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Background Photodynamic therapy (PDT) has been described for photoageing treatment, but its mechanism of action is not clarified. Although PDT-induced matrix metalloproteinase (MMP) expression and collagen production have been studied in normal skin and in inflammatory disease, there is no report about the effect of PDT on the extracellular matrix in photodamaged skin. Objectives To evaluate skin remodelling induced by methyl aminolaevulinate (MAL)-PDT in photodamaged skin by histological and immunohistochemical studies. Methods Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode (635 nm, 37 J cm−2). Skin biopsies were performed in all patients before and at 3 and 6 months after treatment. Immunohistochemical studies evaluated collagen types I and III, MMP-1, MMP-3, MMP-7, MMP-9, MMP-12 and tissue inhibitor of metalloproteinases-1. Results Global improvement in photodamaged skin was observed. A significant increase in expression of MMP-9 in the dermis was detected at 3 months after treatment ( P = 0·002). Significant increases in the expression of collagen type I at 3 months ( P = 0·002) and at 6 months after treatment ( P = 0·001) were also observed. Conclusions Skin remodelling induced by MAL-PDT was demonstrated in photodamaged skin. Two sessions of MAL-PDT increases immunohistochemical expression of MMP-9 in the dermis at 3 months after treatment, and also of collagen type I. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool., Objective: To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors., Methods: 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps., Results: The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented., Study Limitations: The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented)., Conclusion: This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject., (Published by Elsevier España, S.L.U.)

Competing Interests: The authors have declared that no competing interests exist.

Background: High-frequency ultrasound (HFUS) has been studied in the diagnosis and therapeutic management of basal cell carcinoma (BCC). The accuracy of this method for location of deep margins remains unknown. This study evaluates HFUS for localization of deep surgical margins in BCC., Materials and Methods: Ultrasound images of 83 lesions from 67 patients with clinical and dermoscopic diagnosis of BCC were compared with histopathological findings. Pearson's correlation coefficient was used to assess the relationship between thickness as measured by HFUS and histopathology., Results: A strong correlation between HFUS and histopathological measurements was identified (r = 0.9744, P < .001). HFUS had sensitivity of 96%, specificity of 84%, and accuracy of 91% for measurement of deep tumor margins. Factors affecting tumor measurement on HFUS include marked basophilic degeneration of collagen, presence of peritumoral hypertrophic glands or hair follicles, fibrosis, and dense inflammatory changes related to the tumor itself or to prior procedures., Conclusion: High-frequency ultrasound was effective in localizing deep tumor margins in BCC. Therefore, we believe that this diagnostic imaging method is important when selecting a therapeutic approach, considering Mohs micrographic surgery, and evaluating the surgical site., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Atrophoderma of Pasini and Pierini is a skin disorder affecting dermal collagen and is clinically characterized by well-defined plaques of depressed skin. Histopathological changes are subtle, and in most cases, the diagnosis requires a comparative study with healthy skin from the same anatomical site. High frequency ultrasound is a useful imaging method for diagnosis of atrophic skin changes. A case is presented in which ultrasound can support the clinical and the histopathological diagnosis of atrophoderma of Pasini and Pierini.

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.

The present essay is aimed at getting the radiologist familiar with the basic histological skin structure, allowing for a better correlation with sonographic findings. A high-frequency (22 MHz) ultrasonography apparatus was utilized in the present study. The histological analysis was performed after the skin specimens fixation with formalin, inclusion in paraffin blocks and subsequent staining with hematoxylin-eosin. The authors present a literature review showing the relationship between sonographic and histological findings in normal cutaneous tissue, and discuss the technique for a better performance of the sonographic scan. High-frequency ultrasonography is an excellent tool for the diagnosis of different skin conditions. However, as this method is operator-dependent, it is crucial to understand the normal skin structure as well as the correlation between histological and sonographic findings.

Collision tumors are characterized by the coexistence of two cancers in the same anatomical site and its pathogenesis remains controversial. Although uncommon, the association of basal cell carcinoma and melanocytic nevus is the most common among combinations of skin tumors. Even rarer is the association of two malignant tumors. We report a case of tumor collision representing melanoma and basosquamous cell carcinoma, a combination not previously described in the literature, since there are no reported cases of melanoma with this type of basal cell carcinoma.

Pigmented Bowen's disease is rare, though more prevalent in men. It presents as a well-delineated plaque in areas unexposed to sun. There are reports of association with seborrheic keratosis, solar lentigo or exuberant pigmentation of genital and intertriginous regions. A specific dermoscopy finding is the presence of brown or gray dots in regular arrangement and coiled or dotted vessels. Thus, we aim to raise awareness of the diagnosis of pigmented Bowen's disease in pigmented lesions.

The authors present a rare case of osteoma cutis miliaris and briefly update the current knowledge about its clinic, pathogenesis, and therapeutic options.

Lichen aureus is a rare variant of pigmented purpura, with a chronic and benign course. It is generally asymptomatic and often occurs in the lower limbs, presenting as erythematous brownish, coppery or golden macules and/or papules. The diagnosis is based on clinical and histopathological findings. The dermatoscopic pattern has been considered a useful tool in diagnosis presumption. We describe a case with a confluent morphological pattern, called agminate lichen aureus.

Follicular red dots have been described as a trichoscopic feature of active discoid lupus erythematosus of the scalp and its presence associated with a better prognosis. We report five patients with pigmentary disorders in whom follicular red dots were detected during scalp examination. We suggest that this pattern is probably related to the rich vasculature that naturally envelops the normal hair follicle. The possible implications of such proposition in cases of discoid lupus erythematosus and other scalp disorders are also discussed.

