Moisés Wolfenson1,2,3Cláudio Roncatti2,3Telhard Barros1,3Fernando Cerqueira Filho1,3Edvaldo Alfredo da Silva Júnior1,31 Clínica Multiplástica do Recife.2 Clínica Lucano de Cirurgia Plástica. 3 Sociedade Brasileira de LASER em Medicina e Cirurgia. Resumo                                                                                                                                                                                                                                                                                                                                                           As imperfeições da pele constituem um dos mais incômodos efrequentes problemas estéticos da população. Por essa razão diversosestudos são realizados em busca de aparelhos que melhorem oueliminem as deformidades cutâneas. O StarLux 1540® é um LASERfracionado não ablativo de Erbium Glass que tem revolucionado ostratamentos de pele, sendo muito utilizado para atenuar cicatrizesde queimaduras, em cirurgias de remoção de tatuagem e em cirurgiasplásticas.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Descritores: estética, cicatrizes, LASER.

Abstract                                                                                                                                                                                                                                                                                                                                                                                            Skin imperfections are some of the most uncomfortable andfrequent aesthetic problems for the population. For this reason,plenty of studies are developed every year searching for a machinethat improves or eliminates skin deformities. Starlux 1540® is afractional, non-ablative Erbium-Glass laser that has made arevolution in skin treatments, it’s being often used to reduce burnscars, remove tattoo scars and plastic surgery scar.                                                                                                                                        Descriptors: aesthetic, scars, LASER.

Claudio Roncatti1,2,3Romulo de Melo Mene1,3Murillo Francisco Pires Fraga2,3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Resumo                                                                                                                                                                                                                                                                                                             A pele humana é o maior órgão do nosso corpo e pode apresentardiversas doenças, síndromes e tumores. Os tumores malignos depele são os mais comuns dentre todos os tumores que incidem nocorpo humano, chegando em 2009 à impressionante estatística de50% de todos os tumores malignos diagnosticados no corpo humano.Dentre os tumores da pele humana o Carcinoma Baso Celular éo de maior incidência, ocorrendo em 75% dos portadores dessaslesões. Teoricamente, a excisão com margens de segurança livres dalesão significa cura e não indica necessidade de terapia coadjuvante,porém, não é o que se observa na prática clínica diária, onde arecidiva ocorre com frequência apesar dos exames histopatológicosrevelarem margens cirúrgicas livres da lesão. Recidiva em tumoresmalignos na região da face, especialmente próximos aos olhos, nariz,boca e orelhas, podem significar mutilações e perda de funçõesimportantes para a vida de relação, como a visão, a audição e oolfato. A associação da Terapia Fotodinâmica à cirurgia convencionalvisa diminuir a porcentagem de recidivas, aumentando a qualidadede vida dos pacientes tratados.                                                                                                                                                                                                                                                                                                                                                                      Descritores: Carcinoma baso celular, CBC, Terapia Fotodinâmica,

TFD, tumores malignos de pele, ácido amino levulínico e hematoporfirina.

                                                                                                                                                                                                                                                                                                                                                    Abstract                                                                                                                                                                                                                                                                                                                                                                                                  Human skin is the greatest organ of our body and can presenta lot of diseases, syndromes and tumors. Malignant skin tumorsare of higher incidence in humanbean, representing in 2009, 50%incidence of all malignant human body tumors diagnosis. Scamouscell tumor appear in 75% of all malignant skin tumors. Theoretically,resection of all tumor with histologic free margins, signify cure but,in the daily clinical observation the reality is another, where returnshappens continually. Reincidence in the face, especially near eyes,nose, mouth and ears could signify maiming and lost of relevantrelations functions, like vision, smell and hearing. The associationof Photodynamic Therapy with conventional surgery look fordiminish the return of those tumors, and enlarge the life quality oftreated patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Descriptors: Basal Cell Carcinoma, BCC, Photodynamic Therapy,PDT, malignant skin cancer, amino levulinic acid, haematoporphyrin.1 Clínica Lucano de Cirurgia Plástica.2 Faculdade de Ciências Médicas da Santa Casa de Misericórdia deSão Paulo.3 Sociedade Brasileira de LASER em Medicina e Cirurgia.

