Immunotherapy of Malignant Melanoma with Tumor Lysate-Pulsed Autologous Monocyte-Derived Dendritic Cells

PURPOSE: Dendritic cell (DC) vaccination for melanoma was introduced because melanoma carries distinct tumor-associated antigens. The purpose of this study was to investigate the efficacy and safety of DC vaccination for melanoma in Korea. MATERIALS AND METHODS: Five patients with stage IV and one with stage II were enrolled. Autologous monocyte-derived DCs (MoDCs) were cultured and pulsed with tumor-lysate, keyhole limpet hemocyanin, and cytokine cocktail for mature antigen-loaded DC. DC vaccination was repeated four times at 2-week intervals and 2-4x107 DC were injected each time. RESULTS: Reduced tumor volume was observed by PET-CT in three patients after DC vaccination. Delayed type hypersensitivity responses against tumor antigen were induced in five patients. Tumor antigen-specific IFN-gamma-producing peripheral blood mononuclear cells were detected with enzyme-linked immunosorbent spot in two patients. However, the overall clinical outcome showed disease progression in all patients. CONCLUSION: In this study, DC vaccination using tumor antigen-loaded, mature MoDCs led to tumor regression in individual melanoma patients. Further standardization of DC vaccination protocol is required to determine which parameters lead to better anti-tumor responses and clinical outcomes.

A Case of Papular Xanthoma Developed in an Adult / 대한피부과학회지

Papular xanthoma is a normolipemic xanthomatosis, characterized by nonconfluent papular to papulonodular eruptions on the face, trunk, extremities and occasionally mucous membranes. Histologically, there was an infiltration of foamy histiocytes and Touton type giant cells in the dermis without inflammatory cells or a pure histiocytic component. But, occasional lymphocytes were interspersed between the foamy macrophage. No systemic involvement could be found and the blood lipid profiles were normal. We report a case of papular xanthoma in a 30-year-old man with typical clinical, histopathologic findings.

A Clinical Study of Molluscum Contagiosum in Adults / 대한피부과학회지

BACKGROUND: Molluscum contagiosum is a common cutaneous viral infection of the skin. Although molluscum contagiosum generally affects young children, the incidence in adults is rising. OBJECTIVE: The purpose of our investigation was to describe the clinical characteristics of 28 adults with biopsy-proven molluscum contagiosum. METHODS: We reviewed the medical records and clinical photographs of 28 patients who were diagnosed with molluscum contagiosum from June 2000 to May 2007. Personal and clinical information such as onset, age, gender distribution, clinical manifestations, associated diseases, pathologic characteristics and treatment modalities were investigated. RESULTS: Of the 28 patients, 19 (67.9%) were men and 9 (32.1%) were women. The average age of onset in men and women were 39.4 and 46.4 years, respectively and the overall average age of onset was 41.7 years. The most common clinical finding was a typical umblicated papule in 10 (35.7%) of the 28 cases. The atypical presentations including giant molluscum, chickenpox-like lesions, prurigo-like lesions and verruca-like lesions were also seen. The most common affected site was the genital area, followed by the head and neck, extremities and trunk. Except for the 21 asymptomatic patients, 7 patients complained of pruritus. Seropositive ELISA assays for HIV was found in 1 patient. Five patients were under immunosuppressive conditions such as HIV infection, sarcoidosis, taking immunosuppressant drugs after liver transplantation, chemotherapy for breast cancer and chemotherapy for gastric cancer. Molluscum bodies were confirmed in all patients through histologic findings. Molluscum extraction was mainly used as a treatment of molluscum contagiosum. CONCLUSION: In Korean literature, this is the first clinical study of molluscum contagiosum occurring in adults. Molluscum contagiosum in adults shows atypical clinical features, so it can be misdiagnosed as other diseases. We suggest that dermatologists should perceive clinical findings of molluscum contagiosum in adults and perform proper investigation and management.

A Case of Eruptive Xanthoma Associated withType IV Hyperlipoproteinemia and Koebner Phenomenon / 대한피부과학회지

Type IV hyperlipoproteinemia is characterized by increased blood levels of the triglyceride form of the fat that makes up very low-density lipoproteins (VLDL). Eruptive xanthomas have been frequently observed in type I and V hyperlipoproteinemias but rarely observed in patients with type IV hyperlipoproteinemia. The Koebner phenomenon is the development of the isomorphic skin lesions in persons with certain skin diseases after an injury has occurred on skin of normal appearance. Although this response can develop in psoriasis, lichen planus, verruca etc., it has seldom been associated with eruptive xanthoma. We report a case of eruptive xanthoma with type IV hyperlipoproteinemia and Koebner phenomenon in a 28-year-old Korean male.

Two Cases of Dermatofibroma with Sclerotic Fibroma-like Change / 대한피부과학회지

Sclerotic fibroma is often regarded as a unique proliferating lesion, but some authors regard it as an end stage of other neoplasms, especially dermatofibroma. We report two cases of dermatofibroma with sclerotic fibroma-like change. The skin biopsy specimens from different patients showed a common finding of dermatofibroma, while some portions of the tumor were replaced by thick, hyalinized, eosinophilic collagen bundles and empty clefts with low cellularity, which was histologically similar to sclerotic fibroma. According to these findings, dermatofibroma with sclerotic fibroma-like change can be evidence of the possible pathogenesis of sclerotic fibroma.

