Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of non-melanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection.

A controlled trial was performed with the purpose of investigating which factors could be considered of significant risk for the development of basal cell carcinoma. A total of 259 cases of basal cell carcinoma diagnosed from July 1991 to July 1992 were compared with 518 controls matched for age and sex. All subjects in both groups were white. Protocol data were submitted to statistical analysis by the chi-square test and by multiple conditional logistic regression analysis and the following conclusions were reached: 1) light skin color (types I and II of the Fitzpatrick classification), odds ratio of 2.8; outdoor work under constant sunlight, odds ratio of 5.0; the presence of actinic lesions due to exposure to the sun, odds ratio of 4.9, are risk factors perse. 2) Type III skin in the Fitzpatrick classification only represents a risk factor when the patient reports a history of intense sunburns, but not in the absence of such a history. 3) Sunburns per se do not represent a risk factor althorig the point made in item 2 of these conclusions is valid. 4) Other suspected risk factors whose significance was not confirmed by multiple conditioned logistic regression analysis were: residence in rural areas, light eyes and blond hair color, extent of the awareness of the "sun x skin cancer" relationship, familial occurrence of skin cancer, excessive exposure to the sun, and freckles appearing in childhood.Carcinoma, basal cell, epidemiology.Risk factors.

Oculocutaneous albinism is an autosomal recessive disease caused by the complete absence or decrease of melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at increased risk of actinic damage and skin cancer. In Brazil, as in other parts of the world, albinism remains a little known disorder, both in relation to epidemiological data and to phenotypic and genotypic variation. In several regions of the country, individuals with albinism have no access to resources or specialized medical care, and are often neglected and deprived of social inclusion. Brazil is a tropical country, with a high incidence of solar radiation during the year nationwide. Consequently, actinic damage and skin cancer occur early and have a high incidence in this population, often leading to premature death. Skin monitoring of these patients and immediate therapeutic interventions have a positive impact in reducing the morbidity and mortality associated with this condition. Health education is important to inform albinos and their families, the general population, educators, medical professionals, and public agencies about the particularities of this genetic condition. The aim of this article is to present a review of the epidemiological, clinical, genetic, and psychosocial characteristics of albinism, with a focus in skin changes caused by this rare pigmentation disorder.

CONTEXT AND OBJECTIVE: Cutaneous melanoma represents around 3% of all skin tumors. About 20% of such patients will have advanced disease and will die before reaching five years of survival. The aim of this paper was to describe the clinical and histopathological variables and their correlations. DESIGN AND SETTING: Retrospective, descriptive, epidemiological study at the Melanoma Unit, Dermatological Clinic, Irmandade da Santa Casa de Misericórdia, São Paulo. METHODS: Records from 364 cases between May 1993 and January 2006 were analyzed. The frequencies of all study variables and their 95% confidence intervals were determined. The chi-squared test was used to evaluate associations among the variables, adopting a significant level of 0.05. RESULTS: Females predominated, with 1.4 women for each man. The patients’ mean age was 58.9 years. Nonwhite patients represented 13.7% of the sample. The prevalent anatomical sites for cutaneous melanoma were the trunk and feet, for both men and women. Acral lentiginous melanoma represented 22.3% of the cohort. In situ primary lesions were observed in few cases and a high percentage of thick cutaneous melanoma was detected. Ulceration was found in 13.4% of the thin tumors (< 1.0 mm). Thicker and ulcerated lesions predominated in male patients (p = 0.011 and p < 0.001 respectively) and in elderly patients (p = 0.021 and p = 0.015). CONCLUSIONS: The cohort mostly presented thick and ulcerated tumors, denoting late diagnosis and bad prognosis. Also, the sample was characterized by considerable prevalence of female patients, nonwhite patients, limb lesions and acral lentiginous melanoma.

This study allows to validate RCM as a non-invasive method capable of monitoring actinic keratosis therapeutic response to 5-fluorouracil, presenting efficacy comparable to histological examination. Additionally, the results suggest that 5-fluorouracil may be a satisfactory option for therapeutic control of this condition.

BACKGROUNDThe social reality of the albino needs to be more studied in Brazil, as myths and social segregation regarding this illness are likely to be found in the country, with psychosocial and medical implications.OBJECTIVEAs this subject has not been referenced in previous scientific articles in Brazil, this research intends to evaluate the quality of life of the albinos that treated at our medical institution.METHODSThe quality of life was evaluated through the WHOQOL-BREF. Furthermore, two aspects of main relevance in the lives of the albinos were also objects of research, low vision and skin cancer. The sample consisted of forty oculocutaneous albinos and a control group of forty healthy individuals, matched by sex and age.RESULTSAmong the participants, 57.7% were between 18 and 40 years old, 28.2% were between 41 and 60, and 14.1% were over 60. 42.1% had skin cancer before the study, 18.4% had skin cancer during the study and 89.5% stated visual deficit. The results obtained in the questionnaires showed a statistically significant difference in the physical domain, with P < 0.001.CONCLUSIONLow vision combined with skin lesions and social stigma may contribute to disturbances in the quality of life of oculocutaneous albinos. The results presented in this study demonstrated the vulnerability of the affected individuals and the special care required by those patients, at the same time that the need for further research is highlighted in order to better elucidate the aspects related to albinism.

