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Background/Aim: Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer in adults. Surgery remains the golden-standard treatment for this disease. Mohs micrographic surgery (MMS), a surgical technique, is based on the three-dimensional histopathological examination of the margin and surgical bed, layer by layer, in the excised tissue allowing for the determination of the location of the residual tumor, for its complete excision, with high cure rates and preservation of the unaffected tissue. The aim of this study was to present the epidemiological characteristics of the population that was submitted to MMS, as well as, correlate these characteristics with the characteristics of the tumor itself and the surgical procedure. Patients and Methods: A retrospective cross-sectional study was conducted over a 10-year period with an analysis of patient medical records submitted for MMS at the Department of Dermatology of the ABC School of Medicine. Data were presented and evaluated by non-parametric and parametric analyses, using absolute and relative frequency values for the continuous variable, to which a Chi-square test was applied for the verification of power with a significance level of 5%. For the independent variables, the Student’s t-test was used to compare means, with a confidence interval (CI) ranging from 95 to 99%, and Friedman’s test was used to verify if there were significant differences in the variables of interest. Results: Female patients accounted for 67% of all enrolled patients (n=335). The mean age was 67 years (SD±12.04; median=68; range=25-93 years). The predominant skin phototype (Fitzpatrick's classification) was phototype II (n=228, 46%). All procedures were performed under local anesthesia. Flap reconstruction was the most predominant surgery type (n=17, 68%). The mean number of MMS’s stages was 1.6 (range=1-8). There was a mean of 3.8 fragments of skin tissue (range=1-29) per stage. The mean tumor size was 30 mm (92%). This was associated with female sex (p=0.03), H-zone area (p

Introdução: O Carcinoma espinocelular de boca e/ou orofaringe (CEC-OB) tem ganhado importância devido aumento nas taxas de incidência e morbimortalidade. Está associado a múltiplos fatores, cujo conhecimento é importante para diagnóstico/tratamento precoce. Destaca-se o surgimento da relação com o Papilomavírus humano (HPV), responsável por diferente apresentação sociodemográfica-comportamental, morfológica e sintomatológica, bem como melhor prognóstico e resposta terapêutica. Objetivo: Demonstrar o perfil epidemiológico de pacientes atendidos em Roraima de janeiro/2016-janeiro/2018 com CEC-OB e achados sugestivos de HPV, considerando fatores ociodemográficos-comportamentais e associados à lesão. Métodos: Estudo qualitativoquantitativo, retrospectivo, descritivo. Amostragem de 34 pacientes atendidos na Unidade de Alta Complexidade em Oncologia no Hospital Geral de Roraima. Análise de informações (gênero, idade, exposição ao tabagismo e etilismo, localização primária do tumor, estadiamento clínico, presença de papiloma, coilocitose, não queratinização e expressão P16INK4a) dos prontuários dos pacientes incluídos pelos critérios propostos após assinatura do Termo de Consentimento Livre e Esclarecido e aprovação pelo Comitê de Ética em Pesquisa da Universidade Federal de Roraima sob número 2.442.554. Para as análises estatísticas utilizou-se o software EpiInfo® 7.1 Windows (CDC, Atlanta, EUA), planilhas do programa Microsoft® Office Excel 2013 e o Teste Exato de Fisher na análise das tabelas de contingência. Resultados: Dos incluídos, 32% dos pacientes apresentaram achados sugestivos de HPV, com um perfil padrão, gênero masculino, maior que 40 anos, etilista e não tabagista, com avançado estadiamento. Conclusão: Ainda que a etiologia do CEC-OB por muitos anos apresente forte associação ao tabagismo e etilismo, o HPV vem mostrando importante relação com essa neoplasia visto que foi notada sua presença.

Background: The aging process produces facial ptosis, which for many years has been corrected through facial surgery called face lift. Nowadays, to meet the demands of the patient, so-called thread lifts are used. The technique was first described in the late 1990s and has been improved. There are several materials available.