A Case of Unilateral Linear Syringoma / 대한피부과학회지

Although the clinical features of syringoma are usually scattered papules, especially around the eyes, there are several forms showing atypical presentation and location: unilateral, eruptive, acral, and linear. The uncommon characteristic features (linear and unilateral) may confuse and delay the differential diagnoses of syringoma. We report a case of a 35-year-old female who presented with a 10-year history of linear, skin-colored papules on her right arm. Histopathologic findings were consistent with typical syringoma, showing comma-like tubal structures lined by eccrine glandular cells. This case suggests that syringomas need to be included in the differential diagnosis of unilateral, linear, papular or plaque skin lesions.

A Case of Idiopathic Neutrophilic Eccrine Hidradenitis / 대한피부과학회지

Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis which clinically presents with various cutaneous manifestations with or without tenderness and pruritus. NEH has a characteristic histologic pattern, with necrosis of the eccrine glands and local neutrophilic infiltrations. It occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia or, less frequently, other malignancies. More recently, NEH has been observed in other conditions, such as infections, drugs or even in generally healthy individuals. We report a case of a 29- year-old female with no remarkable medical history who has suffered from a solitary skin-colored indurated macule with tenderness on the left sole for 2 weeks. The skin biopsy showed typical features of neutrophilic eccrine hidradenitis. The patient was successfully treated with oral prednisolone for 2 weeks and an intralesional injection of triamcinolone.

Multiple Eruptive Dermatofibromas in a Patient with Systemic Lupus Erythematosus and Juvenile Rheumatoid Arthritis / 대한피부과학회지

Solitary dermatofibroma shows a common occurrence, especially on the lower limbs of young women, while multiple eruptive dermatofibromas are rare and are thought to be associated with altered immunity, such as autoimmune diseases and immunosuppression. We report a patient with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA) who developed multiple, eruptive dermatofibromas while she was being treated with systemic corticosteroid. We also review literature on the previously reported cases of multiple eruptive dermatofibromas associated with SLE.

A Case of Disseminated Epidermolytic Acanthoma / 대한피부과학회지

Epidermolytic acanthoma is an uncommon benign tumor characterized histologically by epidermolytic hyperkeratosis. Clinically, the tumor resembles a verruca or seborrheic keratosis and may occur in either isolated or disseminated forms. Herein, we present a case of a 46-year-old male who developed multiple seborrheic keratosis or verruca like papules on his trunk which showed epidermolytic hyperkeratosis upon microscopic examination. Following clinical and histological findings, the patient was diagnosed as having disseminated epidermolytic acanthoma.

A Case of Syringoid Eccrine Carcinoma Successfully Treated with Mohs Micrographic Surgery / 대한피부과학회지

Syringoid eccrine carcinoma is a rare adnexal tumor of eccrine origin, and has metastatic potential and high recurrence rate following conventional surgical excision. Mohs micrographic surgery has been commonly used for various malignant skin cancers to minimize the defect after surgery, and to decrease the recurrence rate. We present a case of syringoid eccrine carcinoma successfully treated by Mohs micrographic surgery.

Microcystic Adnexal Carcinoma Treated by Mohs' Micrographic Surgery / 대한피부과학회지

Microcystic adnexal carcinoma (MAC) is an uncommon skin appendage neoplasm with both follicular and sweat duct differentiation. It usually extends microscopically far beyond assessed clinical margins and spreads locally in the dermal, subcutaneous fat, muscle, and perineural tissue planes. Although its metastasis is very rare, local recurrence rate after standard excision is 40~59%. Recently, Mohs micrographic surgery (MMS) was introduced for the treatment of MAC and a more favorable cure rate has been reported. We report a case of MAC, which was treated by MMS, which concurred with thymoma and thyroid papillary carcinoma in a 50-year-old woman.

A Case of Pseudoxanthoma-elasticum-like Papillary Dermal Elastolysis / 대한피부과학회지

Pseudoxanthoma elasticum-like papillary dermal elastolysis is a disorder of the dermis, characterized by clinical features similar to pseudoxanthoma elasticum and the pathologic features of elastolysis limited to the papillary dermis, such as sun-protected, intrinsically-aged skin. A 64-year old woman presented with a 7 year history of a localized skin lesion on the back of her neck. Physical examination revealed skin to yellow colored, non-follicular grouped uniform papules, sized 5~8 mm, and coalescent plaques localized below the hair line. Histopathologic and immunohistochemical findings of decrease and elastolysis of the elastic fibers in the papillary dermis confirmed the diagnosis. In this article, we report a case of pseudoxanthoma elasticum-like papillary dermal elastolysis which presented with typical clinical and pathologic features.

The Usage of Micropigmentation in Temporal Triangular Alopecia / 대한피부과학회지

Temporal triangular alopecia is a triangular or oval shaped non-scarring alopecia, occurring on the temporal side of the scalp, which was first reported by Sabourand in 1950. It usually occurs in the childhood. There is no treatment for this disorder except for surgery. In this article, we report a case of focal alopecia which was successfully treated with micropigmentation.

A Case of Dengue Fever / 대한피부과학회지

Dengue fever is caused by the dengue virus which belongs to the flaviviridae family and is transmitted by mosquitos. It occurs in the tropical climates of central and south america, asia, and africa and is considered one of the most important arthropod-borne viral diseases as regards morbidity and mortality, especially due to its hemorrhagic forms, dengue hemorrhagic fever and dengue shock syndrome. We report a case of dengue fever which presented with typical systemic symptoms and signs such as fever, headache, nausea and characteristic erythroderma (white islands in a sea of red) on travelling Bangladesh.