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We describe herein what is to our knowledge the first reported case of an invasive cutaneous metastasis with unknown primary, electively treated solely with electrochemotherapy. We describe a female patient with a large, invasive and painful lesion in her hypogastric region, extending up to the pubic area. The cutaneous biopsy and instrumental and laboratory analyses, all failed to reveal the primary site. A final diagnosis of cutaneous metastasis with unknown primary was made and treatment was performed with electrochemotherapy. Our case highlights the importance of interdisciplinary choices in clinical practice to cope with the lack of a primary site and to improve quality of life, since no standardized therapy exists for these classes of patients.

We describe a case of plantar interdigital cutaneous melanoma in a 22-year-old woman who reported changes in a pigmented lesion during pregnancy. Diagnosis was late and evolution unfavourable. The purpose of this report is to draw the attention of dermatologists to the need for careful regular examination of melanocytic lesions in pregnant women, not ignoring possible changes as always physiological.

Osteoma cutis é a formação óssea no interior da pele, podendo ser primária ou secundária. Única ou múltipla, de tamanhos variados e acometendo ambos os sexos, é uma lesão cutânea rara, de etiopatogenia e classificação ainda discutidas. Nosso objetivo foi relatar o diagnóstico e a terapêutica minimamente invasiva de lesões múltiplas de osteoma cutis na face em pacientes com sequelas de acne. Fizemos a retirada dos osteomas com agulhas BD 0,70 x 25 22G1, sem anestésicos tópicos ou injetáveis no local. As pequenas incisões foram deixadas expostas, com pomada cicatrizante. Obteve-se um excelente resultado estético em 15 dias. Osteoma cutis is a bone formation in the dermis can to be primary or secondary forms. Only, multiples, many forms, occurring on either sex, they are a rare cutaneous disease. The pathogenesis and classification remains unclear. Our objective was the diagnostic and small invasive surgery treatment of the osteoma cutis multiple of the face, in patients as a sequel of acne. To remove the osteoma we used needle BD 0,70x25 22G1, without anesthetic topic or inject able site. The small wounds were exposed with scarring balsam. We got an excellent esthetic result after 15 days.

FUNDAMENTOS - O DNA viral pode atuar como oncogene, favorecendo o desenvolvimento de neoplasias, como as linfoides e da pele. Entre esses vírus, encontram-se alguns herpes-vírus humanos. OBJETIVO - Identificar a presença de DNA do herpes-vírus humano tipo 1 em neoplasias epiteliais pré-malignas,malignas e pele normal de indivíduos controle, avaliando seu papel na carcinogênese. MÉTODOS - Identificação, por reação em cadeia da polimerase, do DNA viral do tumor e pele sã de 41 pacientes e comparação com grupo controle, sem neoplasia. Análise estatística: Testes de Fisher e de McNemar. RESULTADOS - O vírus foi identificado em 20 indivíduos sem e em 21 com neoplasia. Destes últimos, 11 o expessaram apenas nas células tumorais. A diferença, entretanto, não foi estatisticamente significante. CONCLUSÕES - Parece não haver relação direta entre o encontro do DNA viral na pele sã e na pele tumoral. Sua presença pode facilitar o desenvolvimento da neoplasia ou apenas coincidir de se localizar onde esta já ocorreu. BACKGROUND - Viral DNA may act as an oncogene, especially in skin and lymphoid organs. This group includes some human herpes virus. OBJECTIVE - To identify human herpes virus type 1 DNA in pre-malignant and malignant skin samples of epithelial tumors comparing to normal skin to determine its role in carcinogenesis. METHODS - Forty-one patients with epithelial tumors were submitted to biopsies from tumor and normal skin. The control group comprised 41 biopsies from patients with other dermatoses than cancer. After DNA extraction, polymerase chain reaction was performed to identify 199-bp band. The results were statistically evaluated by Fisher and McNemar tests. RESULTS - The virus was identified in 20 subjects without cancer and in 21 with skin cancer. From these, 11 expressed it only in tumor cells. This difference was not significant. CONCLUSION - There seem to be no direct relation between viral findings in normal skin and skin cancer cells. It may act as a promoter or just coexist at the same site where a neoplastic transformation has already occurred.

