Amelanotic Melanoma in the Left Retromandibular Area: A Case Report / 대한피부과학회지

Amelanotic melanomas comprise only 2% of malignant melanomas and are commonly a difficult clinical diagnosis, due to the lack of melanin pigment typically found in melanomas. Even rarer is the amelanotic malignant melanoma, which may clinically mimic a variety of other less serious cutaneous lesions such as erythema or pruritus, and therefore misdirecting the clinician toward improper treatments and frequently delaying necessary diagnostic biopsy. We report a rare case of amelanotic melanoma occurring in the left retromandibular area with a poor prognosis. A 73-year-old woman presented with a 3-year history of a erythematous lesion in the left retromandibular area. The lesion was surgically removed and biopsy was performed. The biopsy specimen showed atypical, pleomorphic tumor cells with little melanin pigment. On immunohistochemical study, the tumor cells were positive for S-100 protein, HMB-45 and Melan-A. These findings were consistent with amelanotic malignant melanoma. On positron emission tomography/computed tomography (PET/CT), hypermetabolic lesions were found in both the axillary lymph nodes. She was treated with chemotherapy. But four months later, the patient died. Amelanotic melanoma is extremely rare and is more aggressive than pigmented lesions in the similarly stage. The absence of pigmentation in the tumor may result in diagnostic confusion. The clinician should be familiar with the presentation of amelanotic malignant melanoma to facilitate prompt diagnosis. Early diagnosis is crucial since survival is related to tumor thickness and tissue invasion.

Subungual Squamous Cell Carcinoma of the Left Fourth Finger: A Case Report / 대한피부과학회지

Subungual squamous cell carcinoma is a rare malignant tumor. It may clinically mimic a variety of benign inflammatory lesions and this frequently misdirects the clinician toward delaying proper treatment. In this article, a 62-year-old woman presented with a 2-year history of repeat swelling, erythema and severe pain on the left fourth fingernail. She had been frequently treated under the clinical impression of paronychia or onychomycosis. Despite the treatment, no improvement was noted. She had an incisional biopsy of the perionychium. The histologic diagnosis was revealed invasive, well-differentiated squamous cell carcinoma. On the whole body PET-CT, hypermetabolic lesion was found in the distal phalanx of the left fourth finger. She underwent amputation at the distal phalangeal joint. There has been no recurrence of tumor for one year after surgery. In conclusion, subungual squamous cell carcinoma is often mistaken for chronic inflammation. When resistance to treatments is observed, the possibility of malignancy must be considered and early biopsy is recommended.

A Case of Zosteriform Kaposi's Sarcoma after Prednisolon Treatment / 대한피부과학회지

Kaposi's sarcoma is a rare lympho-angioproliferative neoplasm with four types of variants: classic, iatrogenic immunosuppressive drug-associated, AIDS-related and Africa-endemic Kaposi's sarcoma. Most immunosuppressive drug- associated Kaposi's sarcomas usually occur after a kidney transplant or after receiving immunosuppressive therapy. A 64-year-old female patient showed numerous purpuric nodules and smaller erythematous plaques on the right lower leg for three months. Previously, the patient was treated with an immunosuppressive drug for rapidly progressive glomerulonephritis for a five-week period. A skin biopsy was performed under the clinical diagnosis of Kaposi's sarcoma. We performed immunohistochemical staining and polymerase chain reaction to detect human herpes virus 8 (HHV-8). We report a case of iatrogenic immunosuppressive drug-associated zosteriform Kaposi's sarcoma that rapidly occurred five weeks after prednisolon therapy in a rapidly progressive glomerulonephritis patient.

Expression of CD133, CD24, CD44 in Cutaneous Malignant Tumors / 대한피부과학회지

BACKGROUND: Based on the unlimited proliferative and self-renewel properties of cancer cells similar to those of stem cells, the idea that cancer may originate from stem cells has been suggested in many different studies and has given rise to cancer stem cell hypothesis. CD133, being normally expressed on the surface of hematopoietic stem cells, has recently been suggested as a marker of cancer stem cells in several malignancies. CD24 and CD44 are membrane proteins reported as markers of various neoplasms. OBJECTIVE: This study was designed to investigate the immunohistochemical expression of the CD24, CD44 and CD133 in squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and malignant melanoma (MM). METHODS: We performed immunohistochemical staining for CD24, CD44 and CD133 using 18 skin cancer tissue samples, including 6 SCCs, 6 BCCs and 6 MMs. The expression of each marker was standardized by the histochemical score (HSCORE). RESULTS: The expression of CD24 showed positive in 1 case of 6 SCCs (mean HSCORE, H; 0.02) and showed negative in 6 BCCs (H; 0.00), 6 MMs (H; 0.00). The expression of CD44 was not observed in 6 SCCs (H; 0.00) but observed in 1 case of 6 BCCs (H; 0.04) and 1 case of 6 MMs (H; 0.03). The expression of CD133 showed positive in 2 cases of 6 SCCs (H; 1.21) and 1 case of 6 BCCs (H; 0.05) and 6 cases of 6 MMs (H; 2.78). CONCLUSION: Our data suggest that CD133 may be a reliable marker of which the higher expression is observed in the more invasive skin cancers and that the existence of cancer stem cells may enhance tumorigenic potential in cutaneous malignant tumors.