Necrobiotic xanthogranuloma without paraproteinemia

Necrobiotic xanthogranuloma is a chronic granulomatous and xantomathous disease, characterized by indurated, nontender, yellowish and erythematous nodules and plaques especially located on the periorbital region. It is commonly associated with paraproteinemia and an increased risk for hematological and lymphoproliferative malignancies. Its pathogenesis remains unclear. Alkylating agents, such as chlorambucil and melphalan may be used to treat the disease with variable success. We report a case of this rare disease in a patient with a solitary tumor and without paraproteinemia.O xantogranuloma necrobiótico é doença crônica granulomatosa e xantomatosa, caracterizada por pápulas e placas infiltradas, eritematosas e amareladas, preferencialmente localizadas na região periorbital. É comum associar-se com paraproteinemia e risco aumentado para malignidades hematológicas e linfoproliferativas. Sua patogênese permanece desconhecida. Agentes alquilantes, como clorambucil e melfalan, podem ser utilizados no tratamento com sucesso variável. Relata-se um exemplo dessa rara doença em paciente com lesão única e sem paraproteinemia.Universidade Federal de São Paulo (UNIFESP) Departamento de Dermatologia Escola Paulista de MedicinaUNIFESP, Depto. de Dermatologia Escola Paulista de MedicinaSciEL

Sebaceous hyperplasia: a pilot study to correlate this skin disease with circulating androgen levels

BACKGROUND: The sebaceous glands are susceptible to the effects of androgens. A benign proliferation of these hormones, i.e. hyperplasia, occurs with age. OBJECTIVES: This was a pilot study to demonstrate whether any correlation exists between circulating androgen levels and an increase in the incidence of sebaceous hyperplasia. METHODS: Sixteen female patients with a diagnosis of sebaceous hyperplasia were compared to a control group of females of a similar age without the disease. Blood tests were performed on participants of both groups to measure circulating androgen levels (free and total testosterone and androstenedione levels). Results were tabulated for statistical analysis. RESULTS: These data showed no statistically significant differences in circulating androgen levels between the patients with sebaceous hyperplasia and the control group. CONCLUSION: These data suggest that no significant changes occur in circulating androgen levels [free and total testosterone, androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulfate] in patients with sebaceous hyperplasia.FUNDAMENTOS: As glândulas sebáceas são suscetíveis à ação dos hormônios androgênios e apresentam proliferação benigna com a idade, ou seja, hiperplasia. OBJETIVOS: Estudo piloto para verificar se há correlação entre a taxa de hormônios masculinos circulantes e o aumento da incidência da hiperplasia das glândulas sebáceas. MÉTODOS: 16 pacientes do sexo feminino, com diagnóstico de hiperplasia sebácea cutânea, foram comparados a um grupo-controle de mesmo gênero e idades semelhantes, sem a doença. Ambos os grupos foram submetidos a testes de dosagem sanguínea para avaliação das taxas de hormônios androgênios circulantes (testosterona livre e total, androstenediona). Os resultados foram tabulados e analisados estatisticamente. RESULTADOS: Os dados demonstraram não haver mudanças nos níveis de hormônios masculinos circulantes dos pacientes com hiperplasia sebácea cutânea, quando comparados ao grupo-controle. CONCLUSÃO: Os dados sugerem que não há alterações estatisticamente significantes nas taxas dos hormônios circulantes (testosterona livre e total, androstenediona, deidroepiandrosterona, sulfato de deidroepiandrosterona) dos pacientes com hiperplasia sebácea cutânea.Universidade Federal de São Paulo (UNIFESP) Departamento de DermatologiaUNIFESP, Depto. de DermatologiaSciEL

Polypoid melanoma and superficial spreading melanoma different subtypes in the same lesion

Melanoma is a malignant melanocytic neoplasm with high mortality rate, and steadily and universally increasing incidence rates. Polypoid melanoma is considered an exophytic variant of the nodular subtype. The incidence of polypoid melanoma is extremely variable, most likely because of the different criteria used for its characterization. We presented a rare case of polypoid melanoma and superficial spreading melanoma in the same lesion.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Melanoma developed during pregnancy - A case report

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.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of DermatologyUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departments of Dermatology and PathologyUNIFESP, EPM, Department of DermatologyUNIFESP, EPM, Departments of Dermatology and PathologySciEL

Giant atypical lipoma

Liposarcomas correspond to the most common histological subtype of soft tissue sarcomas. They can be subdivided into: well differentiated or atypical lipoma, undifferentiated, myxoid, round, and pleomorphic cells. Atypical lipomas are the most prevalent and usually appear as asymptomatic softened tumors. They are locally aggressive but rarely lead to distant metastases. The diagnosis of this tumor is based on the imaging and histopathologic findings. Treatment consists of excision surgery with complete tumor removal. It has a good prognosis due to the low percentage of distant metastases. We report a rare case of giant atypical lipoma as well as the adopted therapy and evolution.Univ Fed Sao Paulo UNIFESP, Dept Dermatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Pathol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Dermatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Pathol, Sao Paulo, SP, BrazilWeb of Scienc