Background: Dysplastic nevi are among the most important cutaneous melanoma simulators. They are important risk markers for this neoplasia and can be its potential precursors. Some authors found a statistically significant relationship between the degree of dysplasia and the risk for developing melanoma. However, reproducibility of grading criteria ranged from poor to fair in the researched articles., Objective: To test the reproducibility of the grading criteria proposed by Sagebiel et al. regarding dysplastic nevi., Methods: Histological specimens of 75 dysplastic nevi were graded, independently and in a blinded fashion, according to preestablished criteria, by a panel of 10 pathologists with different levels of experience. Diagnostic agreement was calculated using weighted kappa and intraclass correlation coefficients., Results: The average of weighted kappa values was 0.13 for all observers, 0.12 for dermatopathologists, 0.18 for general pathologists and 0.05 for residents. Intraclass correlation coefficient values were 0.2 for all observers, 0.18 for dermatopathologists, 0.33 for general pathologists and 0.15 for residents., Conclusions: Histopathological grading for dysplastic nevi was not reproducible in this Brazilian series, so the criteria used are not a helpful histopathological parameter for clinicopathological correlation.

Background: Mesotherapy or intradermotherapy is used as a cosmetic procedure for many purposes, among them for cellulite., Methods: We report a case of oleoma on the thighs and buttocks that appeared two years after the injection of an unknown substance for improvement of cellulite., Results: Lesions and associated pruritus resolved with colchicine, leaving depressed scars., Conclusions: Serious and peer-reviewed investigations must be performed to certify the efficacy and safety of this procedure., (© 2012 The International Society of Dermatology.)

Two cases of relapse in borderline leprosy were reported. Despite the late-reversal, reaction-like feature, the suspicion of relapse in both was based on persistent and slow-developing skin lesions and an absence of acute neuritis or reaction during one year of follow-up. The authors have considered this possible occurrence in lepromatous borderline-treated patients after their immune cellular restoration and defend that not all Type 1 reactions would be an inflammatory answer to persistent Mycobacterium leprae, but that they could be. Therefore, a relapse diagnosis could be applied and it is more advisable, as one year of Multi-Drug Therapy (MDT) is less dangerous and more efficient for these cases than one year of corticosteroids.

Background: Although in the majority of melanomas there is no evidence of pre-existing melanocytic nevus, it is believed that malignant transformation may sometimes occur within a benign precursor., Objectives: We sought to describe the morphologic features of de novo melanoma and melanoma arising from nevi by means of in vivo confocal microscopy, and to correlate them with their corresponding histopathologic features., Methods: A total of 113 consecutive, histopathologically proven melanoma cases, 33 arising from a nevus and 80 occurring de novo, were imaged by confocal microscopy and retrospectively evaluated. Cyto-architectural features preferentially expressed in melanomas arising from nevi and in de novo melanomas were defined., Results: By confocal microscopy, abrupt transition, localized distribution of junctional atypical cells, and the presence of dense dermal nests were the most helpful criteria for categorizing a melanoma as arising from a nevus. Melanomas arising from common and congenital nevi were predominantly composed of roundish, monomorphous cells, whereas melanomas arising either de novo or from dysplastic nevi were characterized by markedly pleomorphic cells., Limitations: The study is retrospective., Conclusion: Confocal microscopy is effective in identifying melanoma even when a nevus is simultaneously present, confirming the clinical usefulness of this methodology. Moreover, distinctive features were observed in de novo melanomas and melanomas arising from nevi, permitting accurate distinction between the two groups. Finally, differences in cell morphology, easily detectable by confocal microscopy, seemed to characterize different melanoma types., (Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

We report a case of primary adenoid cystic carcinoma of the skin in a 44-year-old Brazilian man that was present for 6 years with no metastasis. It is a rare malignant neoplasm of the eccrine gland. Metastases have been found in a few cases, usually to the lungs or lymph nodes. This neoplasm microscopically presents with large nests of cells with adenoid or cribriform features and many epithelial small solid islands. Histopathologic analysis is necessary for diagnosis.

Reed nevus or pigmented spindle-cell nevus may mimic cutaneous melanoma; however, its dermoscopic and histopathological characteristics are different. This case report describes three patients with distinct clinical, dermoscopic and histopathological presentations, which were correlated to enable a differential diagnosis to be made between melanoma and Spitz nevus.

Background: Photodynamic therapy (PDT) is an option for skin rejuvenation. Although many studies report clinical improvement with PDT in photodamaged skin, histologic and morphometric evidence is not documented in most cases., Objective: To evaluate clinical and histopathologic changes induced by methyl aminolevulinate (MAL)-PDT and to morphometrically quantify collagen and elastic fibers in skin remodeling induced by MAL-PDT in photodamaged skin., Methods and Materials: Fourteen patients were treated with two sessions of MAL-PDT. The light source was a light-emitting diode: 635 nm, 37 J/cm(2). Skin biopsies were performed before and 3 and 4 months after treatment. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius techniques. Morphometric studies were done of three samples from each patient., Results: Global clinical improvement was observed in 10 of 14 patients. The histopathologic study showed increased collagen fibers 3 and 6 months after treatment. The decrease in the amount of elastic fiber was statistically significant 3 (p=.016) and 6 (p=.008) months after treatment. The increase in the amount of collagen fiber was statistically significant 6 months after treatment (p=.048)., Conclusion: Clinical improvement with regard to texture, firmness, wrinkle depth, skin coloration, and clearance of actinic keratoses was observed. Histopathologic and morphometric studies were consistent with the clinical findings.

Melanonychia, from the Greek mélaina, means black and is the result of an increased deposition of melanin on the nail plate, originating in the nail matrix. It may have different causes, including subungueal melanoma, making early etiologic diagnosis very important.