Cutaneous Metastasis from Pancreatic Cancer Simultaneously Developed on the Scalp and Chest / 대한피부과학회지

No abstract available.

A Case of Atypical Adult-onset Still's Disease That Presented with Unique Histopathologic Findings / 대한피부과학회지

Adult-onset Still's disease (AOSD) is an uncommon disorder characterized by fever, polyarthralgia, elevated white blood cell count, and maculopapular rash, the histologic features of which have not been well known. A 54-year-old woman presented with fever, arthritis, and persistent pruritic lichenified rash. These cutaneous lesions showed unique histological features such as dyskeratosis with a peculiar, distinctive distribution in the upper epidermis and cornified layers with hyperkeratosis. In addition, dermal mucin deposition was increased, with inflammation and minimal fibroblast proliferation. The patient was diagnosed with AOSD according to the diagnostic criteria of Yamaguchi. Herein, we present an atypical form of AOSD showing distinctive clinical and pathological manifestations.

A Case of Vulvar Syringoma in a 9-year Old Child / 대한피부과학회지

No abstract available.

A Case of Poroid Hidradenoma / 대한피부과학회지

Poroid hidradenoma is a benign tumor that is classified as a poroid neoplasm, and is so called because of its morphology, which is intermediate between the cytological features of a poroid neoplasm (poroid and cuticular cells) and the architectural features of a hidradenoma (solid and cystic areas, and tumor cells restricted to the dermis). As these tumors are cystic and superficially located, fine needle aspiration cytology has been useful, but the diagnosis relies on the histological examination. A 79-year-old woman presented with a solitary walnut-sized, soft, tender, reddish-to-bluish nodular lesion that had been enlarging steadily over a period of two years. Histopathologic examination of the cutaneous lesion showed a well-demarcated tumor composed of poroid and cuticular cells in the dermis not connected to the overlying epidermis, consistent with poroid hidradenoma. Herein, we present a rare case of poroid hidradenoma arising in an unusual location.

Spitz Nevus on the Perianal Area of a Child: An Unusual Location

No abstract available.

Clinical Evaluation of Dermatologic Consultations in Psychiatric Inpatients / 대한피부과학회지

BACKGROUND: The need for dermatological consultations for hospitalized patients has gradually increased and there are a number of dermatoses caused by underlying psychological conditions. However, the data regarding the analyses of these consultations for psychiatric inpatients are limited. OBJECTIVE: To analyze the demographics and the type of dermatoses among inpatients with primary psychiatric diseases. METHODS: We retrospectively reviewed 581 consultation reports for inpatients referred by the Department of Psychiatry between January 1, 2009 and December 31, 2014. RESULTS: The proportion of the consulted patients from the Department of Psychiatry was 25.9% (331 consulted inpatients/1279 psychiatric inpatients). The most common age group was the 40~49 year-old group (19.3%) and the male to female ratio was 1:1.14. There were no remarkable findings regarding the annual or seasonal distribution. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the most common underlying psychiatric disorders were mood disorders (41.0%), followed by schizophrenia and other psychotic disorders (25.0%), and substance-related disorders (12.1%). The most frequent skin disorders were eczematous dermatoses (34.6%) and infectious dermatoses (32.2%); dermatomycosis (20.8%) was especially common. The most common reasons for consultation were new-onset dermatologic problems (68.5%), followed by persistence or aggravation of pre-existing dermatologic disorders (28.7%). CONCLUSION: This study reports the dermatologic characteristics of psychiatric inpatients. We conclude that dermatologists and psychiatrists need to be concerned about the education and continuous management of various skin diseases in psychiatric patients.