Wilson Rubens Andreoni1,2,3Ary Elwing1,2,3Cintia Navaes Andreoni1,2,31 Clínica Lucano de Cirurgia Plástica.2 Dermocentro - Dermatologia e Cirurgia Plástica.3 Sociedade Brasileira de LASER em Medicina e Cirurgia.                                                                                                                                                                                        Resumo                                                                                                                                                                                                                                                                       Os LASERs são empregados no tratamento de lesões dérmicasde características diversas no sentido de renovação da pele. Este éum trabalho de compilação de dados científicos para discorrermossobre o Síndrome de Envelhecimento Cutâneo Facial-SECF mostrandoa importância de conhecermos a ação biofísica dos LASERsnos tecidos, para que possam ser empregados com precisão e indicaçãocorretas.                                                                                                                                                                                                                                                                                                                                                              Descritores: Biofísica dos LASERs, fototermólise, fotoquemólise,Síndrome do Envelhecimento Dérmico Facial.                                                                                                                                                                                                                                                                                                                 Abstract                                                                                                                                                                                                                                                                                                        LASERs are used to treat dermic lesions of many differentaspects, looking for skin renew. This is a scientific data compilationwork with the purpose to discourse about the Aging Effects FacialSyndrome-AEFS showing the importance to know how is the biophysicalaction of LASERs in human tissues, to utilize it with precisionand correct indications.                                                                                                                                                                                                                                                                                                                                                                        Descriptors: LASERs biophysics, photothermolysis, photokemolysis,Aging Effect Facial Syndrome.artigo original 1.pmd 12/8/2010, 13:57 7

Luiza Kassab Vicencio1    Suzana Lerner Cutin Schainberg11 Dermatologista, Serviço de Dermatologia e Laser do Hospital Israelita Albert Einstein (HIAE).                                                                                                                                                                                                                                                                                                                                                                                                         Resumo                                                                                                                                                                                                                                                                                                  A terapia fotodinâmica (TFD) é um novo tratamento para câncerbaseado na aplicação de uma droga específica no tumor seguidode ativação da luz. Este método tem sido utilizado em diversasneoplasias de pele com resultados bem sucedidos. O objetivo desteestudo foi o de descrever um caso de TFD aplicado em lesões denariz e orelha. O cloridrato de aminolevulato de metila foi utilizadona concentração de 160 mg/g, ativados por uma luz laser comë=630 nm (Fluência de 37 J/cm2, Tempo= 7 minutos). A realizaçãode exames físicos e testes laboratoriais, antes e após o tratamentosão mandatórios. Este paciente, que tratamos com TFD, teve umaexcelente resposta, sem complicações. A TFD sugere ser um métodoterapêutico simples, praticável, seguro e eficiente na condutacontra o carcinoma basocelular, proporcionando, sobretudo, umamelhor qualidade de vida. Estudos futuros para avaliar o papel daTFD em lesões de cabeça e pescoço são permitidos e necessáriosem nossa instituição.                                                                                                                                                                                                                                                                                                                                                                                Descritores: Terapia Fotodinâmica (TFD), Carcinoma Basocelular,Risco Estético, Câncer Cutâneo                                                                                                                                                                                                                                                                                                                                                                  Abstract                                                                                                                                                                                                                                       Photodynamic therapy (PDT) is a new cancer treatment basedon a specific drug uptake by the tumor followed by light activation.This method has been used in several skin neoplasms, with quitesuccessful results. The aim of this report was to describe a case ofPDT in ear and nose lesions. Cloridrato of aminolevulato of metilawas used at 160 mg/g, activated by a PDT laser light with ë=630 nm(Dose of 37 J/cm2, Time=7minutes). Patient had physical examinationand laboratory tests, pre and post-treatment. This patient treatedwith PDT had encouraging response, without complications. PDTappears to be a simple, feasible, safe and efficacious therapeuticmethod in the management of basal cell carcinoma, requiringimprovement of quality of life. Prospective studies to evaluate PDT’srole in head and neck cancerous lesions are warranted.                                                                                                                                                                                                                                                                                                                                                            Descriptors: Photodynamic Therapy (PDT), Basal Cell Carcinoma(BCC), Esthetic Risk Outcome, Cutaneous Cancer

