Long-Term Survival Analysis and Clinical Follow-Up in Acral Lentiginous Malignant Melanoma Undergoing Sentinel Lymph Node Biopsy in Korean Patients

BACKGROUND: In cutaneous malignant melanoma (MM) with clinically uninvolved regional lymph nodes, sentinel lymph node (SLN) status is the most powerful indicator of both overall survival (OS) and disease-free survival (DFS). However, no studies on the long-term survival and clinical follow-up of Korean patients with acral lentiginous MM (ALM) undergoing SLN biopsy (SLNB) have been published. OBJECTIVE: The purpose of this study was to investigate the clinical prognosis and long-term survival of Korean patients with ALM according to SLN status. METHODS: Thirty-four ALM patients undergoing SLNB were included in this study. We evaluated clinical and histopathological follow-up data such as the stage of disease, treatment, recurrence, and metastasis, and analyzed OS and DFS according to SLN status. RESULTS: The median follow-up time was 60.5 months (range 3~127 months). Positive SLNs were noted in 14 patients (41.2%). Patients with negative SLNs had better OS and DFS than those with positive SLNs (p<0.05). Increased Breslow thickness was associated with short OS and DFS (p<0.05), and female patients showed better DFS than male patients (p<0.05). CONCLUSION: To our knowledge, this is the first study on the long-term survival and clinical follow-up of patients undergoing SLNB for ALM in Korea. Our findings show that SLN status is an important prognostic factor for predicting OS and DFS.

Tazarotene-Induced Gene 3 May Affect Inflammatory Angiogenesis in Psoriasis by Downregulating Placental Growth Factor Expression

No abstract available.

Spectrophotometric Measurement of Minimal Erythema Dose Sites after Narrowband Ultraviolet B Phototesting: Clinical Implication of Spetrophotometric Values in Phototherapy

BACKGROUND: The spectrophotometer is well known to be a useful tool for estimating the objective minimal erythema dose (MED) during planning of phototherapy protocol. However, only a few spectrophotometric values are used to evaluate the erythema and pigmentation of the MED site during phototesting. OBJECTIVE: To determinea new meaning of the relationships among spectrophotometric values during phototesting. METHODS: Twenty-five patients with psoriasis and 23 patients with vitiligo were selected before undergoing narrowband ultraviolet B phototherapy. We interpreted the gross findings of erythema and measured the L*a*b* values using a spectrophotometer at each phototest spot. We compared MEDs, basic spectrophotometric values (L*a*b*), and b*/L* values separately according to skin type, and determined the correlation of each spectrophotometric value and the correlation between a* and b*/L* values. RESULTS: Among L*a*b* values, only b* values showed a statistically significant difference between the type III and IV groups (p=0.003). There was a positive correlation only between MEDs and b* values (p<0.05). The average b*/L*value in the type IV group was significantly higher than the type III group (p<0.05). CONCLUSION: The higher b* values in type IV skin indicates that skin tanning develops more prominently than type III. The correlation between MEDs and b* values may signify that the skin pigmentation status is deepened with the higher MEDs. The difference in b*/L*values between type III and IV skin reflects that the b*/L*value is thought to be an index of tanning. The a* value, known as an index of erythema, does not influence the degree of tanning.

Expression Patterns of Gli-1, Pleckstrin Homology-Like Domain, Family A, Member 1, Transforming Growth Factor-beta1/beta2, and p63 in Sebaceous and Follicular Tumors

BACKGROUND: Certain epidermal appendage tumors, including hyperplasias (hamartomas), adenomas, benign epitheliomas, primordial epitheliomas, and malignant tumors, can exhibit any stage of differentiation. Several molecules associated with tumorigenesis, such as Gli-1, pleckstrin homology-like domain, family A, member 1 (PHLDA-1), transforming growth factor (TGF)-beta1, TGF-beta2, and p63, are associated with tumor grade and aggressive behavior in follicular and sebaceous tumors in ways that are not well understood. OBJECTIVE: The aim of this study was to elucidate the expression of Gli-1, PHLDA-1, TGF-beta1/beta2, and p63 in benign and malignant tumors of the hair and sebaceous glands and to determine their importance in the degree of tumor differentiation. METHODS: Immunohistochemistry was performed in follicular and sebaceous tumors using antibodies against Gli-1 (sebaceous tumor marker), PHLDA-1 (hair follicle outer root sheath [ORS] cell marker), p63, TGF-beta1, and TGF-beta2. RESULTS: Gli-1 was expressed in basaloid cells, sebocytes, and sebaceous carcinoma cells, and expression levels decreased as differentiation progressed. PHLDA-1 was expressed in ORS cells and some follicular tumor cells. Expression of p63 was observed in the nuclei of the outermost basaloid cells (seboblasts), poorly differentiated sebaceous carcinoma cells, and tumor cells toward the direction of the hair. Remarkably, TGF-beta1 was expressed exclusively in the nuclei of benign and malignant follicular (hair) tumors, but not in sebaceous tumors, at levels that correlated with the degree of differentiation. CONCLUSION: We propose that p63 and/or TGF-beta1 are useful for predicting the degree of differentiation and malignant potential of sebaceous and follicular tumors and for distinguishing trichilemmal carcinoma from sebaceous carcinoma.

