A Case of Superficial Epithelioma with Sebaceous Differentiation / 대한피부과학회지

Superficial epithelioma with sebaceous differentiation (SESD) is a rare benign neoplasm with peculiar histopathologic characteristics. It is characterized by a superficial plate-like proliferation of basaloid to squamoid cells with broad attachments to the overlying epidermis. Keratin-filled cysts and clusters of sebaceous cells are present within the lobules. We herein report an additional case of SESD which developed on a 68-year-old female.

Clinicopathological Study of Hemangioma of Infancy and the Immunohistochemical Study of GLUT1 Expression / 대한피부과학회지

BACKGROUND: Hemangiomas of infancy are common, benign, pediatric tumors of endothelial cells. This is characterized by an initial phase of rapid proliferation, which is followed by slow involution, often leading to complete regression. There has been no large clinicopathological study in Korea. OBJECTIVE: The purpose of this study was to investigate the clinicopathological findings of hemangioma of infancy in Korean patients. METHODS: The clinical study included 256 patients of hemangioma of infancy. Histopathological examination of 18 cases was done with H&E staining. We also performed immunohistochemical staining with GLUT1 in 10 cases. RESULTS: The study results are summarized as follows: 1. The male to female ratio was 1: 3.1. Half of the lesions were noticed at birth. 2. The sites of predilection were head and neck (68.9%), upper extremities (11.7%), trunk (10.2%), and lower extremities (8.8%). 3. The results of clinical classification by depth of lesion were: superficial hemangioma (63.7%), deep hemangioma (20.9%), and combined hemangioma (15.4%). 4. The results of histopathological classification by the developmental phase were: proliferating phase (16.7%), involuting phase (83.3%). 5. In the immunohistochemical study using GLUT1, three out of ten cases of hemangioma were stained positively. CONCLUSION: The clinical findings of our study were identical with previous published reports. The characteristic expression of GLUT1 in hemangioma of infancy can be helpful in differentiating them from other vascular tumors and vascular malformations, and in the examination of developmental pathogenesis in hemangioma.

A Case of Basal Cell Carcinoma of the Nose Successfully Treated with 5% imiquimod Cream / 대한피부과학회지

Basal cell carcinoma is the most common malignant skin lesion. The major aim in the treatment of basal cell carcinoma is the curative treatment, which is best done by Mohs excision of the neoplastic tissue. Despite the effectiveness of surgical excision, non-surgical treatment modalities may be preferred for large tumor size or poor patient performance status. Imiquimod may offer an alternative to surgical excision. Imiquimod is an immune modulator acting as IFN-alpha and other cytokine inducer, stimulating the innate immune response. Imiquimod's anti-tumor effect may be mediated by IFN-alpha, IFN-gamma, IL-12. At this time, there is no published experience on the treatment of basal cell carcinoma with imiquimod in Korea. We report a case of basal cell carcinoma of the nose successfully treated with topical 5% imiquimod cream.

A Case of Vaginal Adenosis / 대한피부과학회지

The mucosa of vagina in normal women is lined with thick nonkeratinizing squamous epithelium. The vaginal adenosis is defined as the abnormal presence of glandular epithelium or columnar epithelium with secretary product in the vagina. The incidence of vaginal adenosis was highly increased when diethylstilbestrol(DES) was in wide use by the mid 1940s. A 44-year-old woman without the previous intrauterine DES-exposure visited our clinic with pain on external genital area and erosive red erythematous patch on the vagina. Histopathologically, the multiple glands consisted of the columnar epithelium existed in the lamina propria of vaginal mucosa. And the lining cells resembled those cells of the fallopian tube and endometrium, namely mucinous columnar cells. We report a case of vaginal adenosis in a 44-year-old woman.

Surgical gems in dermatologic surgery I / 대한피부과학회지

A bolster, simply defined, is any device used to support or cushion. In surgery, bolsters have been used under sutures to reduce skin and subcutaneous tension. Bolsters function to reduce the potential for necrosis and laceration by distributing the wound closure tension over a broader surface area. Pexing stitich is placed between the mobilized tissue and the deep fascia and periosteum to prevent the secondary motion of closure from disrupting anatomic landmarks and moveable structures. The technique aids in obtaining linear closures, prevents distortion of free margins, prevents tenting across concavities, and fixes the closure line at the junction of cosmetic units. Standard treatment of lipoma commonly includes incision with extrication or elliptical excision. Unfortunately, these treatments often elicit a large scar. Using pressure technique, risk of hemorrhage and infection may be minimized secondary to the decreased degree of invasion. In cosmetically sensitive areas, this technique is an effective and aesthetically pleasing method for removal of lipoma.

A Case of Klippel-Trenaunay Syndrome with Bilateral Nevus Flammeus in a Neonate / 대한피부과학회지

Klippel-Trenaunay syndrome is characterized as a triad of skin capillary malformations, varicose veins and venous malformations, and soft tissue hypertrophy of the affected extremity. Venous malformations are the main cutaneous manifestation of this syndrome, present at birth and are usually unilateral. The patient, a 3-day-old male neonate, was consulted to our clinic with the skin lesions of dark red to violaceous patches on both lower extremites and swelling on the right lower extremity. Histopathologically, a specimen from the dark violaceous skin of the right swollen extremity showed dilatation of capillaries of both dermis and subcutaneous fat. We present a case of Klippel-Trenaunay syndrome with the bilateral nevus flammeus of both lower extremities in a 3-day-old male neonate.

