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Background Non-melanoma skin cancer is the most common type of malignancy in the Western world, and surgical excision is the preferred approach. The approach adopted in the face of incomplete excisions of basal cell carcinoma is still controversial. Objectives To compare the number of tumor recurrences after treatment for incompletely excised basal cell carcinoma. Methods Selection and statistical analysis of medical records of patients who had compromised margins after excision of basal cell carcinoma in a tertiary hospital from 2008 to 2013. Results A total of 120 medical records were analyzed; the mean age was 69.6 years, and 50% of the patients were female. The most prevalent histological type was nodular; the mean size was 1.1 cm, and the tumor location with the highest incidence was the nose. The lateral margin was the most frequently positive. Clinical follow-up was more widely adopted; only 40 patients underwent a second surgery. The total number of patients who had tumor recurrence was 34 (28.3%). Only the malar location significantly influenced the incidence of recurrence (p = 0.02). The mean follow-up time was 29.54 months, with no significant difference between the follow-ups, although 32.9% of the patients followed-up clinically showed recurrence, against only 20% of those who underwent a second surgery. Study limitations Mean follow-up time of less than five years and sample size. Conclusions The presence of compromised margins does not necessarily imply recurrence. Location, tumor size, histological subtype, previous epithelial tumors, and clinical conditions of the patient must be considered when choosing the best treatment option.

Ultraviolet light exposure and cutaneous pigmentation are important host risk factors for cutaneous melanoma (CM), and it is well known that inherited ability to produce melanin varies in humans. The study aimed to identify single-nucleotide variants (SNVs) on pigmentation-related genes with importance in risk and clinicopathological aspects of CM. The study was conducted in two stages. In stage 1, 103 CM patients and 103 controls were analyzed using Genome-Wide Human SNV Arrays in order to identify SNVs in pigmentation-related genes, and the most important SNVs were selected for data validation in stage 2 by real-time polymerase-chain reaction in 247 CM patients and 280 controls. ADCY3 c.675+9196T>G, CREB1 c.303+373G>A, and MITF c.938-325G>A were selected for data validation among 74 SNVs. Individuals with CREB1 GA or AA genotype and allele “A” were under 1.79 and 1.47-fold increased risks of CM than others, respectively. Excesses of CREB1 AA and MITF AA genotype were seen in patients with tumors at Clark levels III to V (27.8% versus 13.7%) and at III or IV stages (46.1% versus 24.9%) compared to others, respectively. When compared to others, patients with ADCY3 TT had 1.89 more chances of presenting CM progression, and those with MITF GA or AA had 2.20 more chances of evolving to death by CM. Our data provide, for the first time, preliminary evidence that inherited abnormalities in ADCY3, CREB1, and MITF pigmentation-related genes, not only can increase the risk to CM, but also influence CM patients’ clinicopathological features.

Solid tumors typically contain high levels of fibrillar collagen. The increased stromal collagen deposition usually promotes cancer progression since biochemical and biophysical cues from tumor-associated collagen fibers stimulate neoplastic cells. Few studies have investigated the relationship between Merkel cell carcinoma (MCC) and the extracellular matrix (ECM), but there are no works evaluating collagen. This is an observational, analytical, retrospective study including 11 patients with MCC. Primary tumor-stained sections were evaluated by second harmonic generation microscopy and texture analysis. Peritumoral texture features (area fraction, mean gray value, entropy, and contrast) showed much lower values than normal skin (P

This study aimed to evaluate whether PD1.1 (c.-606G>A), PD1 (c.627 + 252C>T), PD1.5 (c.804C>T), and PD1.9 (c.644C>T) single nucleotide polymorphisms of PDCD1 gene influence the risk, clinicopathological aspects, and survival of cutaneous melanoma (CM). Individuals with phototype I or II and PD1 CC genotype were under 5.89-fold increased risk of developing CM. PD1.5 TT genotype increased PDCD1 expression (2.49 versus 1.28 arbitrary units, p = .03) and PD1.5 CT or TT genotype and allele T increased PD1 expression in TCD4+ lymphocytes (16.6 versus 12.5%, p = .01; 17.0 versus 13.1%, p = .006). At 60 months of follow-up, short recurrence-free survival was seen in patients with PD1.1 AA genotype (33.3 versus 71.8%, p = .03). Patients with PD1.1 AA and PD1.5 CC genotype had 4.21 and 2.62 more chances of presenting relapse and evolving death by disease in Cox analyses, respectively. Our data provide preliminary evidence that abnormalities in regulation of T lymphocyte alter CM risk, clinical aspects, and prognosis.