A Case of Onychomycosis Caused by Candida guilliermondii / 대한피부과학회지

No abstract available.

A Case of Onychomycosis due to Hortaea werneckii / 대한피부과학회지

No abstract available.

A Case of Kerion Celsi Caused by Microsporum gypseum / 대한피부과학회지

No abstract available.

Hailey-Hailey Disease Treated with Topical Tacalcitol

No abstract available.

Primary Cutaneous Epithelioid Hemangioendothelioma That Mimicked Tufted Angioma Histopathologically / 대한피부과학회지

Epithelioid hemangioendothelioma is a rare vascular tumor of endothelial origin that commonly occurs in the deep soft tissue, bone, lung, and liver, although cutaneous forms have rarely been reported. Tufted angioma (TA) is a rare slowly progressive vascular lesion characterized by multiple capillary tufts with the characteristic "canon-ball" appearance scattered throughout the dermis. A 35-year-old male presented a single, 2.5x1.5 cm sized, purpuric mass on the back. A biopsy specimen showed multiple lobules composed of epithelioid endotheial cells with intracytoplasmic vacuoles in a hyalinized and myxoid stroma, and large dilated vessels. The tumor cells were positive for CD31, CD34, and factor VIII-related Antigen, and the crescent shaped dilated vessels were negative for D2-40. We could not find any metastatic lesions on radiologic examinations. The patient was diagnosed with primary cutaneous epithelioid hemangioendothelioma. Herein, we present a rare and interesting case of primary cutaneous epithelioid hemangioendothelioma resembling TA histopathologically.

A Clinical and Statistical Study of Cutaneous Malignant Tumors in Busan City and the Eastern Gyeongnam Province Over 15 Years (1996~2010) / 대한피부과학회지

BACKGROUND: The incidence of cutaneous malignant tumors, especially basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM), has continuously increased in Korea. However, there has been little research into the distribution and incidence of malignant skin tumors in the south-eastern part of Korea. OBJECTIVE: The purpose of this study was to analyze recent trends in incidence and clinical patterns of cutaneous malignant tumors in Busan city and the eastern Gyeongnam Province. METHODS: We reviewed 714 cases of cutaneous malignant tumors that include BCC, SCC, and MM from January 1996 to December 2010 at the Department of Dermatology in Dong-A University Hospital. RESULTS: The average annual incidence of cutaneous malignant tumors among the total number of outpatients was 1.18% and has continuously increased from 0.63% to 1.91% over the last 15 years (1996~2010). In particular, the average annual incidence of BCC and SCC has markedly increased from 0.35% and 0.25% to 0.94% and 0.79%, respectively. The most common cutaneous malignant tumor was BCC (48.32%), followed by SCC (41.18%) and MM (10.50%). The mean age of onset in patients who had been diagnosed with cutaneous malignant tumors was 65.07 years (males: 62.04, females: 67.87). There was a similar incidence between males and females in cutaneous malignant tumors (1:1.08). The most common site of cutaneous malignant tumors was the face (66.25%); the cheek (34.04%) was the most preferential site on the face, followed by the nose (30.23%). CONCLUSION: The incidence of cutaneous malignant tumors has gradually increased in Busan city and the eastern Gyeongnam Province, which was relatively higher than the incidence in other areas. It was thought to be due to the higher proportion of the elderly than in other areas of the country and skin cancer centers in our hospital.