Mohs micrographic surgery is used worldwide for the treatment of skin cancers. After free margins are reached, the surgical defects need to be reconstructed. Deciding which type of closure will be used is challenging.To associate the types of reconstruction used with the characteristics of the tumors and patients undergoing the procedure based on ten years of experience in a Mohs micrographic surgery teaching service.This was a retrospective cross-sectional study with analysis of medical records. Information such as sex, age, tumor location, histological subtype, number of phases required to reach free margins, and type of repair performed were collected.A total of 975 cases of facial and extra-facial tumors were included. Border-to-border closures were the most common (39%) and associated with fewer phases (mean = 1.55). They were also more frequent in the histological subtypes studied and in most anatomical sites. Lesions located on the nose evaluated by Poisson regression model had a 39% chance of having been submitted to closures other than border-to-border (p 0.05). Tumors with two or more phases presented a 28.6% higher frequency of use of other closures compared to those operated in a single phase (p 0.05).This was a retrospective study with limitations in the collection of information from medical records. The type of closure can be a personal choice of the surgeon.Border-to-border closure should always be considered in surgical defects with fewer phases and non-aggressive histological subtypes, in the different sites where Mohs micrographic surgery is performed.

Cutaneous metastases from primary internal malignancies represent 0.7-9% of patients with cancer. We report a 65-year-old female patient referred for evaluation of normochromic papules on the trunk and upper limbs that had been present for three months. A skin biopsy revealed diffuse cutaneous infiltration by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7, estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis of occult breast cancer, since the solid primary tumor was not identified. The location of the primary tumor can not be determined in 5-10% of cases. In these cases, 27% are identified before the patient’s death, 57% at autopsy, and the remaining 16% can not be located.

OBJECTIVES: Dengue has become the most important endemic disease in Brazil. The Amazonian state of Roraima has one of the highest incidence rates of dengue in the country. The objective of this study was to determine whether significant temporal relationships exist between the number of reported dengue cases and short-term climate measures for the city of Boa Vista, the capital of Roraima. If such relationships exist, that suggests that it may be possible to predict dengue case numbers based on antecedent climate, thus helping develop a climate-based dengue early-warning system for Boa Vista. METHODS: Seasonal Pearson product-moment correlations were developed between 3-week running averages of daily numbers of reported dengue cases for September 1998-December 2001 and certain meteorological variables (thermal, hydroclimatic, wind, atmospheric pressure, and humidity) up to 25 weeks before. Two-sample t tests were also applied to test for statistically significant differences between samples of daily dengue cases with above-average values and samples with below-average values for three-variable meteorological combinations. These multivariate combinations consisted of the three climate measures that together explained the greatest portion of the variance in the number of dengue cases for the particular season. RESULTS: The strength of the individual averaged correlations varied from weak to moderate. The correlations differed according to the period of the year, the particular climatic variable, and the lag period between the climate indicator and the number of dengue cases. The seasonal correlations in our study showed far stronger relationships than had daily, full-year measures reported in previous studies. Two-sample t tests of multivariate meteorological combinations of atmospheric pressure, wind, and humidity values showed statistically significant differences in the number of reported dengue cases. CONCLUSIONS: Relationships between climate and dengue are best analyzed for short, relevant time periods. Climate-based multivariate temporal stochastic analyses have the potential to identify periods of elevated dengue incidence, and they should be integrated into local control programs for vector-transmitted diseases.OBJETIVOS: El dengue se ha convertido en la enfermedad endémica más importante de Brasil. El estado amazónico de Roraima presenta una de las tasas de incidencia de dengue más elevadas de ese país. El objetivo del presente estudio fue determinar si existen relaciones temporales significativas entre el número de casos informados de dengue y las mediciones climáticas a corto plazo en la ciudad de Boa Vista, capital de Roraima. De comprobarse esa relación, existiría la posibilidad de predecir el número de casos de dengue a partir de las condiciones climáticas antecedentes, lo que contribuiría a desarrollar un sistema de aviso temprano de dengue basado en las mediciones climáticas en Boa Vista. MÉTODOS: Se calcularon coeficientes de correlación momento-producto de Pearson estacionales entre los promedios deslizantes del número informado de casos de dengue en lapsos de tres semanas entre septiembre de 1998 y diciembre de 2001 y los valores de algunas variables meteorológicas seleccionadas (temperatura, precipitaciones diarias, velocidad y dirección del viento, presión atmosférica y humedad relativa) hasta 25 semanas previas. Se aplicó la prueba de la t para dos muestras para comprobar la significación estadística de las diferencias entre las muestras de casos diarios de dengue con valores por encima del promedio y las muestras diarias con valores por debajo del promedio para las combinaciones de tres variables meteorológicas. Estas combinaciones multifactoriales consistían en tres mediciones climáticas que juntas explicaran la mayor parte de la varianza en el número de casos de dengue para una estación dada. RESULTADOS: La robustez de las correlaciones de las medias individuales fue débil o moderada. Las correlaciones difirieron según el período del año, la variable climática en cuestión y el período transcurrido entre el momento en que se midió el indicador y cuando se notificaron los casos de dengue. La correlación estacional mostró una relación mucho más fuerte que la correlación diaria durante todo el año encontrada en estudios anteriores. La prueba de la t para dos muestras aplicada a combinaciones meteorológicas con múltiples variables de los valores de presión atmosférica, viento y humedad mostraron diferencias significativas en cuanto al número de casos de dengue informados. CONCLUSIONES: Las relaciones entre el clima y el dengue se pueden analizar mejor en períodos de tiempo cortos y pertinentes. Los análisis estocásticos temporales basados en múltiples variables climáticas tienen la posibilidad de identificar períodos de elevada incidencia de dengue, por lo que se deben incorporar a los programas locales de control de vectores transmisores de enfermedades.