Daniel Bonini1    Lilian Tan Moriyama2    Vanderlei Salvador Bagnato2                                                                                                                                                                                                                                                                                                                                                                                                                             Resumo                                                                                                                                                                                                                                                                                      A indicação de terapia fotodinâmica para o tratamento de neoplasiacutânea do tipo não-melanoma é aprovada em diversos paísese vem tendo uso crescente em todo mundo. O método temindicação no tratamento de múltiplas lesões, campo de cancerizaçãoe no tratamento de lesões em áreas onde o resultado estético éimportante. O presente artigo tem a finalidade de relatar, comoobservação de experiência clinica, os resultados estéticos obtidosneste estudo piloto como tratamento de pequenas lesões cutâneasnão-melanoma por terapia fotodinâmica de regiões de cabeça e pescoçoonde o resultado estético se faz imperativo sempre que possível.Foram apresentados três pacientes com lesões do tipo planaulcerada em orelha, nodular em região malar e plana descamativaextensa em região nasal e malar. Tratadas com PDT obtivemos aresolução completa na reavaliação de três meses com bom resultadoestético. Esses dados vêm reforçando o consenso da superioridadenos resultados estético-funcional de tratamento dessas pequenaslesões por terapia fotodinâmica.                                                                                                                                                                                                                                                                                                                                                        Descritores: Terapia Fotodinâmica, Câncer de pele, Resultado clínico                                                                                                                                                                                                                                                                                                                                                                   Abstract                                                                                                                                                                                                                                                                 Photodynamic therapy for treatment of non-melanoma skincancer is approved in several countries and its application isincreasing worldwide. The method is indicated for treatment ofmultiple lesions, cancerization fields and areas where a good aestheticoutcome is important. This article aims to report, as clinical experienceobservation, the cosmetic results obtained in this pilot studythat the treatment of small non-melanoma skin lesions by photodynamictherapy of head and neck regions where the cosmetic resultbecomes imperative whenever it is possible. We presented threecases with lesions as flat ulcer on the ear, nodular on malar areaand extensive flat desquamative on nasal and malar regions. Treatedwith PDT, we obtained complete resolution with good aestheticoutcome after three months of follow up. These results reinforce theconsensus of the photodynamic therapy superiority for the treatmentof small lesions with aesthetic and functional outcome.                                                                                                                                                                                                                                                                                                                                                                                                                          Descriptors: Photodynamic Therapy, Skin cancer, Clinical results

Ruy Carvalho Mattosinho de Castro Ferraz1    Clóvis Grecco1    Cristina Kurachi2   Vanderlei Salvador Bagnato3