A Case of Epidermolysis Bullosa Simplex (Other Generalized Type) / 대한피부과학회지

The other generalized type of epidermolysis bullosa simplex (EBS) is a genetic blistering skin disease, caused by a mutation of the genes encoding keratin 5 and 14. EBS starts at birth and is characterized by generalized blisters following a minor trauma that heals with hyperpigmentation. A 19-year-old man presented with 19-year history of multiple erythematous vesicles in a herpetiform arrangement on the trunk, axilla, and thigh with post-inflammatory hyper-pigmentations. On light and electron microscopy, the biopsy specimen showed intraepidermal blisters that formed within the basal keratinocyte. The serum from a patient with bullous pemphigoid antibody and laminin 5 antibody showed the linear deposition at the floor of the blister on immunofluorescence mapping study. On the basis of our clinical, microscopic, and immunofluorescence findings, we diagnosed the patient as having a generalized type of EBS. Herein, we report on an interesting case of the other generalized type of EBS.

White Piedra of Scalp Hair Caused by Trichosporon asahii / 대한피부과학회지

No abstract available.

Erythema Annulare Centrifugum Associated with Candida guilliermondii / 대한피부과학회지

Erythema annulare centrifugum (EAC), first described by Darier in 1916, is characterized by annular, circinate, gyrate or serpiginous lesions. Although the pathogenesis of EAC is not fully understood, it is considered to be a hypersensitivity reaction to a wide variety of etiological factors, including autoimmune diseases, internal malignancies, drugs, infections, and pregnancy. To the best our knowledge, no case of EAC associated with Candida guilliermondii infection has ever been published in the Korean medical literature, and there have been a few reported cases associated with Candida albicans in other countries. Herein, we report on a rare and interesting case of EAC in a 62-year-old female patient with Candida guilliermondii infection.

Dilated Pore Nevus / 대한피부과학회지

No abstract available.

Lipoblastoma: A Rare Lesion in the Elderly / 대한피부과학회지

Lipoblastoma is a rare, benign tumor arising from embryonic fat tissues that continue to proliferate in the postnatal period. So, lipoblastoma occurs almost exclusively in infants and children younger than 3 years of age. Published reports showed that 70~90% of cases occur before the age of 3. Histopathologically, lipoblastoma, mimicking liposarcoma, was composed of well-defined lobulated fat tissue with multilobulated lipoblasts, undifferentiated mesenchymal cells, such as stellate or spindle cells and minimal myxoid stromas. The diagnosis of lipoblastoma is important because its management differs from that of lipoma and liposarcoma. To our knowledge, there are only a few reports of lipoblastoma in the Korean dermatologic literature. Herein, we present an interesting and atypical case of lipoblastoma in 68-year-old woman.

Frequency of BRAF Mutation and Clinical Relevance for Primary Melanomas

BACKGROUND: This study was conducted to clarify the frequency of the BRAF mutation in primary melanomas and its correlation with clinicopathologic parameters. METHODS: We analyzed the frequency of BRAF mutation in patients with primary cutaneous melanoma (n=58) or non-cutaneous one (n=27) by performing dual priming oligonucleotide-based multiplex real-time polymerase chain reaction to isolate and to purify the DNA from the formalin-fixed and paraffin-embedded tumors. RESULTS: The BRAF mutation was found in 17.2% (10/58) of patients with primary cutaneous melanoma and 11.1% (3/27) of those with non-cutaneous melanoma. The frequency of BRAF mutation was not correlated with any clinicopathologic parameters with the exception of the patient age. The frequency of the BRAF mutation was significantly higher in patients younger than 60 years as compared with those older than 60 years (p=0.005). CONCLUSIONS: Compared with previous reports, our results showed that the frequency of the BRAF mutation was relatively lower in patients with primary cutaneous melanoma. Besides, our results also showed that the frequency of the BRAF mutation had an inverse correlation with the age. Further studies are warranted to exclude methodological bias, to elucidate the difference in the frequency of the BRAF mutation from the previous reports from a Caucasian population and to provide an improved understanding of the molecular pathogenesis of malignant melanoma.