SummaryBackground Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes. Aim To analyze a number of histomorphometric and immunohistochemical findings through vascular endothelial growth factor (VEGF), Ki-67, and CD31 immunostaining in scalp biopsies of 20 patients with CTE, 17 patients with mild FPHL and 9 controls. Methods Ki-67 index and VEGF optical density were analyzed at the follicular outer sheath using ImageJ software. CD31 microvessel density was assessed by a Chalkley grid. Results Significant follicle miniaturization and higher density of nonanagen follicles were found in FPHL, compared with patients with CTE and controls. Ki-67+ index correlated positively with FPHL histological features. The FPHL group showed the highest VEGF optical density, followed by the CTE and control groups. No differences were found in CD31 microvessel density between the three groups. Conclusions Histomorphometric results establish CTE as a distinct disorder, separate from FPHL from its outset. Its pathogenic mechanisms are also distinct. These findings support the proposed mechanism of ‘immediate telogen release’ for CTE, leading to cycle synchronization. For FPHL, accelerated anagen follicular mitotic rates and, thus, higher Ki-67 and VEGF values, would leave less time for differentiation, resulting in hair miniaturization.

Background The P53 Arg72Pro, MDM2 c.+309T>G, BAX c.–248G>A, and BCL2 c.–717C>A polymorphisms have variable roles in the apoptosis pathways. Objective To clarify the roles of these polymorphisms in the risk for cutaneous melanoma (CM). Methods Genomic DNA of 200 CM patients and 215 controls was analyzed by PCR–RFLP. Results In women, the frequencies of BAX GG (83.0% vs. 71.0%, P =0.04), BCL2 AA (32.0% vs. 15.0%, P =0.003), P53 ArgArg plus BAX GG (84.9% vs. 63.2%, P =0.01), P53 ArgArg plus BCL2 AA (37.0% vs. 13.1%, P =0.003), BAX GG plus BCL2 AA (70.3% vs. 33.3%, P =0.001), MDM2 GG plus BAX GG plus BCL2 AA (27.3% vs. 3.7%, P =0.03), and P53 ArgArg plus MDM2 GG plus BAX GG plus BCL2 AA (33.3% vs. 5.6%, P =0.04) genotypes were higher in patients than in controls. Female carriers of the respective genotypes were under 1.98 (95% CI: 1.01–3.91), 2.87 (95% CI: 1.43–5.77), 3.48 (95% CI: 1.34–9.04), 4.23 (95% CI: 1.63–10.96), 6.04 (95% CI: 2.10–17.37), 25.61 (95% CI: 1.29–507.24), and 25.69 (95% CI: 1.11–593.59)-fold increased risks for CM than others, respectively. In men, the frequencies of BCL2 CA+AA (83.0% vs. 67.6%, P =0.01) and MDM2 TG+GG plus BCL2 CA+AA (94.2% vs. 68.3%, P =0.003) genotypes were higher in patients than in controls. Male carriers of the respective genotypes were under 2.43 (95% CI: 1.23–4.82) and 9.22 (95% CI: 2.16–39.31)-fold increased CM risks than others, respectively. Conclusion The data suggest for the first time that P53 Arg72Pro, MDM2 c.+309T>G, BAX c.–248G>A, and BCL2 c.–717C>A polymorphisms, enrolled in apoptosis pathways, constitute distinct determinants of CM in women and men.

A large number of diseases may cause Atrophic skin disorders are caused by a large number of diseases, some of them idiopathic and others inflammatory, in which there is loss of volume of body segments. Localized scleroderma is a rare inflammatory dermatosis, manifested by atrophic skin and subcutaneous tissue alterations. Lipoatrophy may be genetically inherited or acquired as a result of panniculitis, HIV infections or aging. Many treatments have been proposed. Results vary in the acute inflammatory phase and are scarce when sclerosis and atrophy have already been established. This article describes four cases of localized facial scleroderma and one of facial idiopathic lipoatrophy treated with implantation of autologous fat globules extracted from the infragluteal groove, without utilization of cannula aspiration, with lasting results.

