ABSTRACT
BACKGROUND: The treatment of keloids is unsatisfactory and even a challenge to many dermatologists or dermatosurgeons. Simple excision of a keloid alone is associated with a high recurrence rate. Thus, surgical treatment should be combined with various adjuvant therapies. OBJECTIVE: The aim of this study was to evaluate the efficacy of postoperative radiation therapy on the recurrence of keloids. METHODS: Between March 2007 and May 2012, 24 patients with keloids (n=56) in various anatomical sites were treated with our protocol consisting of total or subtotal keloidectomy followed by immediate irradiation of 12~18 Gy in 3 fractions over 3 days with pre- and postoperative intralesional steroid injection as an adjuvant therapy. After a year to a year and a half, treatment was terminated at that point. RESULTS: When treated keloids were classified according to the degree of flattening, the outcomes were excellent in 48.2% (27/56) of the patients, good in 32.1% (18/56), fair in 14.3% (8/56), and poor in 5.3% (3/56). This treatment protocol showed almost excellent outcomes in earlobe, earhelix, retroauricular region and abdomen. Although the sites with high stretch tension such as chest and shoulder showed above good outcomes (72%, 18/25), they also showed three poor results. The most common complication was postinflammatory hyperpigmentation while the most serious one was full-thickness skin necrosis, which was recovered by skin graft later. CONCLUSION: Radiation therapy is an effective and safe therapy for the prevention of recurrence of keloids following keloidectomy.
Subject(s)
Humans , Abdomen , Clinical Protocols , Hyperpigmentation , Keloid , Necrosis , Recurrence , Shoulder , Skin , Thorax , TransplantsABSTRACT
A 65-year-old woman with a deeply infiltrating basal cell carcinoma in the right ala underwent full-thickness excision of most of the ala, including the alar rim, crease, and the adjacent cheek, leaving a 'through-and-through' defect. Reconstruction was performed by using the reverse nasolabial flap and a cartilage graft across the alar defect, harvested from the concha, to prevent nostril collapse and to maintain the alar shape. The reverse or turnover nasolabial flap is a variant of the conventional nasolabial flap; however, it may be more suited for the repair of a full-thickness, lateral alar defect. The reverse nasolabial flap functions both as an inner liner and an outer cover and the repair is performed as a single-stage procedure. Furthermore, this flap can provide both excellent function and excellent cosmetic outcome.
Subject(s)
Aged , Female , Humans , Carcinoma, Basal Cell , Cartilage , Cheek , Nasal Cartilages , Surgical Flaps , TransplantsABSTRACT
BACKGROUND: Port-wine stain (PWS) is a congenital capillary malformations characterized by ectasia of capillaries and venules. These vascular channels progress gradually to hyperplasia of soft and hard tissues, manifested as hypertrophy of involved structures. Especially, when these lesions involve the lip, macrocheilia may develop with time. Usually vascular-specific laser treatment is used for PWS, however with no favorable effect with soft-tissue hypertrophy. Therefore, surgical treatment may be necessary in such cases. OBJECTIVE: The subjects were 9 patients who had PWS with lip hypertrophy, who were aged from 9 to 65 years. METHODS: The patients underwent cheiloplasty which include making an incision horizontally on a labial mucosa of the lip, and dissection of hypertrophied soft tissue in the front and back of the orbicularis oris muscle. RESULTS: Of the 9 patients, only 2 had postoperative complication such as mild chewing of the labial mucosa. After a minor revision surgery, these symptoms disappeared. Good to excellent results were achieved in all patients during the final postoperative cosmetic evaluation. CONCLUSION: Surgical correction is appropriate for treatment of three-dimensional tissue deformity such as lip hypertrophy with good cosmetic results and minimal complications.