FUNDAMENTOS: O câncer da pele é a neoplasia de maior incidência no Brasil, com 122.400 casos novos estimados para 2006, o que corresponde a 26% do total de neoplasias malignas. A exposição solar é o principal fator de risco conhecido. OBJETIVOS: Avaliar a freqüência das neoplasias cutâneas no país, sua distribuição geográfica e hábitos de proteção contra exposição solar. Métodos: A SBD promoveu, de 1999 a 2005, a Campanha Nacional de Prevenção ao Câncer da Pele, com exame dermatológico e orientação sobre exposição, tendo registrado dados demográficos, hábitos de exposição solar e diagnósticos. RESULTADOS: Foram examinados 205.869 indivíduos, sendo diagnosticados 17.980 casos de diferentes tipos de câncer da pele (13.194 de carcinoma basocelular, 2.482 de espinocelular, 1.057 de melanoma e 1.247 outras neoplasias), correspondendo a 8,7% dos examinados. A razão de prevalência entre homens e mulheres foi de 1,7, e a proporção de câncer em negros foi de 1,6%; em amarelos, de 3,2%; em pardos, de 3,4%; e em brancos, e 12,7%. Os estados com maior prevalência foram Santa Catarina e Rio Grande do Norte. Mais de 50% dos examinados se expunham ao sol sem proteção, o que reforça a importância de atividades educativas de prevenção. CONCLUSÕES: O câncer da pele é freqüente no país, e a proteção contra seu principal fator de risco, a exposição solar, é ainda pouco valorizada. BACKGROUND: Skin cancer is the most common type of cancer in Brazil. The estimate for 2006 is 122400 new cases accounting for 26% of the total cancer burden. Sun exposure is the main risk factor. OBJECTIVE: to evaluate the frequency of skin neoplasm in the country, its geographic distribution and people's attitude regarding sun exposure protection. METHODS: The Brazilian Society of Dermatology has been promoting a national screening campaign since 1999, where free dermatological examination and information on the risks of solar exposure are provided. RESULTS: From 1999 to 2005, this campaign performed 205869 dermatological exams, diagnosing 17980 (8.7%) cases of skin cancer (13194 basal cell carcinomas, 2482 squamous cell carcinomas, 1057 melanomas and 1247 other neoplasms). The ratio between sexes was 1.7 and the prevalence was 1.6% in black, 3.2% in Asian descendent, 3.4% in mestizo, and 12.7% in Caucasian individuals. Santa Catarina and Rio Grande do Norte were the national states with the highest prevalence rate. The majority of people, irrespective of sex or race, suffered unprotected solar exposure, hence pointing to the great importance that educational activity must play in the prevention of this disease in the country. CONCLUSION: Skin neoplasm is frequent among the Brazilian population, but unprotected sun exposure is not yet perceived as an important health risk.

Os sarcomas com apresentação cutânea primária são tumores raros e de grande heterogeneidade histológica. Com a evolução da oncologia cutânea e da cirurgia dermatológica, os dermatologistas têm sido cada vez mais requisitados para o diagnóstico e orientação terapêutica de tumores menos freqüentes. Este artigo de revisão analisa os sarcomas cutâneos primários observando suas características clínicas, etiopatogênicas e histológicas, bem como aspectos do tratamento e evolução. Enfatiza os sarcomas de maior relevância para o dermatologista, como angiossarcoma, dermatofibrossarcoma protuberans, fibroxantoma atípico, leiomiossarcoma, lipossarcoma, tumor maligno de bainha de nervo periférico e sarcoma epitelióide. O sarcoma de Kaposi não é abordado devido a suas características individuais específicas. Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. The cutaneous presentation of these tumours is rare. With the evolution of dermatologic surgery and cutaneous oncology, dermatologists have emerged as specialists for skin cancer management. This article reviews primary cutaneous sarcomas with particular emphasis on the epidemiologic, clinical, and histological features of diagnosis, as well as treatment modalities and prognosis. The most frequent cutaneous sarcomas were reviewed, including angiosarcoma, dermatofibrosarcoma protuberans, atypical fibroxanthoma, leiomyosarcoma, liposarcoma, malignant nerve sheath tumor, and epithelioid sarcoma. Kaposi's sarcoma, due to specific characteristics, was omitted from this review.

Bednar tumor is a rare skin neoplasm, considered to be a pigmented variant of dermatofibrosarcoma protuberans. Diagnosis is confirmed through histopathologic examination and immunohistochemical evaluation. Bednar tumor is aggressive locally and recurrences are frequent, but metastases are rare. The most appropriate therapeutic procedure is Mohs' micrographic surgery. The case report presents a 35-year-old patient with this rare neoplasm in which the diagnosis was established through histopathologic examination and immunohistochemical study. The importance is emphasized for dermatologists to be attentive for diagnostic suspicion and have available the necessary means to confirm the diagnosis in order to adopt the best procedure.