We examined the influence of XPC A2920C, XPF T30028C, TP53 Arg72Pro and GSTP1 Ile105Val polymorphisms in the risk of cutaneous melanoma (CM). DNA from 146 CM patients and 146 controls was analysed by polymerase chain reaction (PCR)—restriction fragment length polymorphism (RFLP). The frequencies of XPC CC (15.1 vs. 6.9 %, P = 0.02), TP53 ArgArg (59.6 vs. 45.9 %, P = 0.02), XPC CC plus TP53 ArgArg (19.7 vs. 5.2 %, P = 0.01) and TP53 ArgArg plus GSTP1 IleIle (50.7 vs. 35.6 %, P = 0.03) genotypes were higher in patients than in controls. Carriers of the respective genotypes were under a 2.51 (95 % CI: 1.13–5.55), 1.76 (95 % CI: 1.09–2.83), 4.52 (95 % CI: 1.35–15.16), and 2.01 (95 % CI: 1.04–3.90)-fold increased risks for CM than others, respectively. An excess of TP53 ArgArg genotype was seen in patients with excessive sun exposure compared to patients with standard sun exposure (69.2 vs. 44.1 %, P = 0.02) and also compared to controls (69.2 vs. 45.9 %, P = 0.002). Individuals with TP53 ArgArg genotype and highly exposed to sunlight had 2.65 (95 % CI: 1.42–4.92)-fold increased risk for CM than others. XPC CC (27.8 vs. 10.4 %, P = 0.02) and the GSTP1 IleIle (58.3 vs. 36.8 %, P = 0.04) genotypes were more common in patients with advanced tumours than in patients with localized tumours and were also more common in these patients than in controls (27.8 vs. 6.9 %, P = 0.001; 58.3 vs. 37.0 %, P = 0.02, respectively). Individuals with the respective genotypes had 5.23 (95 % CI: 1.97–13.82)-fold and 2.38 (95 % CI: 1.13–5.01)-fold increased risks for advanced tumour than others, respectively. Our data suggest that inherited abnormalities of XPC, XPF, TP53 and GSTP1 pathways of the DNA repair, apoptosis and metabolism of reactive oxygen species are important determinants of CM in individuals from south-eastern Brazil.

Cutaneous melanoma (CM) cells are resistant to apoptosis, and steroid hormones are involved in this process through regulation of TP53, MDM2, BAX, and BCL2 expression. We analyzed herein sex differences in outcomes of CM patients associated with TP53 c.215G>C, MDM2 c.309T>G, BAX c.−248G>A, and BCL2 c.−717C>A polymorphisms. DNA from 121 men and 116 women patients was analyzed by polymerase chain reaction and enzymatic digestion assays. At 60 months of follow-up, shorter progression-free survival (PFS) was seen in males with MDM2 GG + BCL2 AA (20.0 vs. 62.6%, P = 0.0008) genotype. Men carriers of the genotype had poor PFS (HR 3.78, 95% CI 1.30–11.0) than others. For women, shorter PFS was associated with TP53 GC or CC (61.4 vs. 80.8%, P = 0.01) and TP53 GC or CC + MDM2 TG or GG (59.1 vs. 85.4%, P = 0.01) genotypes at the same time. Women carriers of the genotypes had poor PFS (HR 2.46, 95% CI 1.19–5.09; HR 9.49, 95% CI 1.14–78.50) than others, respectively. Our data present, for the first time, preliminary evidence that inherited abnormalities on TP53, MDM2 and BCL2 genes, enrolled in apoptosis pathways, have a pivotal role in differences of outcomes in women and men with CM.

Background: Keratoacanthoma (KA) is easily confused with squamous cell carcinoma (SCC) on a clinical or a histopathologic basis. However, KA undergoes spontaneous regression, whereas SCC does not. Objective: Our objective was to study the histopathologic features associated with clinical regression in KA-like lesions to support the therapeutic option. Methods: Forty-three biopsies of KA-like lesions were taken at patient admission. One month later, surgical excision was performed in 18 growing lesions. Regressing lesions were left untreated. Classic histopathologic features and diagnosis were blindly recorded in both biopsies and surgical specimens. Results: On a clinical and a histologic basis, 32 lesions were assessed as KA and 11 as SCC. Features that indicated malignancy were observed in both groups, but the probability of SCC was 31 times higher in tumors with five or more of such features. Several of the histologically atypical lesions were found to regress. Conclusion: SCCs and KAs have more pathologic similarities than differences, especially in the proliferative phase. The combination of the most useful features did not allow the nosologic diagnosis in difficult cases but helped. Differential diagnosis was easier to determine after the 1-month follow up. Complete surgical excision should be indicated in nonregressing and growing lesions. Antecedents: II est facile de confondre le kerato-acanthome (KA) avec le carcinome squameux (CS) sur une base clinique ou histopathologique. Toutefois, les KA subissent des regressions spontanees, ce qui n'est pas le cas des CS. Objectif: Etudier les caracteristiques histopathologiques associees a la regression clinique des lesions ressemblant au KA afin de trouver la meilleure option therapeutique. Methodes: Quarante-trois biopsies de lesions ressemblant au KA ont ete pratiquees sur admission des patients. Un mois plus tard, une excision chirurgicale a ete pratiquee sur 18 lesions en etat de croissance. Les lesions en regression n'ont pas ete traitees. Les caracteristiques histopathologiques classiques et le diagnostic des biopsies et des excisions ont ete enregistres en insu. Resultats: Les evaluations cliniques et histologiques ont decele 32 lesions comme KA et 11 comme CS. Les caracteristiques d'une tumeur maligne ont ete observes dans les deux groupes mais la probabilite que ce soit un CS etaient 31 fois plus elevees dans les tumeurs presentant cinq caracteristiques ou plus. Plusieurs des lesions atypiques du point histologique ont regresse. Conclusion: Les CS et les KA ont davantage de similitudes que de differences au niveau pathologique, surtout dans la phase de proliferation. La combinaison des caracteristiques les plus importantes n'a pas permis un diagnostic nosologiques dans les cas complexes, mais y a contribue. Le diagnostic differentiel etait plus facile a etablir apres un mois de suivi. L'excision complete doit etre indiquee dans le cas de lesions non regressives ou en pleine croissance.

