Pigmented Basal Cell Carcinoma of the Nipple-Areola Complex in an Elderly Woman

Basal cell carcinoma (BCC), which frequently occurs in sun-exposed areas of the head and neck region, is the most common cutaneous malignancy. The nipple-areola complex (NAC) is an uncommon site for BCC to develop. BCCs in this region display more aggressive behavior and a greater potential to spread than when found in other anatomical sites. This paper outlines the case of 67-year-old female with a solitary asymptomatic black plaque on the right areola. The lesion was initially recognized as Paget's disease of the nipple by a general surgeon. However, the histopathological features showed a tumor mass of basaloid cells, a peripheral palisading arrangement and scattered pigment granules. Finally, the patient was diagnosed with pigmented BCC of the NAC and was referred to the department of dermatology. Positron emission tomography-computed tomography revealed the absence of distant metastasis. A wide excision was done. The lesion resolved without recurrence or metastasis during 14 months of follow-up.

A Case of Malignant Melanoma Arising from Giant Congenital Melanocytic Nevus in a 4-year-old Girl / 대한피부과학회지

Melanoma may arise from a very giant congenital melanocytic nevus even in the first several years of life. Therefore, excision of a giant congenital melanocytic nevus should be considered as early as possible. However considering surgical and anesthetic risks, the surgery can wait until after the first 6 months of life. Unfortunately, surgical treatment does not completely prevent occurrence of melanoma from a giant congenital melanocytic nevus. Besides, several cases of melanoma occurring after blunt trauma or laser therapy have been reported. We report a case of malignant melanoma associated with a giant congenital melanocytic nevus in a 4-year-old female. The malignant melanoma occurred at the boundaries of the previous surgical excision and laser therapy sites for a giant congenital melanocytic nevus. This is the youngest case of malignant melanoma developed from a congenital melanocytic nevus in the Korean dermatological literature.

Biologic Maggot Therapy in Cutaneous Wounds and Postoperative Defects / 대한피부과학회지

BACKGROUND: Maggots are larva of Phaenicia Sericata, the Green Blowfly, and treatments with maggot have recently become widespread revealing their effectiveness in the treatment of chronic wounds, such as diabetic ulcers and pressure sores, by removing necrotic tissue selectively and avoiding damage of healthy tissue. OBJECTIVE: The aim of this study was to evaluate the usefulness and the adverse effects of maggot therapy in dermatology for the treatment of chronic wounds and rapid granulation tissue formation at postoperative defects before reconstruction. METHODS: Fourteen patients with various kinds of skin wounds were included and applied a biobag containing therapeutic maggots on their wounds. RESULTS: Four cases were included for treatment of acute and chronic skin wounds; 10 cases of surgical defects were included for reduction of the treatment period. Maggot therapy periods ranged from 4 to 17 days (mean: 8.3 days). Complete elimination of necrotic tissue was achieved in 7 cases (50%) and partial elimination was achieved in 7 cases (50%). There weren't any cases of incomplete elimination or no response. Eight cases (57.1%) were in the 'excellent' group which had shown rapid granulation tissue formation and 3 cases (21.4%) were in the 'good' group, which had shown relatively rapid granulation tissue formation. But, there were 3 cases (21.4%) which had shown no difference from the previous time. Acute complications such as pain and bleeding had occurred in a few cases after maggot therapy. CONCLUSION: We suggest that the maggot therapy is a useful and effective method to use in the field of dermatology.

Parry-Romberg Syndrome with En Coup de Sabre

Parry-Romberg syndrome (PRS) is a relatively rare degenerative disorder that is poorly understood. PRS is characterized by slowly progressing atrophy affecting one side of the face, and is frequently associated with localized scleroderma, especially linear scleroderma, which is known as en coup de sabre. This is a report of the author's experiences with PRS accompanying en coup de sabre, and a review of the ongoing considerable debate associated with these two entities. Case 1 was a 37-year-old woman who had right hemifacial atrophy with unilateral en coup de sabre for seven years. Fat grafting to her atrophic lip had been conducted, and steroid injection had been performed on the indurated plaque of the forehead. Case 2 was a 29-year-old woman who had suffered from right hemifacial atrophy and bilateral en coup de sabre for 18 years. Surgical corrections such as scapular osteocutaneous flap and mandible/maxilla distraction showed unsatisfying results.

