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BACKGROUND: Early melanoma detection allows for timely intervention and treatment, significantly improving the chances of favorable outcomes for patients. Small-diameter melanoma (SDM) typically represents an initial growth phase of cutaneous melanoma. One of the challenges in detecting melanoma in their early stage lies in the fact that dermoscopy criteria have been primarily designed for fully developed lesions. Early-stage melanomas may be difficult to detect and possibly even be overlooked or misinterpreted during examinations. METHODS: The primary aim of this study was to identify valuable clinical and dermoscopic clues to enhance the detection of SDMs. To achieve this objective, we conducted a comprehensive retrospective analysis, including forty SDMs with a diameter of 5 mm or less. These cases were diagnosed over an 8-year period and were collected from five referral centers across Brazil. Seven experienced dermatologists independently assessed the dermoscopic features of each lesion. Additionally, this study includes demographic and histological information. RESULTS: The study encompassed a total of 28 patients, of which 16 were females, accounting for 58% of the participants, with an average age of 43.6 years. Among the small-diameter melanomas (SDMs) under investigation, the majority, constituting 27 cases (69.2%), were identified as "de novo" lesions, i.e., not associated with a nevus. Additionally, eight SDMs (20%) exhibited invasive characteristics, with Breslow index measurements ranging between 0.2 to 0.4 mm, suggesting an early stage of malignancy. During dermoscopic examinations, the most prevalent features observed were irregular dots and globules, present in 95% and 87.5% of cases, respectively. Moreover, brown structureless areas were identified in 70% of lesions, followed by atypical network (67.5%), pseudopods (55%), dotted vessels (47.5%), flat structureless blue-gray areas (42.5%), and irregular blotches (40%). Notably, all SDM were diagnosed in patients under surveillance through total body skin photography (TBSP) and Digital Dermoscopy (DD). CONCLUSIONS: Dermoscopy significantly enhances the diagnostic accuracy of melanoma, even in its early stages. Particularly for high-risk patients with numerous nevi, the identification of a new lesion or subtle changes on dermoscopy during follow-up may serve as the sole clue for an early diagnosis. This emphasizes the critical role of dermoscopy in SDM detection and reinforces the importance of surveillance in high-risk patients for timely and effective management.

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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?

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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 the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ?

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INTRODUÇÃO: A pele é o local mais acometido por neoplasias, em ambos os gêneros. De todas as neoplasias cutâneas, cerca de 80% estão localizadas na face. Para favorecer o diagnóstico precoce das neoplasias cutâneas, a dermatoscopia tem sido amplamente utilizada. Na face, porém, o método apresenta limitações. A microscopia confocal in vivo surge hoje como o método de imagem promissor para o diagnóstico não invasivo de lesões cutâneas, com potencial para preencher as lacunas existentes no exame da pele. OBJETIVOS: O estudo realizado visou descrever os aspectos das neoplasias cutâneas na face à dermatoscopia e microscopia confocal, sua frequência e impacto diagnóstico, bem como sua correspondência histopatológica. MÉTODOS: Dezesseis características dermatoscópicas e vinte e seis características de microscopia confocal e caracteres histopatológicos associados foram aferidos de maneira cega para o diagnóstico em 142 pacientes com neoplasias da face, sendo 54 casos de carcinomas basocelulares, 28 melanomas, 38 queratoses actínicas, sendo 16 pigmentadas, 8 queratoses líquen-plano símile, 7 lentigos solares e 4 carcinomas espinocelulares. Foram analisadas as frequências absolutas e relativas, aplicados o Teste Exato de Qui-Quadrado para Independência, a Regressão Logística para cálculo de odds ratio, coeficientes de correlação de Pearson e medidas de avaliação diagnóstica, como sensibilidade e especificidade. RESULTADOS: Foram determinadas as principais características dermatoscópicas e de microscopia confocal associadas aos grupos diagnósticos estudados e suas correspondências anatomopatológicas.nos cortes convencionais e transversais. O acometimento folicular mostrou-se um importante elemento para as lesões de melanoma da pele fotoexposta, refletindo-se nas características dermatoscópicas e notadamente à microscopia confocal (estrutura em "girassol"), com odds ratio 93,5 para este diagnóstico, sensibilidade de 81% e especificidade de 98%. CONCLUSÃO: Este trabalho conclui que a microscopia confocal in vivo é um método útil para o diagnóstico de lesões neoplásicas da face e apresenta as características associadas aos principais diagnósticos diferenciais e seu substrato anatômico., quando possível complementando a análise com cortes histopatológicos transversais, coplanares ao ponto de vista da microscopia confocal, o que permitiu ilustrar e melhor esclarecer a natureza destas observações.