Dermoscopic patterns of molluscum contagiosum: a study of 211 lesions confirmed by histopathology

BACKGROUNDS: Although easily diagnosed, molluscum contagiosum may present as a single lesion or as several small, inflamed lesions of difficult diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of molluscum contagiosum and to compare the findings from clinical examination and dermoscopy. METHODS: Histopathologically confirmed lesions were evaluated clinically and dermoscopically in 57 patients. RESULTS: At clinical examination and dermoscopy of 211 lesions, orifices were visualized in 50.24% and 96.68% of the lesions, and vessels in 6.16% and 89.10%, respectively. The vascular patterns found in the 188 lesions in which vessels were found at dermoscopy were the crown (72.34%), radial (54.25%) and punctiform patterns (20.21%). Half of the 188 lesions had a combination of vascular patterns, with the flower pattern (a new vascular pattern) being found in 19.68% of cases. More orifices and vessels were identified at dermoscopy than at clinical examination, including cases with inflammation or perilesional eczema and small lesions. Punctiform vessels were associated with inflammation, excoriation and perilesional eczema. CONCLUSIONS: Dermoscopy performed on molluscum contagiosum lesions proved superior to dermatological examination even in cases in which clinical diagnosis was difficult. The presence of orifices, vessels and specific vascular patterns aids diagnosis, including differential diagnosis with other types of skin lesion.FUNDAMENTOS: Embora de fácil diagnóstico, o molusco contagioso pode apresentar-se como lesões inflamadas, únicas ou pequenas de difícil diagnóstico. OBJETIVO: Descrever características dermatoscópicas do molusco contagioso e comparar achados do exame clínico e dermatoscópico. MÉTODOS: Avaliou-se clínica e dermatoscopicamente lesões confirmadas pela histopatologia em 57 pacientes. RESULTADOS: Nos exames clínico e dermatoscópico de 211 lesões, foram visualizados orifícios em 50,24% e 96,68% das lesões e vasos em 6,16% e 89,10% delas, respectivamente. Os padrões vasculares encontrados em 188 lesões que apresentaram vasos à dermatoscopia foram coroa (72,34%), radial (54,25%) e puntiforme (20,21%). Metade das 188 lesões apresentou padrão vascular combinado, sendo o padrão em flor (novo padrão vascular) responsável por 19,68%. Foram identificados mais orifícios e vasos no exame dermatoscópico que no clínico, inclusive naquelas com inflamação, eczema perilesional e de tamanho pequeno. Vasos puntiformes relacionaram-se com inflamação, escoriação e eczema perilesional. CONCLUSÕES: A dermatoscopia das lesões de molusco mostrou-se superior ao exame dermatológico mesmo quando seu diagnóstico clínico torna-se difícil. A presença de orifícios, vasos e padrões vasculares específicos auxilia no seu diagnóstico e na diferenciação de outras lesões de pele.Universidade Federal de Goiás Ambulatório de DermatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de DermatologiaUNIFESP, EPM, Depto. de DermatologiaSciEL

Giant congenital melanocytic nevi: 40 years of experience with the serial excision technique

Although giant congenital melanocytic nevus is a rare lesion, it causes significant deformity and carries a risk of malignant degeneration. Different surgical techniques for the lesion removal are described, including serial resection, resection with skin grafting, and resection and coverage with expanded skin flap (skin expanders). The aim of this study is to report the author's 40 years of experience with cases requiring at least 4 serial excisions to complete the treatment. Serial resection is an effective, safe, and simple technique that requires a lot of patience. Treatment often results in a single linear scar, requires no donor sites, nor large flaps. It is not subject to potencial complications of expanders and avoid aesthetic deformities depending on the location.Univ Fed Sao Paulo UNIFESP, Dermatol Dept, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dermatol Surg Ctr, Sao Paulo, SP, BrazilUniv Sao Paulo, Sch Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dermatol Dept, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dermatol Surg Ctr, Sao Paulo, SP, BrazilWeb of Scienc

Necrolytic acral erythema: a rare skin disease associated with hepatitis C virus infection

Abstract: Necrolytic acral erythema is a rare skin disease associated with hepatitis C virus infection. We report a case of a 31-year-old woman with hepatitis C virus infection and decreased zinc serum level. Physical examination revealed scaly, lichenified plaques, well-demarcated with an erythematous peripheral rim located on the lower limbs. After blood transfusion and oral zinc supplementation the patient presented an improvement of lesions