Summary Background: Lentigo maligna (LM) is a common melanocytic malignancy which requires therapy because of the risk of progression to invasive lentigo maligna melanoma which a much worse prognosis. Patients and Methods: 18 patients with clinical and histopathological diagnosis of LM were treated with cryosurgery.The patients were older Caucasians (mean age 59.5 years) and 11 were male. They were chosen for cryosurgery because the lesion posed a surgical challenge or the patient was not a good surgical candidate. They were treated with two freeze-thaw cycles of liquid nitrogen under local anesthesia in a single sitting. Lesions larger than 2 cm2 were divided into smaller segments for freezing. Results: The lesions resolved clinically in all cases, with no recurrence or metas-tasis detected during a mean follow-up of 75.5 months. Some patients developed hypopigmented scars. Conclusions: Cryosurgery with liquid nitrogen is an efficient, safe and in most cases aesthetically acceptable alternative method to treat LM.

OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

This study aimed to evaluate whether XPC A2920C, XPF T30028C, TP53 Arg72Pro, and GSTP1 Ile105Val polymorphisms alter outcomes of cutaneous melanoma (CM) patients. DNA from 237 CM patients seen at the University of Campinas Teaching Hospital from April 2000 to February 2014 was analyzed by polymerase chain reaction and restriction fragment length polymorphism assays. The prognostic impact of genotypes of polymorphisms on progression-free survival (PFS) and overall survival (OS) of CM patients were examined using the Kaplan-Meier probability estimates and univariate and multivariate Cox regression analyses. At 60 months of follow-up, shorter PFS and OS were seen in patients with XPF CC genotype (48.9 vs. 66.7 %, P = 0.002; 77.9 vs. 83.5 %, P = 0.006, respectively) and XPF CC + TP53 ArgArg (43.6 vs. 65.9 %, P = 0.007; 71.6 vs. 84.8 %, P = 0.006, respectively) compared with those with remaining genotypes (Kaplan-Meier estimates). Patients with XPF CC (hazard ratio (HR) 2.45, P = 0.002; HR 3.77, P = 0.005) and XPF CC + TP53 ArgArg (HR 2.67, P = 0.009; HR 4.04, P = 0.03) genotypes had more chance to present tumor progression in univariate and multivariate analyses, whereas patients with XPF CC (HR 2.78, P = 0.009) and XPF CC + TP53 ArgArg (HR 3.84, P = 0.01) genotypes were under greater risk of progressing to death in univariate analysis, compared with those with the remaining genotypes. The data suggest, for the first time, that inherited abnormalities in DNA repair pathway related to XPF 30028C and TP53 Arg72Pro polymorphisms act as prognostic factors for PFS and OS of CM patients.