BACKGROUND: In both genders, the most frequent type of cancer is skin cancer. Of all cutaneous cancers, about 80% locate on the face. Dermoscopy has been a very useful tool to aid in early diagnosis of skin cancer. However, this method has limitations regarding the evaluation lesions on the face. In vivo reflectance confocal microscopy arises as a novel imaging method for non-invasive diagnosis of cutaneous lesions, potentially overcoming some of the existing difficulties on skin examination. OBJECTIVES: The present work assessed the diagnostic features of cutaneous neoplasms of the face, analysing frequencies of main findings on confocal microscopy, dermoscopy and histopathology. METHODS: The presence of sixteen dermoscopic features, twenty-six confocal microscopy aspects and associated histopathological characters were blindly analysed in 142 patients with neoplasms of the face , being 54 cases of basal cell carcinomas , 28 melanomas , 38 actinic keratoses , 16 pigmented type, 8 lichen planus-like keratosis, 7 solar lentigines and 4 squamous cell carcinomas . Absolute and relative frequencies were calculated, exact chi-square test, logistic regression to calculate odds ratios and Pearson correlation coefficients were applied and diagnostic assessment measures, such as sensitivity and specificity were also calculated for each one of the selected features. RESULTS: Main dermoscopic and confocal microscopy features associated with the distinct diagnostic groups of face lesions, as well as their histopathological correspondence in conventional and transversal sections were determined. Follicular involvement proved to be an important element in melanomas of sun damadged skin, contributing to main dermoscopic features and especially proeminent on confocal microscopy (as a "Sunflower-like"structure), with an odds ratio of 93.5, sensitivity of 81% and specificity of 98% for the diagnosis of melanoma. CONCLUSION: We conclude that in vivo confocal microscopy is a useful tool for the diagnosis of neoplastic lesions of the face and present features associated with the differential diagnosis, as well as their anatomic substrate, adding to the analysis with transversal histopathological processing when possible, in order to illustrate and contribute to better understanding of these findings, observed from a common point of view.

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Novos métodos de imagem, como a tomografia óptica de coerência, a ressonância magnética e a ultrassonografia de alta frequência vem sendo desenvolvidos para uso na dermatologia. Entre estes novos métodos, destacamos a microscopia confocal de reflectância in vivo (MCR) como a que mais tem se difundido nos grandes centros de oncologia cutânea e que recentemente mais tem gerado publicações nos grandes periódicos, por permitir resolução semelhante à histológica. A microscopia confocal in vivo tem encontrado espaço nas muitas limitações que ainda se impõem ao diagnóstico dermatoscópico das neoplasias cutâneas, especialmente lesões acrômicas ou hipopigmentadas, lesões na face ou em mucosas. Ainda, alguns estudos tem sugerido grande utilidade na avaliação de margens cirúrgicas e na determinação do melhor local para a realização de biópsias excisionais. Este trabalho prtetende descrever brevemente o funcionamento do microscópio confocal de reflectância a laser e discutir algumas perspectivas que despontam para seu uso na prática cotidiana do cirurgião dermatológico.

New imaging methods, such as optical coherence tomography, magnetic resonance and high frequency ultrasonography, have been developed for use in dermatology. Among the new methods, in vivo reflectance confocal microscopy, has presented the fastest growth in large cutaneous oncology centers and has generated the greatest number of articles in the literature recently, due to its resolution ? similar to histological resolution. In vivo confocal microscopy has been particularly useful given the many limitations of the dermoscopic diagnosis of cutaneous neoplasias, especially of achromic or hypopigmented lesions, lesions in the face or in mucous membranes. Some studies have also suggested considerable utility in the assessment of surgical margins and in determining the best area of the body for carrying out excisional biopsies. This study briefly describes how the confocal laser reflectance microscope works and discusses some of the issues that arise in its use in the daily practice of dermatologic surgeons.