Two Cases of Recurrent Dermatofibrosarcoma Protuberans Treated by Mohs Micrographic Surgery / 대한피부과학회지

Dermatofibrosarcoma protuberans(DFSP) is an uncommon recurrent soft-tumor of skin and is locally highly invasive and aggressive, although it rarely metastasizes. When possible, of the many treatment modalities, the surgical excision is indicated primarily. There are three surgical modalities, which are excision with undefined or conservative surgical margins, excision with wide surgical margins and Mohs micrographic surgery(MMS). And the classical standard surgery was the local wide excision with at least 3cm margin around the primary tumor and through the deep fascia. However recent studies has showed that MMS decreased the recurrent rate of the tumor, conserving the normal uninvolved tissue, and MMS is accepted as the first choice treatment modality of DFSP. Some studies reported that the margin of 2.5cm is necessary to clear the tumor in MMS. We present two cases of recurrent DFSP treated by Mohs micrographic surgery, one through 4-staged resection, the other, 3-staged resection of the tumor.

A Case of Dermal Melanocyte Hamartoma / 대한피부과학회지

Dermal melanocytosis is characterized by the presence of ectopic melanocytes in the dermis. Dermal melanocytosis assumes several morphologic forms, including the Mongolian spot, the blue nevus, the nevus of Ota, the nevus of Ito and dermal melanocytic hamartoma. Differential diagnostic features of these dermal melanocytic lesions depend on onset, course, distribution, histologic features, uniformity of pigmentation, etc. In our case, an 18-year-old girl had asymptomatic 5x3cm sized ill-defined bluish patch on left forearm since birth. Histologic examinations revealed marked increased infiltrate of pigment cells mainly in the upper dermis in Hematoxylin & eosin stain . Fontana-Masson stain and Gp 100 stain revealed marked infiltrate of melanin-containing cells in upper dermis. We report a rare case of dermal melanocyte hamartoma.

A Clinical Analysis for Surgical Treatment of Axillary Osmidrosis by Subcutaneous Tissue Remover and Carbon Dioxide(CO2) Laser / 대한피부과학회지

BACKGROUND: Axillary osmidrosis is a distressing problem characterized by and unpleasant odor, profuse sweating, and occasionally staining of clothes that may handicap those affected socially, psychologically and in the work place. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. However, it is still not clear whether which type of surgery can provide the best long-term results. OBJECTIVE: We evaluated the long-term(more than 2 years) follow-up results of subcutaneous tissue remover and Carbon Dioxide(CO2) laser for surgical treatment(Kim's operative method) of axillary osmidrosis retrospectively. METHODS: The number of patients who had been surgically operated wase 132 and among them, 62 patients were interviewed by telephone. The degree of recurrence, scar, satisfaction, the causes of dissatisfaction, and recommendation were evaluated. RESULTS: Thirty-eight of the 62 patients(61.3%) had no recurrence. Twenty-one patients(33.9%) of the 62 patients had rarely scar. Forty-five patients(72.6%) had a feeling of satisfaction. CONCLUSION: This combined method has the advantages of a high success rate, low complication rate and less scarring for the treatment of axillary osmidrosis based on the long-term evaluation.

A Case of Black Hairy Tongue Associated with Minocycline / 대한피부과학회지

Black hairy tongue is the name given to the appearance of an abnormal coating of the tongue and occurs in adults. It is the result of hyperkeratosis of the filiform lingual papillae which, on gross examination appear hair-like with a variable tinctorial aspect from yellow-brown to black. The pathogenesis is unknown. A number of etiologic factors have been implicated including the administration of topical or systemic antibiotics, poor hygiene, smoking, alcohol and the use of mouthwashes. We report a case of black hairy tongue that may be associated with oral administration of minocycline.

A Case of Invasive Squamous Cell Carcinoma of the Vulva / 대한피부과학회지

Vulvar cancer is uncommon and represents about 4% of malignancies of the female genital tract. Squamous cell carcinomas account for about 90% of the cases. However few cases are reported in dermatologic literatures. Theses lesions are usually characterized by firm, hyperkeratotic papules, plaques or indurated erosions. Human papilloma virus(HPV)DNA has been reported in 20-60% of patients with invasive vulvar cancer. The HPV-positive group has been characterized by a younger mean age, more tobacco use, and simultaneous presence of vulvar intraepitherial neoplasia(VIN) and the invasive component. We report a case of invasive squamous cell carcinoma of the vulva associated with HPV type 16 positive according to polymerase chain reaction.

A Case of Multiple Keratoacanthoma with Intralesional 5-FU and Etretinate Therapy / 대한피부과학회지

Keratoacanthoma is a benign epithelial growth tumor arising from the hair follicle predominantly in elderly patients on sun-exposed skin. Intralesional therapy with 5-fluorouracil is a safe treatment and may be the treatment of choice for multiple keratoacanthoma and solitary lesion which are difficult to remove surgically. We have experienced a case of multiple keratoacanthoma which involved the right nasolabial fold and the left ear. We treated them with oral etretinate and intralesional 5-fluorouracil(5-FU), therefore minimized the scar of the lesion and the possibility of recurrence.

Two Cases of Pilonidal Sinus / 대한피부과학회지

Pilonidal sinus is a chronic inflammatory disease that is associated with hair; a midline hairy patch or pit in the sacral region with a sinus orifice in the bottom, or a cyst beneath it, in which hair is growing. Also, it is considered to belong in the category of follicular occlusion tetrad. It sometimes becomes inflamed, resulting in a subcutaneous abscess with recurrent infection. It becomes symptomatic during adolescence and presents as a foreign body abscess, with hair as the offender. Histological findings show follicular hyperkeratosis of the infundibulum with plugging and dilatation of follicle. Infiltration of hair occurs in one half of the specimens. Also, inflammatory cells are gathering to meet the challenge. The recommended treatment has been surgical excision of the lesion.