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Made available in DSpace on 2018-12-11T17:27:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-01-01. Added 1 bitstream(s) on 2021-07-15T15:03:57Z : No. of bitstreams: 1 S0365-05962016000100049.pdf: 319668 bytes, checksum: 5210661e92fd56dd2bdededc908c4a4f (MD5) The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?. Hospital Israelita Albert Einstein Hospital Alemão Oswaldo Cruz-São Paulo Oncoderma-São Paulo Universidade Federal do Rio Grande do Sul (UFRGS) Hospital de Clínicas de Porto Alegre Departamento de Câncer de Pele A. C. Camargo Cancer Center Universidade Federal de Minas Gerais (UFMG) Universidade Estácio de Sá (UNESA) Hospital Ipiranga Universidade Estadual do Pará (UEPA) Instituto do Câncer do Estado de São Paulo (ICESP) Universidade Estadual Paulista “Júlio de Mesquita Filho”(UNESP) Universidade Estadual Paulista “Júlio de Mesquita Filho”(UNESP)

Earlobe keloids are benign, fibrous proliferations that occur in predisposed persons at sites of cutaneous injury. No single best therapeutic modality is indicated.To describe a 1-year follow-up of 12 patients with earlobe keloids treated by shaving followed by cryosurgery and intralesional injection of triamcinolone.Twelve patients were treated with combined surgery and cryosurgery.After 1 year, major response was observed in nine cases (75%) and moderate response in two cases (16%); one case had a relapse 5 months after the surgery.These results are highly encouraging because all patients showed improvement. Shaving associated with cryosurgery seems to be a useful treatment for large keloids scars.

INTRODUCTION: There are various approaches to the treatment of cutaneous tumors; one of them is treatment with imiquimod, a synthetic toll-like receptor agonist with a low molecular weight that offers a topical, noninvasive, and non-surgical therapeutic option. The main objective of our study was to provide data on 89 patients who used a 5% imiquimod cream for the treatment of cutaneous tumors at the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas from 2003 to 2008. MATERIALS AND METHODS: Here, we present our experience in the treatment of 123 cutaneous tumors of various types, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen's disease, erythroplasia of Queyrat, Paget's disease, and trichoepithelioma, with 5% imiquimod cream from 2003 to 2008 in the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas. Patients were divided into two separate groups according to their diagnosis and comorbidities; these comorbidities included epidermodysplasia verruciformis, xeroderma pigmentosum, albinism, basal cell nevus syndrome, Brooke-Spiegler syndrome, HIV, chronic lymphocytic leukemia, B-cell lymphoma, and kidney transplantation. Treatment duration, response to imiquimod, follow-up, recurrence, and local and systemic reactions associated with use of the drug were analyzed. Epidemiological data were obtained and cure rates were calculated. RESULTS: The ratio of women to men was 1.28:1, and the mean age was 63.1 years. Tumors were located mainly on the face, back, trunk, and legs. For patients with comorbidities, the overall cure rate was 38%. These specific patients demonstrated cure rates of 83.5% for superficial BCC and 50% for Bowen's disease. Aggressive BCC and superficial and nodular BCC did not present a good response to treatment. Trichoepitheliomas and nodular BCC showed a partial response, and erythroplasia of Queyrat showed a complete response. For patients without comorbidities, the overall cure rate was 73%. For these patients, the cure rates were 85.7% for superficial and nodular BCC, 88% for superficial BCC, 57% for Bowen's disease, 50% for nodular BCC, and 50% for aggressive BCC. One SCC lesion demonstrated a complete response, and tumors caused by Paget's disease and erythroplasia of Queyrat presented a partial response. None of the tumors considered as clinically cured recurred. Thirty-seven lesions demonstrated no response to imiquimod. Having a cutaneous comorbidity, high-risk tumors such as mixed aggressive BCC (sclerodermiform or micronodular), nodular BCC, or Bowen's disease, and presenting no local reaction to imiquimod were considered as risk factors for a worse prognosis. We demonstrate that patients with no response to imiquimod, even when they demonstrated no local reaction, can undergo another cycle of six weeks of imiquimod treatment and show a complete response. The healing pattern led to good cosmetic outcomes, and the side effects were tolerable. CONCLUSIONS: Our experience confirms imiquimod as an effective treatment option for several types of cutaneous tumors, especially in patients without the cutaneous comorbidities cited above and with low-risk tumors. Imiquimod has a relatively low cost compared to other therapeutic options and can be delivered via ambulatory care to patients with surgery contraindications, and its side effects are tolerable.