Characterization of Actinic Keratosis by Dermoscopy in Koreans / 대한피부과학회지

BACKGROUND: Dermoscopy is a real-time, noninvasive technique that increases the diagnostic accuracy of clinical evaluation by the dermatologist. Characterization of facial actinic keratosis via dermoscopy is valuable in guiding the dermatologist in the differential diagnosis of facial skin lesions. To our knowledge, dermoscopic evaluation of actinic keratosis has not yet been reported in Korean literature. OBJECTIVE: The purpose of this study was to investigate the dermoscopic features of facial actinic keratosis in Koreans. METHODS: We examined 60 patients with facial actinic keratosis using dermoscopy. We determined the frequency of specific features revealed by dermoscopy across the Korean patient population and compared our results with those of other published studies. RESULTS: A total of 67 facial actinic keratoses were observed in 60 patients. The common features of non-pigmented actinic keratoses revealed by dermoscopy were a red pseudo-network (66%), white-to-yellow surface scales (48.9%), linear wavy vessels (38.3%), and targetoid hair follicles (42.6%). The common features of pigmented actinic keratoses revealed by dermoscopy were slate-grey dots (55%) and globules (30%), annular-granular pattern (35%), a brown-to-gray pseudo-network (40%), and targetoid hair follicles (30%). The frequency of specific features revealed by dermoscopy across the analyzed patient population was not significantly different from that reported in other studies, except for rhomboidal structures (5%), which was lower in Koreans than in other populations (35.8%, p<0.05). The frequency of dermoscopic features was different according to histopathologic subtypes (hypertrophic, atrophic, bowenoid, acantholytic actinic keratosis). CONCLUSION: Dermoscopy revealed specific features of facial actinic keratosis that can be utilized to evaluate and diagnose facial skin lesions.

A Case of Acantholytic Squamous Cell Carcinoma

Acantholytic squamous cell carcinoma is a well-defined variant of squamous cell cancer in which significant portions of the neoplastic proliferation show a pseudoglandular or tubular microscopic pattern. It usually presents as a nodule with various colors, and it is accompanied by scaling, crusting, and ulceration on the sun-exposed areas of older aged individuals. Histologically, the tumor consists of a nodular, epidermal-derived proliferation that forms island-like structures. At least focally or sometimes extensively, the tumor cells shows a loss of cohesion within the central gland-like or tubular spaces. This tumor resembles the structure of eccrine neoplasms, but it is negative for dPAS, CEA and mucicarmine and it is only positive for EMA and cytokeratins. Herein we report a case of acantholytic squamous cell carcinoma that occurred on the face of an 82-year-old woman.

A Case of Clear Cell Basal Cell Carcinoma / 대한피부과학회지

Basal cell carcinoma (BCC) is noted for its many histologic variants because of its pluripotential origin from epithelial germ cells. Clear cell BCC has been recognized as a distinct variant and has a clear cell component made up of cells which are either vacuolated or display a finely granular eosinophilic cytoplasm. We report a case of clear cell BCC in a 62-year-old man who had a well-demarcated, skin-colored nodule on the left nasal ala. It was treated by surgical excision with a Burow's graft and no recurrence has been observed.

A Case of Neurotized Nevus with Sclerotic Fibroma-like Change / 대한피부과학회지

We report a case of neurotized nevus with a sclerotic fibroma-like change in a 60-year-old female patient, who presented with a brown colored pedunculated nodule on the upper quadrant of the abdomen. The skin biopsy revealed a well-circumscribed, non-encapsulated nodule in the reticular dermis, which consisted of hypocellular hyalinized collagen bundles separated by clefts mixed with nevus cells. Nevus cells are small with a spindle appearance and contain Meissner corpuscle-like structures called nevic corpuscles. We suggest that a sclerotic fibroma-like change is an evolutionary end-point of a pre-existing lesion. This is supported further by the fact that neuroid change in the intradermal nevus represents the end stage of maturation of melanocytes of the nevi.