Five Cases of Glomuvenous Malformations / 대한피부과학회지

Glomuvenous malformation (GVM), an uncommon variant of venous malformation (VM), reveals dilated venous channels lined by variable amounts of glomus cells histopathologically. It appears as compressible blue or blue-purple nodules or plaque(s), sometimes showing a familial tendency. GVM usually involves only the superficial layer of the cutis or subcutaneous tissue, unlike VM, which frequently involves deeper tissue. Although GVM shares features of VM and glomus tumor, their clinicopathological and/or genetic features are sufficiently distinctive to enable a differential diagnosis, which is important for management decisions. Herein, we report five patients who showed a large confluent patch or several scattered patches composed of tender bluish blebs. Two patients among them were siblings. Histopathological and immunohistochemical examinations confirmed GVM.

Metastatic Melanoma of the Right Axilla Developing 22 Years after the Treatment of Primary Cutaneous Melanoma of the Right Thumb: Probability of "Ultra-late Recurrence" / 대한피부과학회지

The recurrence of late onset cutaneous melanoma is not a common phenomenon. Ultra-late recurrence, which is defined as recurrence more than 15 years after initial treatment, is especially rare. A patient presented with a 2-month history of firm subcutaneous tumors in his right axilla. He had been diagnosed with melanoma of his right thumb 22 years ago, treated with amputation of the right thumb and partial ipsilateral axillary node dissection; there had been no previous recurrences. The present biopsy of the right axilla revealed lymph nodes occupied by melanoma cells. Distant metastasis was revealed on PET-CT and included the lung, pancreas and abdominal lymph nodes. Three possible explanations were proposed: (i) ultra-late recurrence of primary melanoma; (ii) axillary metastases from primary malignant melanoma of internal organ(s); (iii) axillary metastases of another unknown primary cutaneous melanoma which had completely regressed. After careful consideration, we concluded the most probable diagnosis to be "ultra-late recurrence" and report this case with reviews of late and ultra-late recurrence of melanoma.

Three Cases of Noninvoluting Congenital Hemangioma / 대한피부과학회지

Congenital hemangioma (CH), which is already fully formed at birth, is a rare clinical entity that is distinctly different from the common postnatally-occurring hemangioma of infancy (HOI). These two forms of CH have been described according to their clinical courses: apart from the clinical features of presentation at birth, there is the rapidly involuting congenital hemangioma (RICH) with rapid involution shortly after birth and the noninvoluting congenital hemangioma (NICH) with neither postnatal enlargement nor spontaneous involution. It is important to recognize this uncommon disease entity NICH in the early period because it has no tendency for spontaneous regression, so timely therapeutic intervention is needed, which is in contrast to that of HOI. We present 3 patients who were 1-, 3- and 13-year-old girls with red-stippled blue to blue gray vascular lesion. They all showed their lesions since birth and the lesions remained unchanged with no subjective symptoms. Doppler ultrasonography demonstrated a well-defined fast-flowed vascular lesion confined to the dermis and subcutis. The histology commonly showed lobular growth of capillaries, centrilobular irregular and often stellate vessels, extralobular large vessels and more conclusively, negative staining for GLUT-1, which is unlike HOI.