Hair follicle aging and the aging of the skin are physiological phenomena that commence between a person’s 30s and 40s. The main changes manifest in the increased graying of hair and androgenic alopecia. These changes, however, do not present a defined pathophysiology.

Background Hyaluronic acid fillers are used for facial rejuvenation and are classified as non-cross-linked or cross-linked (monophasic mono- or polydensified). Objectives To histologically assess the intradermal durability of three types of fillers (biphasic, monophasic monodensified, and monophasic polydensified), to compare the durability of the products over 6 months, and to evaluate the structural changes after application. Methods In all, 25 volunteers received injections of three different fillers in the dermis of the right lumbar region (in one line), and equal amounts of the fillers were injected into three different sites (in the same column), yielding nine points of application in each patient. Each line was biopsied on days 2, 92, and 184; these skin samples were analyzed histologically, and the presence or absence of these fillers was verified by a dermatopathologist. Results The histological analysis showed that over 182 days, the amount of the injected monophasic polydensified, monophasic monodensified, and biphasic filler products decreased by 62.5%, 25%, and 12.5%, respectively. Conclusions The biphasic and monophasic monodensified fillers presented greater intradermal durability than did the monophasic polydensified filler at 6 months after intradermal injection. Level of Evidence 2

OBJECTIVES: Dengue has become the most important endemic disease in Brazil. The Amazonian state of Roraima has one of the highest incidence rates of dengue in the country. The objective of this study was to determine whether significant temporal relationships exist between the number of reported dengue cases and short-term climate measures for the city of Boa Vista, the capital of Roraima. If such relationships exist, that suggests that it may be possible to predict dengue case numbers based on antecedent climate, thus helping develop a climate-based dengue early-warning system for Boa Vista. METHODS: Seasonal Pearson product-moment correlations were developed between 3-week running averages of daily numbers of reported dengue cases for September 1998-December 2001 and certain meteorological variables (thermal, hydroclimatic, wind, atmospheric pressure, and humidity) up to 25 weeks before. Two-sample t tests were also applied to test for statistically significant differences between samples of daily dengue cases with above-average values and samples with below-average values for three-variable meteorological combinations. These multivariate combinations consisted of the three climate measures that together explained the greatest portion of the variance in the number of dengue cases for the particular season. RESULTS: The strength of the individual averaged correlations varied from weak to moderate. The correlations differed according to the period of the year, the particular climatic variable, and the lag period between the climate indicator and the number of dengue cases. The seasonal correlations in our study showed far stronger relationships than had daily, full-year measures reported in previous studies. Two-sample t tests of multivariate meteorological combinations of atmospheric pressure, wind, and humidity values showed statistically significant differences in the number of reported dengue cases. CONCLUSIONS: Relationships between climate and dengue are best analyzed for short, relevant time periods. Climate-based multivariate temporal stochastic analyses have the potential to identify periods of elevated dengue incidence, and they should be integrated into local control programs for vector-transmitted diseases.