Human bartonelloses are a group of illnesses of poorly understood pathogenesis. Bartonella henselae is one of the most studied bacterium of its genus. The objective of this study was to observe whether passages of these bacteria, in vivo, would determine ultrastructural changes in them. For this purpose, isogenic mice were inoculated with a standard strain of B. henselae (I). These were initially retrieved from genetically immunodeficient animals (II) and then inoculated in immunocompetent ones. The bacterial colonies obtained (III) were compared, by transmission electron microscopy, with colonies I and II. Loss of fimbriae and an abundant bleb formation were the most common morphological changes found in colony III. Also, on day 6 postinfection, the main histological abnormalities were the endothelial proliferation presented in immunodeficient animals and the incipient granulomata reaction found in one of the immunocompetent inoculated mice, which died spontaneously. These features agree with the Bartonella human disease clinical and histological observations. This study demonstrates that B. henselae in vivo passages induce significant morphological changes in the bacteria and that these abnormalities could explain their seemingly greater virulence. Most of these observations have not been previously described. Thus, further studies on the Bartonella species pathogenesis should consider these data.

Case ReportUltrasound hydrolipoclasia is a form of mesotherapy in which physiological solution is injected subdermally before ultrasound application; it is an off-label treatment for localized fatty areas. A 28-year-old white woman presented with painful erythematous-secreting nodules in her abdomen

Stretch marks or striae distensae (SD) can be considered a common skin disorder, but their physiopathogenic mechanisms have not been totally clarified. Although it is considered an esthetic complaint, it may have serious psychosocial consequences besides the local and systemic alterations of the conjunctive tissue. This study aims at assessing and quantifying the estrogen, androgen and glucocorticoid receptors in skin samples with striae and comparing with normal skin.Skin samples for biopsy were obtained from eight patients with SD and eight patients without lesions. The samples were frozen at -80 degrees C and underwent processing to obtain proteic extract to quantify the estrogen, androgen and glucocorticoid receptors with the Western Blot method.When the estrogen receptor in the skin with SD was compared with healthy skin, it was observed to have increased twice as much (P = 0.00001). The androgen and glucocorticoid receptors in the SD skin had also increased (P = 0.00015 and P = 0.00083, respectively).These findings indicate that under certain conditions there is an increase in hormonal receptor expression, suggesting that regions that undergo greater mechanical stretching of the skin may express greater hormonal receptor activity. This activity may influence the metabolism of the extracellular matrix, causing the formation of SD. Alterations in hormone receptors occur within a well-defined time period during the formation of SD; however, there are differences in the functionality of hormone receptors during different stages in the development of the lesions. The preliminary results appear to be relevant and represent an initial step towards an understanding of the pathophysiology of SD.

Viral DNA may act as an oncogene, especially in skin and lymphoid organs. This group includes some human herpes virus.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.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.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.

OBJECTIVE: To evaluate the efficiency of biological sealant, an autologous fibrin glue, in dermatological surgery. DESIGN: Randomized clinical trial. SETTING: The Dermatology Service of Hospital das Clínicas, Universidade de Campinas (UNICAMP), referral center. PATIENTS: 14 patients with malign epithelial cutaneoos tumors participated in the evaluation, each having two tumors, generally facial and symmetrical, in order to perform a comparative evaluation on the same individual. PROCEDURES: The glue was prepared beforehand with a sample of autologous blood. Surgical extirpation of the tumor was followed by grafts or second intention healing. OUTCOMES: The efficiency of the sealant was then evaluated in relation to hemostasis, adhesion, surgical time and evolution of the granulation tissue, clinically and histologically. RESULTS: Immediate hemostasis and graft adhesion, with a significant reduction of surgical time, and in the open wounds there was immediate hemostasis and a clinical increase in granulation tissue, but with no histological differences among the groups on the 7th day. CONCLUSION: It is an adjuvant resource in skin cancer surgery. OBJETIVO: Avaliar a eficácia de um selante biológico, a cola de fibrina autóloga, na cirurgia dermatológica. TIPO DE ESTUDO: Estudo prospectivo, randomizado. PARTICIPANTES: 14 doentes com dois tumores cutâneos epiteliais malignos, principalmente faciais e simétricos, para avaliação comparativa no mesmo indivíduo. LOCAL: Serviço de Dermatologia do Hospital de Clínicas da UNICAMP. PROCEDIMENTOS: A cola foi preparada, previamente, com amostra de 50 ml de sangue autólogo. Após a exérese do tumor, seguiu-se a colocação de enxertos ou cicatrização por segunda intensão. VARIÁVEIS: Hemostasia, adesão, tempo cirúrgico e evolução do tecido de granulação, clínica e histologicamente. RESULTADOS: Os resultados com a cola mostraram hemostasia e adesão imediata dos enxertos, com redução significativa do tempo cirúrgico e nas feridas abertas houve hemostasia imediata e maior tecido de granulação clinicamente mas sem diferenças histológicas, no 7º dia, entre os grupos. CONCLUSÃO: Concluiu-se que é recurso adjuvante na cirurgia do câncer de pele.