A Comparison of ALA-IPL Photodynamic Therapy and Acne Mode IPL Phototherapy in the Treatment of Acne Vulgaris / 대한피부과학회지

BACKGROUND: Acne vulgaris is one of the most prevalent and emotionally debilitating dermatologic diseases. Emerging problems with conventional acne treatments, such as the resistance of Propionibacterium acnes to antibiotics and the safety of oral isotretinoin, create a demand for other treatment modalities for acne. An evolving understanding of the Propionibacterium acnes-produced porphyrins and the development of a number of light sources have led to the application of photodynamic therapy for the treatment of acne. OBJECTIVE: To study the effect of light therapy on the treatment of Acne Vulgaris using acne mode intense pulsed light (IPL), and photodynamic therapy with a combination of topical 5-Aminolevulinic acid (ALA, 20%) and acne mode IPL. A comparison of the two treatment modalities would then be made to examine the effect on inflammatory acne lesions and sebum excretion. METHODS: Thirteen patients with varying degrees of acne were included in the study after a 4 week washout period. ALA (20%) was applied to half of the face on each patient. After one hour, the whole face was exposed to intense pulsed light (DECA(R), Italia) using an acne mode (400~1,200 nm) starting at a fluence of 11 J/cm(2). The procedure was carried out three times with 2 week intervals, and the patients were evaluated on post-op 2nd, 4th, and 6th weeks. Histologic changes were observed before and after treatment. RESULTS: After the first and second treatment, there was a statistically significant reduction in inflammatory acne lesion counts and the amount of sebum production from baseline, in both the ALA-PDT group and the IPL group (p<0.05). However, no statistically significant reduction was shown after the third treatment in both groups. There was a slightly higher reduction in the count of inflammatory lesions and the amount of sebum production in the ALA-PDT site compared to the IPL site, but it was not statistically significant. On histologic examination, dermal inflammatory cell infiltrations around the perivascular and periappendageal area were significantly reduced and sebaceous glands became smaller after the 3rd treatment. The adverse effects were negligible. CONCLUSION: ALA-PDT using acne mode IPL, and light therapy using acne mode IPL alone were effective in the reduction of inflamed lesions and sebum secretion in patients with mild to moderate acne vulgaris. Furthermore, no significant adverse effects were observed with both treatments. However, no remarkable contrast of therapeutic effect was statistically observed between the two therapies either.

A Case of Reticulate Pigmented Anomaly of the Flexures (Dowling-Degos Disease) / 대한피부과학회지

Dowling-Degos disease is a rare autosomal dominant genodermatosis with a genetically determined disturbance of epidermal proliferation. The clinical symptoms of Dowling-Degos disease are characterized by the acquired reticulate pigmented anomaly of the flexures. We report a case of Dowling-Degos disease in a 27-year-old female, who presented with numerous small, hyperpigmented macules in reticular pattern, localized to the axillae, inframammary and inguinal areas, popliteal fossa, neck, and face.

A Case of a Symplastic Glomus Tumor / 대한피부과학회지

A glomus tumor is a benign neoplasm of neuromyo-arterial glomus, composed of vascular channels surrounded by proliferating glomus cells and nerve fibers. Occasionally it displays unusual histopathologic features such as a large size, deep location, infiltrative growth, mitotic activity, nuclear pleomorphism, or necrosis. It can be diagnosed as an "atypical" glomus tumor, including malignant glomus tumor, glomus tumor of uncertain malignant potential, symplastic glomus tumor, or glomangiomatosis. Glomangiomatosis and symplastic glomus tumors reveal benign biologic behavior. We report a typical case of a symplastic glomus tumor, showing only marked nuclear atypia, compared with a classical glomus tumor.

A Review of Mohs Micrographic Surgery and Reconstruction of Cutaneous Malignant Tumors over the Past 10 Years / 대한피부과학회지

BACKGROUND: Recent studies have shown that Mohs micrographic surgery (MMS) decreased the recurrent rate of tumors and conserved the normal, unaffected tissue. Therefore, MMS is accepted as the first choice treatment modality for cutaneous malignant tumors. OBJECTIVE: The purpose of this study was to review the use of MMS and reconstruction of cutaneous malignant tumors over the past 10 years. METHOD: We retrospectively evaluated 104 patients who had been diagnosed with cutaneous malignant tumors between January 1994 and December 2003, and had been treated with MMS and tumor reconstruction. RESULTS: There were 54 males and 50 females. The mean age was 62. Basal cell carcinoma was the most common skin tumor, and the most common anatomical site was the face. Mean number of stages of MMS were 1.91, and the mean size of the final defect after MMS was 19.46x25.4 mm. A local flap was most commonly used to repair the surgical defects (59%). Recurrent cases totalled 2 out of 104 over the 4-60 months of follow up. CONCLUSION: MMS and proper reconstruction are a reliable and effective method for the treatment of cutaneous malignant tumors and offers the lowest functional and cosmetic morbidity in skin cancer treatment.