Comparative Study of a Combination of Intralesional Corticosteroid, 5-fluorouracil and/or Pulsed Dye Laser for the Treatment of Keloids and Hypertrophic Scars / 대한피부과학회지

BACKGROUND: Despite the physical disfigurement, bothersome symptoms and psychological problemsfrom the proliferative scarring process of keloids and hypertrophic scars, there is currently no consensus regarding the best management of these lesions. OBJECTIVE: The purpose of this study was to determine the therapeutic efficacy and safety of intralesional corticosteroid injection combined with 5-fluorouracil (5-FU) and/or pulsed dye laser (PDL) in Koreans with keloids or hypertrophic scars. METHODS: Twenty-five patients with keloids and/or hypertrophic scars over 2 cm in size or who had more than 3 separated lesions were included in this study. Each scar was divided equally into 2 or more segments and these were treated with 1 of the following 3 different modalities: (1) intralesional injection of triamcinolone acetonide (TCA: 20 mg/ml weekly), (2) intralesional injection of TCA 0.1 ml (40 mg/ml) mixed with 5-FU 0.9 ml (50 mg/ml) weekly and (3) treatment #2 combined with PDL (585 nm, 5~7.5 J/cm2) at baseline and at the 3rd and 7th weeks. We estimated the change of the height, the erythema, the pliability, the pruritus, the pain/tenderness scores, the patient-self assessment and the complications. This study was an 8-week prospective study and the assessment of relapse was done at 4 and 12 weeks after the last treatment. RESULTS: There was a statistically significant improvement of the clinical signs and symptoms in all the treated groups. However, the 5-FU-treated groups had more sustained effects compared to the group that underwent TCA monotherapy with respect to flattening and pliability. Complications such as ulcerations, crusts and hyperpigmentation were more frequent in the 5-FU-treated groups. CONCLUSION: Although 5-FU may be preferable to TCA for improving the symptoms of keloids and hypertrophic scars, we believe it is prone to induce more complications in Koreans.

Five Cases of Atypical Herpes Zoster / 대한피부과학회지

Herpes zoster is characterized by multiple groups of vesicles on an erythematous base located within the distribution of a single spinal or cranial sensory ganglion. Classically, herpes zoster occurs in elderly patients, distributed unilaterally within one dermatomal area. The response to antiviral treatment is usually good, with rare recurrence. Herein we report 5 cases of atypical herpes zoster, which showed non-ordinary clinical features of the onset age, location and distribution, clinical course and treatment response. Moreover, since herpes zoster is a viral disorder in dermatologic clinics, different treatment protocols according to various underlying conditions are crucial. Therefore, we reviewed pertinent remedies under such uncommon circumstances.

Five Cases of Atypical Herpes Zoster / 대한피부과학회지

Herpes zoster is characterized by multiple groups of vesicles on an erythematous base located within the distribution of a single spinal or cranial sensory ganglion. Classically, herpes zoster occurs in elderly patients, distributed unilaterally within one dermatomal area. The response to antiviral treatment is usually good, with rare recurrence. Herein we report 5 cases of atypical herpes zoster, which showed non-ordinary clinical features of the onset age, location and distribution, clinical course and treatment response. Moreover, since herpes zoster is a viral disorder in dermatologic clinics, different treatment protocols according to various underlying conditions are crucial. Therefore, we reviewed pertinent remedies under such uncommon circumstances.

Fabrication and Characterization of a One-dimensional Fiber-optic Dosimeter for Electron Beam Therapy Dosimetry / 의학물리

In this study, we have fabricated a one-dimensional fiber-optic dosimeter for electron beam therapy dosimetry. Each fiber-optic dosimeter has an organic scintillator with a plastic optical fiber and it is embedded and arrayed in the plastic phantom to measure one-dimensional high energy electron beam profile of clinical linear accelerator. The scintillating lights generated from each sensor probe are guided by plastic optical fibers to the multi-channel photodiode amplifier system. We have measured one-dimensional electron beam profiles in a PMMA phantom according to different field sizes and energies of electron beam. Also, the isodose and three-dimensional percent depth dose curves in a PMMA phantom are obtained using a one-dimensional fiber-optic dosimeter with different electron beam energies.