Resumo                                                                                                                                                                                                                                                                                                   A terapia fotodinâmica (TFD) é uma modalidade terapêuticasendo que uma das principais aplicações é para o tratamento local decâncer. A TFD baseia-se na interação do fotossensibilizador (FS) comfonte de luz adequada na presença de oxigênio molecular, gerandoespécies reativas de oxigênio, especialmente o oxigênio singlete, capazesde induzir a morte das células tumorais por necrose ou apoptose.Este método apresenta várias vantagens em comparação aos métodostradicionais de tratamento (quimioterapia, radioterapia e cirurgia) umavez que apresenta dano seletivo as células tumorais e menos efeitoscolaterais. O sucesso da terapia fotodinâmica, no tratamento de câncerdepende de vários fatores sendo que um dos principais é a corretadosimetria. A resposta fotodinâmica é dependente da quantidade defotossensibilizador no tumor, iluminação adequada, concentração deoxigênio no tecido e sua geometria. A fotomodificação das moléculasdo agente fotossensível durante o tratamento varia em função dascondições de iluminação, como taxa de fluência, dose total fracionadaou contínua, comprimento de onda de excitação, e das condições doambiente como pH, temperatura e concentração de oxigênio. A TFDé altamente indicada para os casos de câncer de pele não-melanomapor ser de fácil acesso para entrega de luz e possibilidade de aplicaçãode FS tópicos. Apresenta-se neste trabalho uma breve revisão daliteratura mundial referente às publicações recentes em TFD aplicadoà pequenas lesões e a descrição de um caso clínico realizado pelonosso próprio grupo de pesquisa associado a um hospital referêncianacional em tratamento e diagnóstico em oncologia. Através dos bonsresultados pelo grupo de pesquisa e pela literatura mundial, é possívelrelatar que a TFD é fortemente indicada no tratamento de pequenaslesões (diâmetro de até 20 mm) de carcinomas não-melanoma,principalmente, carcinomas basocelulares superficiais.                                                                                                                                                                                                                                                                                                                                                                                                             Descritores: Terapia Fotodinâmica (TFD), Câncer de pele, Pequenaslesões                                                                                                                                                                                                                                                                                                                                                         Abstract                                                                                                                                                                                                                                                                                                                                  Photodynamic therapy (PDT) is a therapeutic technique mainlyused for the local treatment of cancer. This technique is based on theinteraction of a photosensitizer (PS) under irradiation of an adequatelight source and in presence of molecular oxygen, resulting in theproduction of reactive oxygen species, especially the singlet oxygenthat may induce tumor cell death by necrosis or apoptosis. Themethod has several advantages over traditional methods of treatment(chemotherapy, radiotherapy and surgery) since it promotes selectivedamage to tumor cells with less side effects. The success of photodynamictherapy in cancer treatment depends on several factorsand one of them is the correct dosimetry. The photodynamic responseis dependent on the amount of PS in tumor, adequate irradiation,oxygen concentration in tissue. The photomodification of PS duringtreatment changes with irradiation conditions, such as fluence rate,total dose delivery mode (fractionated or single dose), excitationwavelength and environmental conditions such as pH, temperatureand oxygen concentration. PDT is highly recommended for nonmelanoma skin cancer cases due to direct access for light deliveryand topical PS application. In this paper we show a brief literaturereview on TFD for small lesions and also, a clinical case reportperformed by our research group. The clinical results and theliterature show that PDT is a good treatment option for small lesionstreatment (diameter < 20 mm) of non-melanoma carcinomas, mainlysuperficial basal cell carcinomas.                                                                                                                                                                                                                                                                                                                                                                      Descriptors: Photodynamic Therapy, Skin cancer, Small lesions

Rodrigo Rodrigues Hattori¹   Daniela Botura Rodrigues¹    Álvaro Otávio Isaías Rodrigues¹    Andréa Carmen Raya²    Flávio Isaías Rodrigues³    Maria Cristina Chavantes4     Vanderlei Salvador Bagnato 5                

Resumo                                                                                                                                                                                                                                                                                     O carcinoma espinocelular no paciente imunossuprimido ocorreem indivíduos mais jovens e tendem a ser mais agressivos. Há umrisco aumentado para recorrência local, metástases regionais e àdistância e mortalidade. A Radioterapia pode ser utilizada para ocarcinoma espinocelular de pele e o papel da Terapia Fotodinâmicapermanece incerto. Este relato de caso mostra um exemplo de carcinomaespinocelular em paciente imunossuprimido e as dificuldadespara o seu tratamento.                                                                                                                                                                                                                                                                                                                                                                            Descritores: Carcinoma epidermóide ou espinocelular, Pele, Radioterapia,Terapia Fotodinâmica (PDT)                                                                                                                                                                                                                                                                                                                                                                    Abstract                                                                                                                                                                                                                                                                                                   The squamous cell carcinoma in immunosuppressed patientoccurs at a younger age and tends to be more aggressive. There isan increased risk of local recurrence, regional and distant metastasis,and mortality. Radiation therapy may be applied for cutaneous squamouscell carcinoma and the Photodynamic Therapy’s role remainsuncertain. This case report shows an example of squamous cellcarcinoma in immunosuppressed patient and theirs difficulties fortreating it.                                                                                                                                                                                                                                                                                                                                                                            Descriptors: Cutaneous squamous cell carcinoma, Skin, Radiationtherapy (RT), Photodynamic Therapy (PDT)