A Case of Frontal Fibrosing Alopecia / 대한피부과학회지

Frontal fibrosing alopecia is considered to be a clinical variant of lichen planopilaris. This condition is characterized by progressive frontal hairline recession associated with scarring. Frontal fibrosing alopecia has become an increasingly recognized distinct clinical entity in recent years. We report a typical case of frontal fibrosing alopecia and review the pertinent literature.

The Clinical Effect of Topical Diphenylcyclopropenone (DPCP) Therapy in the Treatment of Atopic Dermatitis in Children and Adolescents / 대한피부과학회지

BACKGROUND: Atopic dermatitis is the most common chronic skin disease in childhood. Severe atopic dermatitis may require use of topical or systemic corticosteroids. These treatments are prone to several adverse side effects. This paper highlights the impressive effect of diphenylcycloprope none(DPCP) sensitization in some cases of childhood and adolescent atopic dermatitis. OBJECTIVE: The purpose of this study was to examine the effect of DPCP in treating severe atopic dermatitis of children and adolescents. METHODS: Twenty eight patients, who had moderate to severe atopic dermatitis, were recruited in the treatment of DPCP weekly for 10 weeks and followed up for another 4 weeks. Severity of atopic dermatitis was measured using SCORAD index. RESULTS: Sixteen of 28 patients had finished the treatment courses. After 10 weeks of therapy with DPCP, the patient's symptoms were improved and the mean SCORAD index was significantly reduced from 48.9+/-17.8 to 18.0+/-9.1 (p<0.01). During the follow-up period, patients could be managed by topical steroid and oral antihistamine and flare-up was not observed. CONCLUSION: According to our study, DPCP can be an effective, safe and well-tolerated therapy for moderate to severe atopic dermatitis in children and adolescents. We suggest that DPCP may be effective in the treatment of moderate to severe atopic dermatitis of children and adolescents without serious complications.

A Case of Congenital Eruptive Vellus Hair Cyst / 대한피부과학회지

An eruptive vellus hair cyst is an uncommon, benign, epithelial tumor with hair differentiation. Clinically, it presents as asymptomatic, flesh-colored to yellowish, follicular papules, 1 to 4 mm in diameter, most commonly on the chest. It is usually seen in children and young adults but may be congenital. Histologically, it shows a middermal cyst lined by squamous epithelium containing keratinous material and vellus hairs. It has a tendency to clear spontaneously but may be persistent. We report a case of congenital eruptive vellus hair cyst in an 11-year-old girl who presented multiple pinhead-sized brown to black papules on her anterior chest since birth.

A Case of Zosteriform Cutaneous Metastasis from Transitional Cell Carcinoma of the Urinary Bladder / 대한피부과학회지

The usual sites of the bladder cancer metastases are lymph nodes, liver, lungs and bone. The incidence of metastases to the skin from bladder cancer has been reported to be between 0.2 and 2%. Cutaneous metastases from transitional cell carcinoma (TCC) of the bladder occur infrequently. Metastatic skin cancers vary in type, in rare instances, zosteriform metastases may occur. A 77-year-old man with transitional cell carcinoma of the bladder presented with multiple grouped erythematous papuloplaques and nodules which had developed on the right abdomen, flank and back in zosteriform distribution. Histopathologic examination revealed dermal pleomorphic cellular infiltration and tumor cells in lymphatic vessels. It represents a case of zosteriform cutaneous metastasis from transitional cell carcinoma of the urinary bladder.

Clinical and Histopathological Study of Cutaneous Melanoma in Korea / 대한피부과학회지

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.

Clinical and Histopathological Study of Cutaneous Lymphomas in Korea / 대한피부과학회지

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.