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Notes: Background  Basal cell carcinoma (BCC) is one of the most frequent malignancies in the general population. Its best treatment option is the complete excision of the lesion. Mohs’ micrographic surgery has demonstrated to be the surgical method with the highest cure rates, however, it is not available in many countries or institutions.Methods  We propose, as a treatment option for high-risk BCC, surgical resection of the tumor with transoperatory histological examination with the hematoxilin-eosin technique, delaying closure of the wounds until the margins and surgical bed are tumor-free.Results  We studied 83 patients with BCC; 49 were treated with the transoperatory technique and delay closure. We observed no recurrence in any patient that we followed up and there were no complications resulting from the technique in a 25-month follow up.Conclusions  We recommend this technique for tumors with high-risk of recurrence if Mohs’ micrographic surgery is not available.

Notes: Case 1 A 50-year-old woman presented to our Dermatology Department with a 2-month history of edema and pain in the third right toe. She had a past history of common warts, chronic venous insufficiency, fibromyalgia, and noninsulin-dependent diabetes mellitus. No previous trauma to the toe could be recalled.Physical examination revealed digital clubbing, minimal lateral onycholysis, and subungual keratosis (〈link href="#f2-1"〉Fig. 1). Mycologic examinations (KOH and culture) were negative on two separate occasions and the X-ray revealed only soft tissue augmentation without evidence of bone involvement. A nail biopsy was performed with the clinical diagnosis of glomus tumor vs. neuroma vs. neurilemmoma. Histologic sections showed a dermal unilocular cyst lined by an epidermis-like epithelium with a granular cell layer, filled with laminated orthokeratin (〈link href="#f2-2"〉Fig. 2); a diagnosis of subungual epidermoid cyst was established. The patient experienced recurrent pain 1 month after surgery, and a re-excision was performed. The second biopsy showed only fibrous collagen bundles consistent with scar tissue. Intralesional steroid was injected to the site of the scar, and the patient is currently free of pain.〈figure xml:id="f2-1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1254-3:IJD_1254_f2-1"/〉Digital clubbing of the third finger. There is also lateral onycholysis and subungual keratosis〈figure xml:id="f2-2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD1254-3:IJD_1254_f2-2"/〉Hyperkeratosis and, in the dermis, a subungual epidermoid cyst. The wall is composed of stratified squamous epithelium, and the cyst is filled with laminated orthokeratin Case 2 A 40-year-old woman presented to our Dermatology Department with a 5-year history of throbbing pain in the first right toe. Her medical history was only relevant for syringomas and onychomycosis, and no traumatic event was recalled.Physical examination revealed a slight increase in volume in the lateral aspect of the toe. There were no changes in the skin. Palpation increased the painful sensation. With the presumptive diagnosis of neuroma, a nail biopsy was performed, showing a subungual epidermoid cyst. The patient is currently free of pain 15 months after surgery.

Notes: A 43-year-old woman presented with a soft, smooth, cystic, slightly erythematous, dome-shaped nodule, 6 × 8 mm in diameter, located on the dorsum of the middle finger of the right hand, between the proximal fold and the distal interphalangeal joint, lateral to the midline ( 〈link href="#f1"/〉). The nail of the affected finger showed longitudinal grooving and mild distal transverse overcurvature. The lesion had been present for 3 months and was tender upon pressure.〈figure xml:id="f1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD715:IJD_715_f1"/〉Digital mucoid cyst, lateral to the midline of the third finger, causing nail deformityClinical examination revealed early signs of osteoarthritis and Heberden’s nodes on the distal interphalangeal joints of both hands. Previous treatment included the intake of nonsteroidal anti-inflammatory drugs (NSAIDs) indicated by a rheumatologist. An X-ray of the right hand showed decreased joint spaces between the second and third phalanges of the middle finger.Diagnosis of a digital mucoid cyst (with nail deformity secondary to the former) was made. Surgical excision was performed. During surgery, a pedicle connecting the cyst to the joint capsule was clearly observed and two satellite lesions were also found ( 〈link href="#f2"/〉). The cyst and its satellite lesion, including the communicating tract, were totally removed.〈figure xml:id="f2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD715:IJD_715_f2"/〉(A) direct link of the cyst to the distal interphalangeal joint during surgery is clearly observedThe histopathologic study showed large cystic spaces containing mucin (colloidal iron stain) which were lined in some areas by synovial membrane ( 〈link href="#f3"/〉). The histopathologic report was compatible with a digital mucoid cyst of the ganglion type.〈figure xml:id="f3"〉3〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD715:IJD_715_f3"/〉Large cystic spaces containing mucin lined, in some areas, by synovial membrane (×100, original magnification)Six months after excision, no recurrence has been detected, and the nail plate deformities have improved.