The Role of in vivo Reflectance Confocal Microscopy in Cutaneous T-cell Lymphoma follow up

Background: Over the last few decades, Reflectance Confocal Microscopy (RCM) has been tested as a diagnostic technique and recently, demonstrates effectiveness to monitor the therapeutic response in melanoma and non-melanoma skin cancer, but it has not been used for follow-up in Cutaneous Lymphoma. This innovative technology allows an in vivo dynamic evaluation of multiple lesions and helps to identify areas of active disease. Moreover, the non-invasive nature of this technique allows repetitive sampling without biopsy collection, causing no further morbidity to patients. Its main advantage is the possibility of risk-free longitudinal monitoring. Objective: Our aim was to evaluate the role of RCM in the follow-up of patients with Mycosis Fungoides (MF). Additionally, to correlate RCM features with clinical and histopathological features before and after treatment. Method: Patients were assessed with RCM on the same site that diagnostic biopsies were performed and re-assessed 6 months after treatment. RCM descriptors were defined by a systematic review. Histopathological correlation and clinical correlation were assessed. Results: A total of 30 patients were assessed by RCM and biopsies were taken in 38 lesions. After 20 to 30 weeks under treatment, 19 lesions were re-assessed by RCM and 12 were re-biopsied. RCM demonstrated good correlation with clinical and histopathological assessments with 4 RCM parameters (epidermotropic lymphocytes, Pautier’s microabscess, interface dermatitis and junctional lymphocytes) achieving an AUC 0.955 (SD: 0.053, p: 0.003). Conclusion: RCM is an excellent tool to assess the response of skin lesion in patients with MF, with excellent correlation with clinic and histological assessment. Keywords: Follow up, Score, Cutaneous T-cell lymphoma, Skin cancer, Reflectance Confocal Microscopy, Mycosis Fungoide

APLICAÇÃO DE ÁCIDO TRICLOROACÉTICO NO TRATAMENTO DE ÚLCERA CRÓNICA

Background: The treatment of leg ulcers is multidisciplinary and varies with extent, duration, factors that triggered the wound and also, patient comorbities. In literature, many studies have focused only on the treatment of venous ulcers in patients without comorbidities or with compensated comorbidities, which, in practice, correspond to a restricted group of patient. There is no study that addresses the treatment of multifactorial ulcers in patients with multiple comorbidities.Methods: Case report about a patient with comorbidities and multifactorial chronic ulcer, who was submitted to 66 applications of trichloroacetic acid (ATA) in a concentration of 90%.Results: The ulcer was complete healed in 10 months with pain control and improvement of quality of life.Conclusion: Our case report discusses the application of trichloroacetic acid (ATA) in a concentration of 90% as an effective therapeutic option, low cost and easy applicability in patients with multiple comorbidities and multifactorial decompensated chronic ulcers.Introdução: O tratamento de úlcera crónica é multidisciplinar e depende da extensão, da duração, dos fatores que a desencadearam e também das comorbidades do paciente. Na literatura, a maioria dos estudos aborda tratamento da úlcera de etiologia venosa em pacientes sem comorbidades ou com as mesmas compensadas, o que, na prática, corresponde a um grupo restrito de pacientes. Há a necessidade de estudos sobre tratamento de úlceras multifatoriais em pacientes com múltiplas comorbidades.Método: Relato de caso de paciente com comorbidades descompensadas, portador de úlcera crónica multifatorial, submetido a 66 aplicações do ácido tricloroacético (ATA) na concentração de 90%.Resultados: Cicatrização completa da úlcera em 10 meses com melhora da dor crónica e melhora considerável da qualidade de vida do paciente.Conclusão: Esse relato de caso apresenta o ácido tricloroacético como opção terapêutica efetiva, de baixo custo e fácil aplicabilidade para pacientes com múltiplas comorbidades, portadores de úlceras crônicas multifatoriais

Lasers e preenchimentos: possíveis complicações

O tratamento das cicatrizes de acne, queixa dermatológica comum e motivo de ansiedade para os pacientes é desafiante, consistindo geralmente em múltiplas abordagens seriadas. Descreve-se um caso em que foram indicados preenchimento com ácido hialurônico e laser fracionado de CO2, tendo ocorrido complicação inusitada, devido ao curto intervalo de tempo entre a utilização das técnicas. Discutem-se a necessidade de relação médico/paciente estreita e confidente para conter a ansiedade dos pacientes e de estudos que determinem o intervalo ideal entre as abordagens terapêuticas no tratamento das cicatrizes de acne

Onychomatricoma: a case report with 5-year follow-up

Tullia Cuzzi. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Submitted by Janaína Nascimento ([email protected]) on 2019-04-24T15:01:46Z No. of bitstreams: 1 ve_Ishida_Cleide_etal_INI_2016.epub: 1274391 bytes, checksum: ae36438cb28cd6e94f0cc04945cc2474 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-04-25T13:38:37Z (GMT) No. of bitstreams: 1 ve_Ishida_Cleide_etal_INI_2016.epub: 1274391 bytes, checksum: ae36438cb28cd6e94f0cc04945cc2474 (MD5)Made available in DSpace on 2019-04-25T13:38:37Z (GMT). No. of bitstreams: 1 ve_Ishida_Cleide_etal_INI_2016.epub: 1274391 bytes, checksum: ae36438cb28cd6e94f0cc04945cc2474 (MD5) Previous issue date: 2016Federal University of Rio de Janeiro. School of Medicine. University Hospital. Sector of Dermatology. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. School of Medicine. University Hospital. Sector of Dermatology. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. School of Medicine. University Hospital. Sector of Pathology. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. School of Medicine. University Hospital. Sector of Dermatology. Rio de Janeiro, RJ, Brazil.The authors present a case of onychomatricoma, a rare benign tumour of the nail matrix, first described by Baran and Kint in 1992. The lesion appeared on the proximal nail fold, covering half the nail of the second left finger. The nail was thickened and yellowish with longitudinal melanonychia. It was surgically removed with very satisfactory aesthetic results even after 5 years. A review on the subject is also presented

Case report of a challenging medium-sized congenital melanocytic nevus (CMN): Highlighting a role for reflectance confocal microscopy (RCM) for evaluating changing CMN in children.

A 3.5-month-old boy presented with a changing medium-sized congenital melanocytic nevus on his leg. Due to atypical features on dermoscopy and reflectance confocal microscopy (RCM), an excision of the area of concern was performed. Histopathology showed many of the pathological features usually associated with a diagnosis of melanoma in situ in older patients, but due to the young age of the patient, absence of mitoses, and the degree of atypia, a diagnosis of a dysplastic compound nevus arising in a congenital compound (predominantly dermal) nevus was favored. In our case, RCM corresponded to histopathology helped target the area of concern and map the clinical and subclinical components to facilitate an optimal biopsy