Resumo: FUNDAMENTOS-As características do melanoma acrolentiginoso (MAL) diagnosticado no Brasil são pouco estudadas. OBJETIVOS-Avaliar as características do MAL diagnosticado na Unidade de Melanoma da Santa Casa de São Paulo-UMSC, com-parando essa manifestação com outros subtipos e verificar se as possíveis diferenças entre eles teriam importância na deter-minação do diagnóstico, tratamento e prognóstico. MÉTODO-A casuística da UMSC foi subdividida em dois grupos, um de melanoma acrolentiginoso (MAL) e outro de melano-ma não acrolentiginoso (NAL), que foram comparados quanto a sexo, cor, idade, espessura e nível de invasão da lesão pri-mária, estadiamento, tempo decorrido entre a percepção do tumor e o atendimento pelo médico. RESULTADOS-A casuística correspondente ao MAL mostrou freqüência significativa de pacientes não brancos, com faixa etária mais elevada, com a lesão primária em média, mais espessa e ulcerada. Não ocorreram diferenças significativas quanto ao sexo e estadiamento, bem como com relação ao tempo decorrido entre perceber a neoplasia e procurar o médico. CONCLUSÕES-O MAL diagnosticado na UMSC ocorre, principalmente, em pacientes que normalmente não são alertados para câncer da pele (não brancos) e pertencem a uma faixa etária mais elevada (portanto, do ponto de vista teórico, poderiam estar menos atentos ao início da doença). A maioria apresentou lesão espessa e ulcerada, conseqüentemente de maior risco para metástases. Essa forma de câncer é desconhecida do público em geral e mesmo por boa parcela da classe médica. Palavras-chave: Diagnóstico; melanoma. Summary: BACKGROUND-The characteristics of acral lentiginous melanoma diagnosed in Brazil have been subject to few studies. OBJECTIVES-To evaluate the characteristics of acral lentiginous melanoma diagnosed at the Melanoma Unit of Santa Casa Hospital of Sao Paulo, to compare them with the other melanoma subtypes and to verify whether the possible differences between them are important in the determination of the diagnosis, treatment and prognosis. METHOD-Patients were divided into acral lentiginous melanoma and non-acral lentiginous melanoma groups and compared in reference to sex, color, age, depth and level of invasion of the primary lesion, stage, time between perceiving the tumor and seeking medical assistance. RESULTS-The cases of acral lentiginous melanoma were significantly more frequent among non-whites and the elderly, with the primary lesion, on average deeper and ulcerated, without significant differences in the sex, stage or the time elapsed between noticing the neoplasia and seeking the physician. CONCLUSIONS-Acral lentiginous melanoma diagnosed at the Melanoma Unit of Santa Casa Hospital of Sao Paulo, occurred mainly: in patients: who had not been advised about skin cancer (non-whites) and patients who are elderly and therefore , theoretically, could be less liable to notice the onset of the disease. The majority also presented deeper and ulcerated lesions and consequently with a higher risk of metastasis. This kind of cancer is u...

Resumo: FUNDAMENTOS: Estrias ocorrem em mais de 70% das gestantes. Elas tendem a se desenvolver a partir da 25ª semana gestacional. Apesar de sua etiologia não ser bem compreendida, aceita-se que a combinação de fatores genéticos com alterações endócrinas e estiramento mecânico da pele tem papel significante. Em função dos diferentes resultados encontrados na literatura, os autores avaliaram os fatores de risco comumente citados com o objetivo de determinar se estão associados com a ocorrência de estrias na gestação. OBJETIVO: Avaliar em primíparas os supostos fatores de risco para o aparecimento de estrias. MÉTODOS: Estudo observacional transversal não controlado e descritivo em primíparas. O período avaliado foi de quatro meses (janeiro a maio de 2008), em uma maternidade pública. Foram incluídas 164 primíparas de feto único após 48 horas do parto. Um total de 14 variáveis foi registrado em cada paciente. RESULTADOS: Das 164 mulheres em estudo, 59,8% desenvolveram estrias durante a gestação. Foi estatisticamente significante a associação entre a faixa etária materna (p < 0,01), o peso materno adquirido durante a gestação (p < 0,01) e o peso de recém-nascido (p = 0,01) com o aparecimento de estrias na gestação. O teste de associação utilizado foi o qui-quadrado. CONCLUSÃO: As estrias foram mais frequentes em pacientes mais jovens, nas que adquiriram maior peso na gestação e/ou nas que deram à luz bebês mais pesados. Este estudo sugere que a idade materna mais avançada poderia ser um fator protetor contra a presença de estrias na gestação. Palavras-chave: Derme; Estrias angioides; Fatores de risco; Gravidez; Primíparas Abstract: BACKGROUND: Striae occur in over 70% of pregnant women and tend to develop after 25 weeks of gestation. Despite the fact that their etiology has not yet been fully understood, it is accepted that a combination of genetic factors, endocrine alterations and mechanical stretching of skin play a significant role. Due to different results reported in the literature, the authors assessed commonly cited risk factors to determine whether they are associated with the development of striae in pregnancy. OBJECTIVE: To assess hypothetical risk factors for the development of striae in primiparous women. METHODS: This was a cross-sectional, observational, non-controlled, descriptive study with primiparous women. The study was conducted in a public maternity unit and lasted for four months (from January to May 2008). 164 primiparous women who had had a single fetus pregnancy took part in the study 48 hours after delivery. Fourteen variables were recorded for each patient. RESULTS: From the total sample, 59.8% developed striae during pregnancy. The association of maternal age range (p < 0,01), maternal weight gain during pregnancy (p < 0,01) and birth weight of newborn infants (p = 0,01) with the development of striae during pregnancy was statistically significant. The chisquared test of association was used. CONCLUSIONS: Striae were more frequently observed in younger women, in those who gained more we...