high risk of melanoma: a simple tool.

Simple and reliable tools for identifying patients at high risk for melanoma with preventive measures have important public health implications. An individual risk score for cutaneous melanoma was constructed and externally validated. With the summary coefficients of the risk factors for cutaneous melanoma, derived from a meta-analysis, a melanoma risk score was tested in an Italian population and externally validated in a Brazilian population. Common nevi, skin and hair color, freckles, and sunburns in childhood were the variables included in the final predictive model. The discriminatory ability of the models was assessed by the receiver operating characteristic (ROC) curve. The performance of the model was also evaluated by conducting an external validation. The area under the curve (AUC) of the candidate model was 0.79 (95% confidence interval: 0.75-0.82). The same model, when applied in the Brazilian population, presented an AUC of 0.79 (95% confidence interval: 0.70-0.86). At the cut-off level of 3 and more, 89 and 80% of the melanoma cases were correctly classified as 'at risk for melanoma' in the Italian and in the Brazilian populations, respectively. The risk model is a simple tool that identifies patients for preventive measures and may be used with reasonable confidence in different populations. The risk model may help family doctors in referring patients to dermatological clinics and thus improve early diagnosis.

Is season important for the diagnosis of cutaneous melanoma in southern Brazil? A 10-year hospital-based study.

BACKGROUND: Exposure to sunlight is an important etiologic factor in cutaneous melanoma (CM). In several countries, more cases of CM are diagnosed in summer than in winter. AIM: To analyze whether there is seasonal variation in the diagnosis of CM in southern Brazil. METHODS: Data were collected from a hospital-based registry, including all cases of CM diagnosed between 1996 and 2005. Summer to winter and spring to fall ratios were used for the analysis, and a 95% confidence interval (CI) was calculated using Poisson regression. RESULTS: Two hundred and eighty-one patients were diagnosed in this period. Although some months were shown to have higher absolute numbers of diagnosed melanomas (April, July, and January), there was no statistically significant seasonal variation in most of the melanomas in terms of either the summer to winter ratio [odds ratio (OR) = 1.09; 95% CI, 0.77-1.44] or spring to autumn ratio (OR = 1.01; 95% CI, 0.71-1.43). Only the number of lentigo maligna melanomas (LMMs) diagnosed in summer was higher than that in winter (OR = 2.83; 95% CI, 1.07-8.78). CONCLUSIONS: In southern Brazil, CMs do not seem to be more frequently diagnosed in summer than in winter. Darkening of melanocytic lesions and increased awareness of skin lesions during the summer could be possible explanations for LMMs being more frequently diagnosed in summer than in winter in this sample.

A proteína p16 e o melanoma cutâneo / P16 protein and cutaneous malignant melanoma

Nas últimas décadas, é intensa a procura de uma explicação genética sobre a origem, o crescimento e a progressão do melanoma cutâneo. A tentativa de encontrar uma ligação direta entre as mutações gênicas e a origem da doença tem sido o objetivo dos pesquisadores dedicados ao estudo dessa neoplasia. Diversos métodos são utilizados na busca de uma avaliação prognóstica para a progressão do melanoma, citando-se, entre eles, a pesquisa do linfonodo sentinela, a imuno-histoquímica, as técnicas moleculares e a técnica de microarray. A necessidade de estabelecer um método, com excelente sensibilidade e especificidade, tem levado os pesquisadores a buscarem melhores evidências. É importante para esses estudos a obtenção de dados confiáveis sobre as técnicas, progressão e sobrevida livre de doença. Por meio da imuno-histoquímica, técnica relativamente simples e de baixo custo, a expressão da proteína p16 pode ser analisada e correlacionada com o prognóstico da doença. No melanoma cutâneo, a expressão da proteína diminui, à medida que aumenta sua agressividade, ou seja, é forte nos nevos e melanomas in situ e fraca ou ausente nos melanomas metastáticos. Em alguns estudos, a comparação com outros marcadores é analisada. A finalidade deste estudo é fazer uma revisão da literatura internacional sobre o uso da proteína p16 como fator prognóstico para o melanoma, bem como avaliar a importância das alterações do gene p16INK4a, corresponsáveis pela gênese e evolução do melanoma

In the last decades there has been an intense search for a genetic explanation of the origin, growth and progression of cutaneous melanoma. The attempt to find a direct link between gene mutations and the root of the disorder has been the aim of researchers devoted to the study of this neoplasia. Many are the methods used in the search of a prognostic evaluation for the progression of melanoma, e.g. research on the sentinel lymph node, immunohistochemistry, molecular techniques and the microarray technique. The need for a method with optimal sensitivity and specificity has led researchers to search for better evidence. For these studies it is important to obtain reliable data on the techniques, progression and survival free of disease. By means of immunohistochemistry, which is a relatively simple, low cost technique, the p16 protein expression can be assessed and correlated with disease prognosis. In cutaneous melanoma, p16 expression decreases as its aggressiveness increases, i.e. it is strong in the nevi and melanomas in situ and weak or absent in the metastatic melanomas. Other studies have analyzed how it compares with other markers. The purpose of this study is to make a review of the international literature on the use of p16 protein as a prognostic factor for melanoma, as well as to evaluate the importance of alterations in the p16INK4a gene, co-responsible for the genesis and progress of melanoma

Cicatricial ectropion correction in a patient with pyoderma gangrenosum: case report.

A 19 year old female with pyoderma gangrenosum was referred to the oculoplastic clinic for evaluation of severe cicatricial ectropion of the right lower eyelid. Examination evidenced important scarring of lower eyelid and malar region with secondary ectropion. A full-thickness skin graft associated with a lateral tarsal strip procedure and scar tissue release was performed. The patient's corticosteroid dose was raised for the procedure, and after surgery there was no healing problem or ulcer formation in the eyelid or in the graft donor site. As pyoderma gangrenosum is associated with a pathergy phenomenon in up to 25% of the cases, the onset of new lesions is a relevant concern when performing surgery in these patients. In this case, the surgery was safely performed under corticosteroid immunosuppression.