RESUMO
O carcinoma basocelular é o tumor maligno de pele mais frequente, e sua incidência está aumentando, emergindo como um problema de saúde pública. O frequente atraso na busca de tratamento dificulta a remoção tumoral. Reportam-se um caso de dois carcinomas basocelulares sincrônicos na face e o desafio de sua resolução cirúrgica. Foi obtido bom resultado estético e funcional por meio da técnica de rotação de retalho e reconstrução complexa da hemiface. A reconstrução cirúrgica constitui um desafio para o cirurgião, que deve priorizar a cura oncológica, preservando a funcionalidade e o aspecto estético quando possível.
Basal cell carcinoma is the most frequent malignant skin tumor. Its incidence has been increasing, leading to the emergence of a public health problem. The common delay in seeking treatment hampers tumor removal. The objective of this paper was to report a case of two synchronous basal cell carcinomas on the face and the challenge of their surgical resolution. Good aesthetic and functional outcomes were obtained using the rotation flap technique and a complex reconstruction of the hemiface. Surgical reconstruction constitutes a challenge for the surgeon, who should prioritize the oncologic cure while preserving the functionality and aesthetic appearance, when possible.
RESUMO
OBJECTIVES: Fogo Selvagem (FS) in Limao Verde (LV), Brazil shows clinical and histological features of pemphigus foliaceus (PF) and shares pathogenic IgG4 anti-desmoglein 1 (Dsg1) autoantibodies. Previously, our group reported that mothers with active FS deliver babies with normal skin and low/negative titers of IgG4 autoantibodies by indirect immunofluorescence. It was postulated that maternal pathogenic IgG4 autoantibodies do not cross the placenta due to differential receptor mediated transplacental passage of IgG subclasses. It was also thought that placental Dsg1 may immunoadsorb pathogenic autoantibodies from the mother; hence pathogenic IgG4 autoantibodies do not reach the baby. In this study we use a Dsg1-specific ELISA to test anti-Dsg1 autoantibodies of the IgM, IgG and the IgG subclasses in the sera of 68 pairs of normal mothers and their neonates living in a highly endemic area of FS. Determination of these baseline anti-Dsg1 autoantibodies will allow us to follow and predict in this and other cohorts the appearance of preclinical serological markers of FS. METHODS: The sera of mothers and neonates living in the endemic region were tested by ELISA for IgM, IgG and IgG subclasses using recombinant Dsg1 and anti-IgG subclass-specific monoclonal antibodies. RESULTS: The index values of anti-Dsg1 IgG1, IgG2 and IgG3 are similar in mothers and neonates (all p>0.18), while the index values of IgM, total IgG and IgG4 are higher in mothers (all p<0.001). CONCLUSIONS: Narrowing the IgM, IgG and IgG subclasses of mothers and neonates to autoantibodies against Dsg1, we found, as expected, that IgM remains only in maternal circulation. In three mothers and two neonates we detected IgG4 anti-Dsg1 autoantibodies above the normal range. The remaining IgG subclasses show low values. The results of the neonatal sera will serve as a baseline for ongoing seroepidemiological studies of children and adults in the endemic regions of FS.