C. Kurachi1Moriyama L. T.2 Bagnato V. S.3  

Resumo                                                                                                                                                                                                                                                                                                      A Terapia Fotodinâmica (TFD) constitui uma técnica terapêuticaindicada principalmente para o tratamento de câncer de pelenão-melanoma e envolve procedimentos relativamente simples quandocomparados aos de uma cirurgia. Apesar da simplicidade na suaexecução, a dosimetria para a TFD é relativamente complexa, poisenvolve a interação dinâmica de três componentes principais: luz,fotossensibilizador e oxigênio. A resolução das quantidades ótimasde cada um desses parâmetros é determinante para o sucesso daterapia. A profundidade de penetração da luz é um dos fatoreslimitantes da técnica, de modo que a associação desta terapia comoutros métodos, como a remoção cirúrgica, podem viabilizar a eliminaçãode lesões mais espessas. O desenvolvimento de novosfármacos fotossensibilizadores também representa um importanteaspecto, pois um fotossensibilizador que seja capaz de absorver emcomprimento de onda com maior penetração nos tecidos biológicos,certamente propiciará uma resposta biológica mais adequada. Métodose ferramentas para a caracterização das condições da lesão aser tratada são fundamentais para o planejamento da dosimetriapara terapia fotodinâmica.                                                                                                                                                                                                                                                                                                                                                              Descritores: Fotoquimioterapia, Neoplasias cutâneas, Terapêutica,Dosimetria, Planejamento                                                                                                                                                                                                                                                                                                                                                                       Abstract                                                                                                                                                                                                                                             Photodynamic therapy (PDT) is a therapy mainly indicated forthe treatment of non-melanoma skin cancer and involves simpleclinical procedures when compared to a surgery. Even though PDTis of relatively easy execution, its dosimetry and planning may becomplex, since it depends on a dynamic interaction of three coreelements: light photosensitizer and oxygen. The determination of theoptimized quantities of each one of these parameters is crucial forthe PDT success. Light penetration at the tissue is one of the limitingfactors in PDT, in this sense, the association with other techniques,as surgical resection, may result in the complete treatment of thickerlesions. The development of new sensitizers also represents a relevantissue, due to the possible enhancement in the illumination wavelengthand so in the light penetration. Methods and instrumentation for insitu characterization of individual lesions are needed for the improvementof PDT dosimetry planning.                                                                                                                                                                                                                                                                                                                                                               Descriptors: Photochemotherapy, Skin neoplasms, Therapeutic,Dosimetry, Planning

Mardoqueu Martins da Costa1   Cíntia Teles de Andrade2    Natalia Mayumi Inada2    Liliane Ventura2    Cristina Kurachi3    Vanderlei Salvador Bagnato4                                                                                                                                                                                                                                                                                                                                         Resumo                                                                                                                                                                                                                                                                       A mortalidade e morbidade devido a vários tipos de câncer podemser reduzidas através de uma identificação precoce de células anormais.O Brasil é um país com grande dimensão e está localizado próximo daLinha do Equador, onde a incidência solar é extrema. Como resultado, apopulação apresenta um alto índice de câncer de pele, o principal tipona população brasileira e que acometerá, segundo o Instituto Nacionalde Câncer (INCA, Brasil), cerca de 113.850 novos casos do câncer dotipo não-melanoma e cerca de 5.930 de casos do tipo melanoma, no anode 2010. Diante deste grande número de casos de câncer, algumasmedidas devem ser tomadas para redução destes números, tais como:ações preventivas e educacionais, divulgação dos males causados peloconsumo de tabaco, álcool e pela exposição excessiva ao sol e ainda, énecessário investimentos na área de pesquisa para uma detecção maisprecoce do câncer, favorecendo a um tratamento mais efetivo. A fluorescênciapor imagem é uma técnica que apresenta o potencial de aumentaro poder de discriminação de tecidos, podendo constituir uma importanteferramenta de detecção de lesões como câncer bucal e de pele. Aocontrário da espectroscopia, que fornece uma análise pontual, as técnicaspor imagem podem contribuir para a detecção de lesões ocultas epara o delineamento das margens de lesões. Neste trabalho evidenciamoso desenvolvimento e aplicação de um sistema de fluorescênciacomposto por iluminação à base de LEDs de alta intensidade, com umabanda de emissão entre 400-460 nm para excitação da protoporfirinaIX (PpIX), e filtros para visualização da fluorescência da PpIX naregião do vermelho do espectro.                                                                                                                                                                                                                                                                                                                                                                                        Descritores: Fluorescência, Câncer de pele, Diagnóstico                                                                                                                                                                                                                                                                                                                                                                                   Abstract                                                                                                                                                                                                                                                                                                               The mortality and morbidity of many cancer diseases could bereduced with an early identification of the abnormal cells. Skin canceris the most common cancer type in Brazil. Malignant skin tumorsare divided in two large groups: melanoma and non-melanoma.The National Cancer Institute in Brazil (INCA) has estimated 113,850new cases of non-melanoma skin cancer (basal cell carcinoma andspinocellular carcinoma) as well as 5,930 of melanoma for 2010.The clinical procedure commonly used to identify the cells abnormalityis invasive and in a case of an extensive lesion, is impossible toseparate the region used for biopsy and the lesion itself, then the firstoption of treatment is the surgical excision. In this work was presentedthe development and application of a fluorescence system which iscomposed by a high intensity LED light source, with emission bandbetween 400-460 nm, that allows for PpIX excitation, and filters thatpermit to observe PpIX red fluorescence emission. For fluorescencediagnosis application, 5-aminolevulinic acid solution (15%; wt/v)was used. It was topically placed onto the lesions and PpIXfluorescence production analyzed during a total of 4-6 hours postapplication. Applying the visual fluorescence monitoring system hereis presented; it was possible to monitor PpIX generation and tostudy a relative new modality as a noninvasive fluorescencediagnosis technique.                                                                                                                                                                                                                                                                                                                                                                                                            Descriptors: Fluorescence imaging, Skin cancer, Diagnoses

