Giant Acral Melanoma on the Left Thumb of a Korean Patient

The acral regions of the limbs of Asians are predisposed to develop malignant melanoma, but giant-sized acral melanoma has not been previously reported in the Asian population. Giant-sized melanoma implies aggressive tumor invasion and so it is more difficult to achieve a therapeutic cure. A 56-year-old woman presented with a giant acral melanoma of the left thumb with concomitant bone destruction and axillary lymph node metastasis. The initial lesion was a subungual black macule on the left thumb that had grown into a giant 7.0*4.0*3.5 cm-sized melanoma over a 3 year period. The left thumb was amputated and the axillary lymph nodes were completely dissected. During the ensuing 3 months, she underwent adjuvant treatment with interferon-alpha-2a. The interesting feature of this case is that the large melanoma mass of this patient, which was accompanied with adjacent bone destruction and lymph node metastasis, had developed rapidly from a small black macule in the nail matrix, and this black macule was suspected to be a subungual melanoma.

A Case of Acute Diffuse and Total Alopecia of the Female Scalp / 대한피부과학회지

Diffuse alopecia areata is the least common clinical type of alopecia, and this diffuse form lacks the characteristic hairless patches of alopecia and it begins as diffuse hair loss. Diffuse alopecia areata has been poorly characterized. In 2002, there was a suggestion to define this form of alopecia areata as acute, diffuse and total alopecia of the female scalp (ADTAFS). ADTAFS is characterized by a marked female predominance, tissue eosinophilia and a uniquely short clinical course. We report here on one case of ADTAFS.

Nuchal-type Fibroma of the Coccyx

Nuchal-type fibroma is a recently described, rare, tumor-like process of fibrous tissue occurring chiefly in the dorsocervical area. Nuchal-type fibromas in extranuchal locations are morphologically indistinguishable from lesions involving the nuchal region. Histopathologic findings of nuchal-type fibroma are poorly demarcated, dense collagen bundles with sparsely scattered fibroblasts, some interspersed adipose tissue, and entrapped nerve fibers. We report a patient with a mass on the coccyx area, and these were histopathologically consistent with nuchal-type fibroma. This tumor was surgically excised, and no recurrence had been noted during the two year follow-up period.

A Case of Congenital Smooth Muscle Hamartoma Presenting as a Human Tail / 대한피부과학회지

A human tail is a rare congenital anomaly, and is characterised by a prominent lesion from the lumbosacrococcygeal region. Human tails are classified into 'true tails' and 'pseudotails'. True tails are comprised of only mesenchymal tissue. They are presumed to be remnants of the embryologic tail. All other lumbosacrococcygeal protrusions are summarized as pseudotails. Congenital smooth muscle hamartoma usually presents as a well-circumscribed, hypertrichotic, hyperpigmented or skin-colored patch or plaque on the trunk or an extremity at birth. Histologically, numerous thick, long, well-defined bundles of smooth muscle fibers are scattered throughout the dermis in various directions. We report a case of congenital smooth muscle hamartoma in a 15-year-old male patient who presented with a tail-like protruding mass accompanied by hypertrichosis and underlying soft tissue deviation.

Epidermal Cyst on the Lower Lip

An epidermal cyst is the most common cutaneous cyst, and is the result of the proliferation of surface epidermal cells within the dermis. It is unusual that these cysts occur in mucosa, including an oral or perioral location. We report a patient with a labial epidermal cyst, which probably originated from adjacent hair follicles. We excised the tumor using an intraoral approach for better cosmetic result. This case is interesting, due to findings of a labial epidermal cyst resembling a mucocele or salivary gland tumor in morphology, and a connection finding of a cystic base with adjacent hairy skin, suggesting a subcutaneous infiltration of the cyst.

The Effectiveness of a Dressing Method using Nanocrystalline Silver for Chronic Wounds / 대한피부과학회지

BACKGROUND: The successful management of chronic wounds requires adequate dressing materials and methods. Nanocrystalline silver is a recently developed form of silver antimicrobial barrier dressing material which has rapid and sustained anti-bacterial activity, reduces inflammation and promotes wound healing. OBJECTIVE: This study was done to evaluate the effect of nanocrystalline silver dressing method on the treatment of chronic wounds. METHODS: Twenty three patients with chronic wounds of various etiologies were treated with nanocrytalline silver mesh dressing material (Acticoat(TM)) using an occlusive method. Dressing changes were performed every 2 to 3 days until reepithelization. RESULTS: The treatment with nanocrystalline silver was effective in 21 of 23 cases. This dressing method can significantly reduce the frequency of dressing changes, and thus it was more comfortable to both patients and doctors. CONCLUSION: Occlusive method using nanocrystalline silver is a useful dressing method for various chronic wounds, particularly in an outpatient setting.

A Case of Fibroelastolytic Papulosis / 대한피부과학회지

Fibroelastolytic papulosis is proposed as the diagnostic term for cases previously identified as pseudoxanthoma elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck. Clinical presentation of fibroelastolytic papulosis is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone- patterned plaques resembling pseudoxanthoma elasticum. Histology is characterized by normal, decreased, or absent elastic fibers in the papillary dermis sometimes accompanied by a thickening of collagen fibers. We report a 60-year-old woman with flesh to yellowish colored papules with cobblestone appearance, which were histologically consistent with fibroelastolytic papulosis.

