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Robledo F. Rocha's Blog

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Sunlight exposure: a cause of melanoma?

On June 14th, the overwhelming majority of the audience in the Arena Amazonia for the England vs. Italy match, including me, cheered the Squadra Azzurra. That's because the England manager, Roy Hodgson, has said Manaus was the venue ideally to avoid, and that he preferred to be drawn in the most difficult group of the 2014 FIFA World Cup rather than had to play in the heat of the Amazon Rainforest. As a matter of fact, I got another reason for have supported Italy. Nothing against what Hodgso

Robledo F. Rocha

Robledo F. Rocha

Classification and nomenclature of early squamous cell carcinoma of genital region.

Early squamous cell carcinomas of penis and vulva, the so-called precancerous lesions of genital region, have similarities in morphology and pathogenesis, but they also have, unfortunately, similarities in their classification and nomenclature that are quite confusing. Archaic terminologies lacking epidemiologic value and good reproducibility are still in use and, armed with their historical importance, compete for space in medical publications against modern terms which were coined on solid sci

Robledo F. Rocha

Robledo F. Rocha

Actinic cheilosis graduation? What for?

Some months ago, our admirable colleague Dra. Marcia Lanzoni de Alvarenga Lira warned me that clinicians were starting to request dysplasia grading in cases of actinic cheilosis with the aim of predict malignant transformation and guide a more suitable therapeutic decision for an individual patient. At that time, I still hadn't received such a request. However, things changed somewhat in the last few weeks. Nowadays in my routine practice, clinicians not only started to request dysplasia grading

Robledo F. Rocha

Robledo F. Rocha

Merely histological detail? Or something really reportable?

It's not uncommon a tumor appearing in the form of a histological subtype or a microscopic variant, in such a way that makes more difficult the correct diagnosis. There's no remaining alternative for practitioner pathologists but to be aware, as much as possible, about subtypes and variants of tumors, thereby reducing the chances of rare features be misconstrued as evidence of another tumor, or even of no tumor at all. For example, adenoid melanoma can be misconstrued as adenocarcinoma, and desm

Robledo F. Rocha

Robledo F. Rocha

An evasive diagnosis is not a diagnosis at all!

Melanocytic lesions always represent diagnostic challenge. Some nevi might display features disquieting enough to be unskillfully misdiagnosed as melanoma. And some melanomas have too subtle malignant characteristics that can pass unnoticed if a careful scrutiny is not accomplished. Not surprisingly, some melanocytic lesions are so difficult to be rendered as benign or malignant that even worldwide recognized experts in the field fail in achieve a reproducible diagnosis. During a recent pract

Robledo F. Rocha

Robledo F. Rocha

Occupational health risks of pathologists.

In the same way as for any occupational group, numerous potential health hazards are associated with the routine work of pathologists. Empirical evidence gathered from close observation of work colleagues' complaints and of their own suggests to pathologists that their most common health problems are intolerance reactions to formalin, musculoskeletal disorders due to non-ergonomically optimized office chair and microscope, and cutting injuries during macroscopic organ dissection and autopsy.

Robledo F. Rocha

Robledo F. Rocha

Dermatopathology books in Camoens' language.

There are many books of Dermatopathology available for physicians who are interested or committed to this field of the diagnostic medicine. Written in different formats, depth and methods, they came to meet any kind of taste and requirement, except to the language. Of course English is the usual language of the most famous Dermatopathology books. It wouldn't be a hassle for dermatopathologists with sufficient English proficiency if they had not to use another language to prepare reports and t

Robledo F. Rocha

Robledo F. Rocha

Prolonging the debate about precursors of invasive squamous cell carcinoma.

A busy Friday prevented me from participating in Case 875 of spot diagnosis, but I make a point of getting into the relevant discussion brought up by Dr. Sasi Attili. Foresseing my comment could be the last one, I thought it was a good idea prolong the debate in my own blog. A number of key principles are enshrined in the medical science, and the fact that tumors are monoclonal proliferations is one of them. That implies any tumor arise from the clonal expansion of a single cell which has und

Robledo F. Rocha

Robledo F. Rocha

Using the microscope as a crystal ball.

Like any other pathologist, I often receive specimens without adequate clinical information on request form. As a consequence, my mobile phone has been a working tool as essential as my microscope. A few days ago I phoned up to a first-year dermatology resident just to ask about the withhold information concerning a worrisome melanocytic lesion. While I was waiting for her answer, I was thinking of how to explain to a neophyte, as kindly and didactically as I can be, that, in dermatopathology

Robledo F. Rocha

Robledo F. Rocha

It must be evident to the patient and to the non-dermatologist clinician! Or: how I learned to stop worrying and no longer spurn the word 'eczema'.

When I still was a medical student, I undertook a practical training program in Internal Medicine at Allgemeines Krankenhaus der Stadt Wien, the legendary AKH, in Vienna. One of the admitted patients suddenly developed pruritic clear vesicles along the sides of his fingers, and Prof. K. wanted to know a diagnostic hypothesis from me. Trying to demonstrate some confidence, I quickly answered: “It’s a kind of eczema.” But he gave me back this reply: “You’re right and you're wrong. You’re right bec

Robledo F. Rocha

Robledo F. Rocha

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