Subject(s)
Aged , Humans , Capillaries , Congenital Abnormalities , Cosmetics , Dilatation, Pathologic , Hyperplasia , Hypertrophy , Lip , Mastication , Mucous Membrane , Port-Wine Stain , Postoperative Complications , Vascular Malformations , VenulesABSTRACT
Merkel cell carcinoma is a malignant neuroendocrine tumor with a high rate of recurrence and metastasis. However, approximately 23 cases of spontaneous regression have been reported. We report a case of Merkel cell carcinoma which showed spontaneous regression. The patient was an 84-year-old male with a large red-colored, hemispheric tumor on the left inner thigh which had been presented for a year. We planned to perform surgery, but the tumor suddenly started to regress spontaneously. The size of the tumor decreased, the surface was flattened, and the color changed from red to brown. The lesion finally appeared as a brownish flat plaque. Excision of the regressed tumor was performed; immunohistopathological analysis showed CD3+ T cells infiltrating around the regressed merkel cell carcinoma.
Subject(s)
Humans , Male , Carcinoma, Merkel Cell , Neoplasm Metastasis , Neuroendocrine Tumors , Recurrence , T-Lymphocytes , ThighABSTRACT
Lymphoepithelioma-like carcinoma is a neoplasm at extranasal sites with striking histological similarity to lymphoepithelioma arising in the nasopharynx. The tumor is composed of islands of pleomorphic cells with a lymphocytic infiltrate. The head and neck are the principal locations for this tumor, which occurs in the skin. Differential diagnoses include squamous cell carcinoma, Merkel cell tumor, lymphoma, cutaneous lymphadenoma, malignant melanoma, and metastatic lymphoepithelioma. Here, we report a case of lymphoepithelioma-like carcinoma of the skin in a 78 year-old male who had a firm nodule on the right upper eyelid. He was treated with wide excision and local flap coverage. The patient had been disease-free for more than 1 year.
Subject(s)
Humans , Male , Carcinoma, Merkel Cell , Carcinoma, Squamous Cell , Diagnosis, Differential , Eyelids , Head , Islands , Lymphoma , Melanoma , Nasopharynx , Neck , Skin , Strikes, EmployeeABSTRACT
Scleromyxedema is a rare disorder characterized by generalized papular and sclerodermoid eruption, increased fibroblast proliferation, mucin deposition, and monoclonal gammopathy in the absence of thyroid disease. It is a generalized subtype of lichen myxedematosus. A paraproteinemia, typically an IgG lambda, is observed in more than 80% of patients with scleromyxedema. Here, we report a 38-year-old woman with a 1-year history of a progressively spreading of eruption of small papules on the entire body, including the face, neck, arms, legs, and trunk. Laboratory tests were within normal limits, except lambda light chain monoclonal gammopathy. We administered oral retinoid and topical steroid with slight clinical improvement. To our knowledge, this is the first reported case of scleromyxedema in Korea.
Subject(s)
Adult , Female , Humans , Arm , Fibroblasts , Immunoglobulin G , Korea , Leg , Light , Mucins , Neck , Paraproteinemias , Scleromyxedema , Thyroid DiseasesABSTRACT
Soft fibromas are benign fibrous tissue tumors of the dermis. In general, they appear as small, soft, pedunculated or sessile tumors and they are mostly located on the axillae, lateral neck and inguinal region. Although large sized soft fibromas may occur in the groin or upper thighs, and especially in patients with diabetes, they rarely exceed 2 cm in size. We report herein a case of multiple giant soft fibromas, including an unusually huge, giant lesion in the labium majus of a healthy, middle-aged woman, and such fibromas on the labium majus are very rare.
Subject(s)
Female , Humans , Axilla , Dermis , Fibroma , Groin , Neck , ThighABSTRACT
Langerhans cell histiocytosis (LCH) is a reactive disease in which abnormal Langerhans cells accumulate in various body sites. We report here on a 51-year-old male patient with LCH that was classified as single-system disease (restricted LCH). The skin lesions were a small, deep ulcer in the right inguinal area and multiple erythematous papules scattered on the lower abdomen, and the patient had these lesions for 1 year. The histopathologic examination revealed a dense histiocytic infiltration in the dermis, and most of the cells showed the characteristics of "LCH" cells. The immunohistochemistry for S-100 protein and CD1a complex all showed positive results. The patient was much improved after surgical excision of the inguinal ulcer and administering oral isotretinoin (20 mg daily) for 8 months, and there was no recurrence. We think retinoid is an effective treatment option for LCH, especially for single system disease.