Frequency of BRAF Mutation and Clinical Relevance for Primary Melanomas

BACKGROUND: This study was conducted to clarify the frequency of the BRAF mutation in primary melanomas and its correlation with clinicopathologic parameters. METHODS: We analyzed the frequency of BRAF mutation in patients with primary cutaneous melanoma (n=58) or non-cutaneous one (n=27) by performing dual priming oligonucleotide-based multiplex real-time polymerase chain reaction to isolate and to purify the DNA from the formalin-fixed and paraffin-embedded tumors. RESULTS: The BRAF mutation was found in 17.2% (10/58) of patients with primary cutaneous melanoma and 11.1% (3/27) of those with non-cutaneous melanoma. The frequency of BRAF mutation was not correlated with any clinicopathologic parameters with the exception of the patient age. The frequency of the BRAF mutation was significantly higher in patients younger than 60 years as compared with those older than 60 years (p=0.005). CONCLUSIONS: Compared with previous reports, our results showed that the frequency of the BRAF mutation was relatively lower in patients with primary cutaneous melanoma. Besides, our results also showed that the frequency of the BRAF mutation had an inverse correlation with the age. Further studies are warranted to exclude methodological bias, to elucidate the difference in the frequency of the BRAF mutation from the previous reports from a Caucasian population and to provide an improved understanding of the molecular pathogenesis of malignant melanoma.

The Expression of Cytokine and Chemokine Related with Dendritic Cell and Effector T Cell in Psoriatic Lesions / 대한피부과학회지

BACKGROUND: T cells and dendritic cells (DCs) are more observed in the psoriatic lesion. Inflammatory DCs stimulate T cell differentiation (Th1 or Th17 cells) by producing IL-12 and IL-23 in psoriasis. Th1 expresses CCR5, while CCR6 is expressed by Th17. CCL20, the ligand of CCR6, is expressed mostly in keratinocytes to play an important role in the migration of Th17 cells. Transforming growth factor (TGF)beta inhibits the inflammatory cytokines and induces fibrosis. But, there are still controversies about the role of TGFbeta1 in psoriasis. OBJECTIVE: The purpose of this study is to clarify the pathogenesis of psoriasis by comparing the expression patterns of CD11c/IL-23, CCR5/CCR6, CCR6/CCL20, CD11c, IFN-gamma, and TGFbeta1 among overall lesional assessment (OLA) 1, 3, 5, and the control group. METHODS: We performed CD11c/IL-23, CCR5/CCR6, CCR6/CCL20 double-immunofluorecence and immunohistochemistry of CD11c, IFN-gamma, and TGFbeta1 after classifying the severity of the lesion in 1, 3, 5 with OLA score. RESULTS: As OLA score increased, the infiltration of CD11c+IL-23+ cells, CCR5+ cells, and CCR6+ cells and the expression of CCL20 also showed a significant increase. While IFN-gamma+ cells also increased with the OLA score, TGFbeta1 showed positivity usually in the increased vascular endothelial cells and the number of TGFbeta1+ vascular endothelial cells increased with OLA score. CONCLUSION: From the results, the interaction among the dendritic cell-effector T cell, and cytokine derived from the cells, and chemokine/chemokine receptor was confirmed to be important in pathogenesis of psoriasis. It was also confirmed that TGFbeta1 is not only important at neoangiogenesis, but at inflammatory angiogenesis in psoriasis.

Chilblain Lupus Erythematosus: A Case Report and Review of Literature / 대한피부과학회지

Chilblain lupus erythematosus (LE) is a rare, chronic form of cutaneous LE (CLE), which presents mostly in women as erythematous to violaceous plaques on the acral areas and face, precipitated by cold and damp climates. It may be accompanied by discoid LE (DLE) lesions or other forms of CLE. Up to 20% of patients develop systemic LE (SLE). Although two missense mutations in TREX1, encoding the 3'-5' repair exonuclease 1, were described in familial chilblain LE, the pathogenesis of sporadic chilblain LE remains unknown. To our knowledge, there are a few reports of chilblain LE in the Korean dermatologic literature. Herein, we present a rare and interesting case of sporadic chilblain LE in 71-year-old man and review the Korean literatures.

Vitiligo Developed in a Patient with Discoid Lupus Erythematosus / 대한피부과학회지

Vitiligo has been associated with various disorders, including pernicious anemia, diabetes, hyperthyroidism, alopecia areata, and Addison's disease. Discoid lupus erythematosus (DLE), the most common form of chronic cutaneous lupus erythematosus, is an autoimmune disease characterized by skin involvement. A 64-year-old man presented with multiple DLE lesions on the face and the neck, as well as photosensitive eczema on the nape of the neck. After treatment, the DLE lesions improved, but poliosis and several depigmented patches appeared on the vertex, the nape of the neck, and on the right hand. Few reports are available about the concurrence of DLE and vitiligo in other countries, and only one case, which showed coexisting systemic lupus erythematosus and vitiligo, has been reported in the Korean literature. The pathogenesis of concurrence of these two diseases has not been fully elucidated. Herein, we present a case of vitiligo that developed in a patient with DLE.