Renato Araujo Prates1Antonio José da Silva Santos1Daiane Thais Meneguzzo1Ilka Tiemy Kato1

Martha Simões Ribeiro1

Resumo                                                                                                                                                                                                                                                                                                    A terapia laser em baixa intensidade vem sendo utilizada com oobjetivo de promover regeneração tecidual, modulação dos efeitosinflamatórios e redução de processos de dor. Como ela pode induziraumento na proliferação celular, um possível efeito colateral poderiaocorrer com sua aplicação sobre processos infecciosos agudos,pois poderia estimular o crescimento das células microbianas presentesno tecido. O objetivo deste estudo foi investigar o efeito dairradiação laser em baixa intensidade sobre um processo infecciosoagudo induzido em pata de camundongos. Para isso, foram utilizadosdezesseis camundongos BALB/c que após anestesia, receberaminoculação de suspensão de Pseudomonas aeurginosa para induziro processo inflamatório infeccioso. O edema foi avaliado no grupocontrole (sem tratamento) e no grupo submetido à irradiação únicacom laser (ë=660 nm, P=50 mW) com fluência de 3 J/cm2 sobre apata esquerda. Os resultados indicaram uma redução no edema nogrupo tratado com laser (p<0,05), enquanto no grupo controle foiobservado persistência do processo inflamatório. Concluiu-se que airradiação laser não aumentou o processo infeccioso agudo no modelo testado.                                                                                                                                                                                                                                                                                                                                                                        Descritores: Processo inflamatório, Efeito colateral, Laserterapia                                                                                                                                                                                                                                                                                                       Abstract                                                                                                                                                                                                                                                                                                                                                 Low-intensity laser therapy has been used to promote woundinghealing, to modulate inflammatory process, as well as to controlpain. Cell proliferation, including bacteria, is generally pointed asan effect of laser irradiation, thus it may be interpreted as a possibleside effect of this therapy on infected lesions. The aim of this studywas to investigate the effect of laser irradiation on acute infectiousdisease induced in mice. Therefore, back left paw of sixteen BALB/cmice were inoculated with a suspension of Pseudomonas aeurginosato induce acute inflammation following general anesthesia. Edemawas evaluated in control group (without treatment), and in the testgroup, the lesions were treated with laser irradiation ( ë=660 nm,P=50 mW) with fluence of 3 J/cm². The results indicated that lasergroup presented reduction on edema size (p<0.05), and controlgroup showed a persistent inflammation process. In conclusion,laser irradiation did not increase an acute infection on this experimentalmodel.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Descriptors: Inflammatory process, Side-effects, Lasertherapyartigo original - 7.pmd 12/4/2010, 08:25 60