O carcinoma basocelular (CBC) é tumor constituído por diferentes tipos histológicos, que demonstram diverso potencial de agressividade. Sabe-se que a correlação entre os tipos histológicos de CBC encontrados no material de biópsia pré-operatória e no material da peça cirúrgica excisional não é total. Na literatura esta correlação varia de 42,7 a 80,0% quando analisados os tipos histológicos predominantes (THP). No presente estudo foi feita análise retrospectiva de 70 casos de CBC primário submetidos a biópsia préoperatória e cirurgia excisional. A amostra foi analisada estatisticamente quanto ao gênero e idade dos doentes e localização anatômica dos CBC, demonstrando ser comparável aos demais estudos da literatura. Também foram avaliados o tamanho médio tumoral e o tipo de reconstrução utilizado. A média do maior eixo dos CBC foi de 20 mm e 54% dos casos necessitaram reconstrução complexa, como retalhos e enxertos, mostrando ser amostra representativa de tumores de médio a grande porte. A avaliação histológica foi feita de modo padronizado, determinando tanto o THP quanto os tipos histológicos acessórios (THA) encontrados no material das biópsias pré-operatórias e nas peças cirúrgicas excisionais. Houve 78,3% de correlação entre THP da biópsia e peça cirúrgica, 87,0% de correlação entre THP e/ou THA da biópsia e THP da peça cirúrgica e 92,7% de correlação entre tipos agressivos ou não agressivos. Conclui-se que a biópsia préoperatória é útil para predizer o THP de CBC da peça cirúrgica excisional na maioria dos casos. No entanto, é importante ressaltar que, quando descrito apenas o THP encontrado na biópsia, ocorre 21,7% de falha no diagnóstico. Quando descritos THP e THA encontrados na biópsia a falha diagnóstica cai para 13%. Quando a intenção da biópsia for a determinação da presença de tipos de CBC agressivos ou não, a falha no diagnóstico é de apenas 7,3% Basal cell carcinoma (BCC) is a tumor presenting many histological types, each one possessing a specific aggressivity potential. It\'s known that correlation between histological types found in preoperative biopsy specimens and excisional surgery specimens is not total. When correlation between predominant histological types (PHT) is analyzed, concordance value varies from 42,7 to 80,0% in the literature. In the present study 70 primary BCC submitted to preoperative biopsy and excisional surgery were retrospectively analyzed. The sample was statistically analyzed in terms of patients\' gender and age and anatomical location of the tumour and was found to be similar to other reports in the literature. Average size of tumors and type of surgical reconstruction employed were also evaluated. Average size of the largest tumour axis was 20 mm and 54% of the cases needed complex reconstructions, such as flaps and grafts, demonstrating that the sample was represented by medium to large sized tumors. Histological evaluation was made in a patterned way, determining PHT and accessory histological types (AHT) in both preoperative biopsies and excisional surgery specimens. Results obtained were: 78.3% correlation between biopsy PHT and excisional surgery PHT, 87.0% correlation between biopsy PHT and/or AHT and excisional surgery PHT and 92.7% correlation when BCC were classified as \"aggressive\" or \"non aggressive\" . Conclusion: preoperative biopsy is useful to predict BCC\'s PHT of excisional surgery specimen in most cases. However, it\'s important to note that when biopsy findings are limited to the description of the PHT , there is a 21.7% diagnostic failure. When both PHT and AHT found in biopsy are described, diagnostic failure falls to 13%. When the intention is determining the presence of aggressive or non aggressive types of BCC, diagnostic failure is only 7.3%

FUNDAMENTOS: O carcinoma basocelular é tumor constituído por diferentes tipos histológicos, que demonstram diversificado potencial de agressividade. Sabe-se que a correlação entre os tipos histológicos de carcinoma basocelular encontrados no material de biópsia pré-operatória e no material da peça cirúrgica excisional não é total. Na literatura essa correlação varia de 42,7 a 80%. OBJETIVO: Avaliar a correlação entre os tipos histológicos de carcinoma basocelular nas biópsias incisionais e respectivas peças cirúrgicas excisionais. MÉTODOS: Análise retrospectiva de 70 casos de carcinoma basocelular primário submetidos a biópsia pré-operatória e cirurgia excisional. A avaliação histológica foi feita de modo padronizado, determinando tanto o tipo histológico predominante quanto os tipos histológicos acessórios encontrados no material das biópsias préoperatórias e nas peças cirúrgicas excisionais. RESULTADOS: Houve 78,3% de correlação entre tipo histológico predominante da biópsia e peça cirúrgica e 87% de correlação entre tipo histológico predominante e/ou tipo histológico acessório da biópsia e tipo histológico predominante da peça cirúrgica. CONCLUSÃO: A biópsia pré-operatória é útil para predizer o tipo histológico predominante de carcinoma basocelular da peça cirúrgica excisional na maioria dos casos. No entanto, é importante ressaltar que, quando descrito apenas o tipo histológico predominante encontrado na biópsia, ocorre 21,7% de falha no diagnóstico. BACKGROUND: Basal cell carcinoma is a tumor with many histologic types, each one with different aggressiveness potential. The known correlation between histologic types found in preoperative biopsy samples and excisional specimens is not absolute. Correspondence rates vary from 42.7 to 80.0% in medical literature. OBJECTIVE: To evaluate the correlation between histologic types of basal cell carcinoma in preoperative biopsies and their respective excised surgical specimens. METHODS: A retrospective analysis of 70 primary basal cell carcinoma cases submitted to preoperative biopsies and excisional surgery. The histologic evaluation was performed according to standard practice determining both the predominant and secondary histologic types found in preoperative biopsy materials and surgically excised specimens. RESULTS: There was a 78.3% correlation rate between the predominant histologic type of the biopsy and the surgical specimen, and an 87% correspondence between the predominant histologic type and/or secondary histologic type of the biopsy and/or predominant histologic type of the surgical specimen. CONCLUSION: The preoperative biopsy is useful for predicting the predominant basal cell carcinoma histologic type of the surgical excisional specimen in most cases. Nevertheless, when only the predominant histologic type found in biopsy is described, there is a 21.7% failure rate in diagnosis. When both predominant histologic types and secondary histologic types found in the biopsy are described, diagnostic failure drops to 13%.