Generalized Granuloma Annulare Associated with Myelodysplastic Syndrome / 대한피부과학회지

Generalized granuloma annulare (GGA) is a rare variant of granuloma annulare, presenting with diffuse papules and annular patches on the trunk and extremities. Though the pathogenesis of GGA has not been totally understood, recent studies have shown the relationship between malignancy and GGA. A 74-year-old man developed a generalized, mildly pruritic erythematous papules, which slowly coalesced into annular patch with elevated rim. Punch biopsy showed palisading and interstitial granuloma with giant cells. A complete blood cell count with differential revealed leukopenia and subsequent findings of the bone marrow biopsy were compatible with myelodysplastic syndrome (MDS). As there was no more progression of MDS, only the skin lesions were treated with hydroxychloroquine, isotretinoin and phototherapy, and improved after 14 months of treatment. We recommend that careful evaluation of the underlying solid tumor, as well as hematologic malignancy, should be done when the dermatologists encounter with the patient presenting generalized granuloma annulare.

Reconstruction of Periorbital Basal Cell Carcinoma after Mohs Micrographic Surgery by Combination of Local Flaps and Graft / 대한피부과학회지

In reconstructing skin defects on the periorbital area, functional maintenance, as well as cosmetic outcomes, should be seriously considered. The periorbital defects, after Mohs micrographic surgery, are not easily treated with simple closure or flaps, as the defects are relatively large, but the areas have low laxity and locate closely with cosmetically important components in the face. We experienced two patients of basal cell carcinoma (BCC) on the medial canthus, which were completely excised with Mohs micrographic surgery. The defects after Mohs surgery were reconstructed by combining the techniques of transposition flap, island pedicle flap, and skin graft. Two patients were very satisfactory with post-operative results in both functional and cosmetic aspects. To our experiences, the combination of flaps and graft can be a simple and a cosmetically excellent method in reconstructing the relatively large defects for BCC removal on the periorbital area.

Kissing Nevus of the Penis

Kissing or divided nevi are similar in shape to congenital melanocytic nevi located on an adjacent part of the body that are separated during embryogenesis. Kissing nevi of the upper and lower eyelids have been reported infrequently since the first report in 1908. Kissing nevi of the penis are very rare, with only 12 cases being reported until now, and this is the first case report in the Korean dermatological literature. A previously healthy 27-year-old man presented with asymptomatic black colored patches, which were detected 10 years ago, on the glans penis and the prepuce with growth in size. We report here a case of kissing nevus of the penis, which showed an obvious mirror-image symmetry relative to the coronal sulcus.

Pigmented Paget's Disease: A Rare Clinical Manifestation of Recurred Breast Carcinoma / 대한피부과학회지

Pigmented mammary Paget's disease is a rare variant of mammary Paget's disease, and this mimics malignant melanoma both clinically and histopathologically. Two women aged 48 and 44 years old, respectively, presented with 2-cm pigmented patches and 1-cm pigmented erosive crusted papules without discharge or palpable masses, respectively. They had previously undergone breast-conserving surgery following the diagnosis of intraductal carcinoma of the breast. Physical examinations and imaging studies revealed no evidence of the recurrence of breast cancer. However, histopathological and immunohistochemical analyses demonstrated the presence of 1) Paget's cells in the epidermis and these cells contained melanin within their cytoplasm and 2) numerous melanophages in the upper dermis. We diagnosed the two patients with pigmented Paget's disease. Subsequent pathological analyses revealed recurrent intraductal carcinoma. We recommend that skin biopsies should be taken from patients presenting with pigmented lesions of the nipple, who have previously undergone breast-conserving treatment, to test the possibility of cancer recurrence.