Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes.

BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.

Ensaio clínico randomizado sobre a análise comparativa entre excisão de nevos melanocítos intradérmicos por shaving versus excisão em elipse e sutura / Comparative analysis between sutured elliptical excision and shaving of intradermal melanocytic nevi: a Randomized Clinical Trial

Introdução: apesar de os nevos melanocíticos intradérmicos serem lesões benignas, muitos pacientes recorrem ao dermatologista para sua exérese. Entretanto, não existem estudos sobre o melhor método para esse procedimento. Objetivo: comparar em ensaio clínico randomizado a exérese de nevos melanocíticos intradérmicos na face, por shaving e excisão em elipse com sutura Métodos: foram selecionados pacientes com nevos melanocíticos intradérmicos na face para os dois métodos, randomicamente. Os resultados foram descritos quanto à satisfação do paciente e aos registros fotográficos avaliados por médico cegado. Resultados: 18 pacientes foram submetidos à exérese de nevos melanocíticos intradérmicos. A média de tamanho da cicatriz após seis meses foi de 8,11mm para as lesões excisadas por fuso e de 2,92mm para as por shaving (p < 0,05). A média da nota dos pacientes após seis meses foi 9,67 (fuso) e 9,57 (shaving) (p = 0,8). A média pelo médico cegado foi 7,78 (fuso) e 7,86 (shaving) (p = 0,91). Ocorreu recidiva da lesão em 28,6% dos pacientes submetidos ao shaving. Conclusões: As duas formas de excisão se equivalem quanto à satisfação do paciente e nota dada pela equipe médica quanto aos resultados estéticos da cicatriz. Contudo, a exérese por fuso tem a vantagem de apresentar menor índice de recidiva.

Introduction: Although the intradermal melanocytic nevi are benign lesions, many patients seek for dermatologists for their excision. However, there are no studies about the best method for this procedure. Objective: To compare in a randomized clinical trial the excision of intradermal melanocytic nevi in the face for shaving and elliptical excision with suture Methods: Patients with intradermal melanocytic nevi on the face were selected for removal by shaving or ellipse, randomly. The results were described regarding patient satisfaction and photographic records evaluated by a blinded physician. Results: 18 patients underwent excision of intradermal melanocytic nevi. The mean scar size after six months of the procedure was of 8,11mm for the excision in ellipse and 2,92mm for the shaving (p < 0.05). The mean score of the patients after six months was 9.67 (ellipse) and 9.57 (shaving) (p = 0.8). The mean by the blinded physician was of 7.78 (ellipse) and 7.86 (shaving) (p = 0.91). 28.6% of patients undergoing shaving had recurrence of the nevus. Conclusions: The two forms are of excision are equivalent concerning patients satisfaction and the judgment of medical team about the aesthetic results of the scar. However, ellipse with suture excision has the advantage of having a lower relapse.

Análise da prevalência de conjuntivite no atendimento emergencial do serviço de oftalmologia do Hospital Universitário da Universidade Federal de Santa Catarina nos anos de 2004 a 2008

Introdução: Conjuntivite significa ?inflamação da conjuntiva?. É a causa mais comum de doença conjuntival, de doença ocular e a mais frequente causa de ?olho vermelho? na atenção primária. Classifica-se pela etiologiaem: infecciosas (bacteriana e viral), e não infecciosas (alérgica e não alérgica). Essa afecção geralmente cursa com prurido, secreção e hiperemia na superfície ocular. Objetivo: Verificar a prevalência de conjuntivite nos pacientes atendidos emergencialmente, no ambulatóriodo Serviço de Oftalmologia do Hospital Universitário (HU/UFSC), correlacionando-os com o ano, mês, sexo, faixa etária, etiologia, procedência e estação do ano. Métodos: Realizou-se um estudo clínico observacional, descritivo, com delineamento transversal e coletaretrospectiva de dados de prontuários de 1695 pacientes atendidos no ambulatório do Serviço de Oftalmologia do HU/UFSC no período de janeiro de 2004 a dezembro de 2008. Resultados: A conjuntivite foi responsável por 424 (25%) dos atendimentos. O sexo feminino representou 60% dos atendimentos. A faixa etária predominante foi a dos 20 aos 29 anos, representando 34,9% dos pacientes. Dos pacientes atendidos no período, 79,2% eram procedentes de Florianópolis, seguidos por São José, com11,1%. Dentre as etiologias, a bacteriana representou a maioria (52%), seguidas pelas conjuntivites alérgicas (28%). O número de pacientes com conjuntivite foi maior na primavera, totalizando 28,5% dos casos. Conclusão: A conjuntivite possui freqüência alta entre os atendimentos emergenciais, sendo a etiologia bacteriana a mais comum. A maioria dos pacientes são adultos jovens, do sexo feminino, sendo a primavera aestação climática onde a doença é mais prevalente.

Introduction: Conjunctivitis means ?inflammation of the conjunctiva?. It is the commonest cause of conjunctival disease, of ocular disease and the most frequently cause of ?red eye? in the primary attention. It is classifiedin: infectious (bacterial and viral), and no infectious (allergic and non allergic). This disorder usually produces itching, secretion and hyperemia over ocular surface. Objectives: To verify the prevalence of conjunctivitison patients examined in emergency on the ophthalmology service in the Hospital Universitário (HU/UFSC), correlating gender, age, etiology, proceeding and season. Methods: Was performed an observational, transversal, and descriptive study with data collected from the clinical files of 1695 patients examined in the ophthalmologic service of the HU/UFSC from January/2004 to December/2008. Results: Conjunctivitis were responsible for 424 (25%) of the emergency examinations. The female gen der represented 60% consults. The predominant agegroup was 20 to 29 years, representing 34,9% patients. Among the patients examined in the period, 79,2% proceeded from Florianópolis, followed by São José, with 11,1%. Among the conjunctivitis, the bacterial conjunctivitis was majority (52%), followed by the allergic ones(28%). The number of patients with conjunctivitis was higher in the spring, totalizing 28,5% of the cases. Conclusion: Conjunctivitis are highly frequent between the emergency examinations, being the bacterialthe main etiology. Most patients are young adults and female, considering spring the season which the disease is more prevalent.