Multiple Dermatofibrosarcoma Protuberans on the Scalp Treated by Tissue Expansion and Mohs Micrographic Surgery / 대한피부과학회지

Dermatofibrosarcoma protuberance is a relatively rare malignant soft tissue tumor which is locally invasive and looks like a protruded hardened plaque composed of multiple nodules. It seldom occurs on the scalp and the occurrence rate is less than 5%. Nowadays there is a tendency to choose Mohs surgery as a primary treatment instead of a wide excision, because Mohs surgery can reduce cases of recurrence. We report a case of multiple dermatofibrosarcoma protuberans on the scalp of a 32-year-old man. We planned a delayed operation using tissue expanders. We inserted two skin expanders and successfully expanded scalp tissue more than 150% after 7 months. Mohs surgery was performed with a 4 cm distance from borderline of lesions and then the large scalp skin defect was covered by the expanded skin which had been prepared by tissue expanders. It has been 9 months since the operation was performed and there have been no signs of recurrence.

A Clinical Study of 90 Patients with Rosacea / 대한피부과학회지

BACKGROUND: Rosacea is well recognized as a chronic cutaneous disorder primarily of the convexities of the central face. Despite its apparent high incidence, the nosology of rosacea is not well established in Korea. OBJECTIVE: The purpose of this epidemiological study was to investigate the clinical manifestations of Korean rosacea patients diagnosed by the US National Rosacea Society guidelines of US. METHODS: We performed a clinical study in 90 patients with rosacea who visited the Department of Dermatology, Korea University Ansan Hospital from January 2005 to December 2006. These patients were evaluated with regard to age, sex, primary/secondary features, clinical subtypes and predisposing factors. RESULTS: The ratio of males to females was 1 : 1.3. The age distribution showed a peak incidence in the fifth decade. Primary features of rosacea were telangiectasia (70.0%), nontransient erythema (68.9%), papules and pustules (62.2%) and flushing (61.1%). The most common secondary features of rosacea were burning and stinging (62.2%). Other secondary features were dry appearance (46.7%), edema (35.6%), plaque (20.0%), phymatous changes(18.9%), ocular manifestations (17.8%) and peripheral location (2.2%). The most common subtype was erythematotelangiectatic rosacea (51.1%), followed by papulopustular rosacea (34.4%), phymatous rosacea (12.2%) and ocular rosacea (2.2%). The majority of rosacea patients revealed mild symptoms (83.3%). Predisposing or exacerbating factors of rosacea were stress (52.2%), hot baths (46.7%), alcohol (44.4%), hot weather (42.2%), sun exposure (38.9%), exercise (35.6%), cold weather (25.5%), skin-care products (23.3%), spicy foods (21.1%), indoor heat (15.6%), heated beverages (12.2%) and humidity (4.4%). CONCLUSION: In this study, the National Rosacea Society classification system applied well to Korean patients. We identified female predominance, a peak in the fifth decade and the majority of Korean rosacea patients suffering from the erythrotelangiectatic type of rosacea. Other similarities and differences to previous reports were also discussed.

The Effectiveness and Safety of Local Bichloroacetic Acid in the Treatment of Xanthelasma Palpebrarum / 대한피부과학회지

BACKGROUND: Xanthelasma palpebrarum is the most common type of xanthoma. Due to its delicate location near the eye, treatment of xanthelasma palpebrarum is rather difficult. The treatment includes surgical excision, local treatment with chemicals, and various laser therapies. OBJECTIVE: This study was designed to review the various therapeutic modalities and to evaluate the efficacy and safety of bichloroacetic acid (BCA) for the treatment of xanthelasma palpebrarum. METHODS: Nine patients, with a total of 19 xanthelasma lesions, were treated with BCA. The efficacy and safety were assessed over a follow-up period of 6 to 24 months (average, 16 months). RESULTS: All lesions were grossly removed completely with a single treatment and the treatment was well-tolerated by patients. Erythema and oozing were observed in six patients but improved after two weeks' dressing. Xanthelasma palpebrarum recurred in three patients, but the mean size of the recurred lesions was smaller in comparison to the primary lesion. CONCLUSION: BCA is an effective and safe therapeutic modality for xanthelasma palpebrarum. Advantages include simplicity, cost-effectiveness, speed, safety and efficacy.

A Case of Eccrine Porocarcinoma on the Scalp / 대한피부과학회지

Eccrine porocarcinoma is a very rare, locally-aggressive, potentially fatal tumor arising from the intraepidermal ductal portion of the eccrine sweat gland. It develops either spontaneously or from a long standing benign eccrine poroma. It usually affects older people and is located most commonly on the lower extremities. We report a case of eccrine porocarcinoma which developed on the scalp of an 82-year-old woman. There was no evidence of metastasis, and the tumor was successfully removed by Mohs micrographic surgery.

Two Cases of Giant Keratoacanthoma Treated with Intralesional Methotrexate / 대한피부과학회지

Keratoacanthoma is a rapidly-growing tumor, which histologically resembles squamous cell carcinoma. Although it may regress spontaneously, keratoacanthoma is routinely treated by excision. Although excisional surgery is the treatment of choice, this can result in functional and cosmetic defects when large or strategically located lesions are treated. An effective nonsurgical treatment would be desirable in such cases. We report two cases of giant keratoacanthoma treated with intralesional methotrexate. Each case showed complete resolutions over 6 injections within 10 weeks. No recurrence occurred during the followup period. We suggest that intralesional injection of methotrexate is an effective and non-operative modality for the treatment of giant keratoacanthoma.

A Case of Recurrent Atypical Fibroxanthoma Treated with Mohs Micrographic Surgery / 대한피부과학회지

Atypical fibroxnathoma (AFX) is a pleomorphic spindle cell neoplasm of the dermis, and is a clinically-benign reactive lesion, despite apparently malignant histologic features. We describe a case of 16-year-old female with recurrent AFX which developed on the occipital scalp. The lesion was totally excised by Mohs micrographic surgery and no recurrence was observed during one year follow up period. It is uncommon for AFX, such as the present case, to develop on a non-sun-exposed area and in adolescence.