An Analysis of Clinical and Histopathological Pattern of Malignant Melanoma

PURPOSE: Malignant melanoma is a fatal tumor arising in the melanocytic systems of the skin. The incidence of malignant melanoma, formerly considered a rare tumor in Korea, is observed to increase. The aim of this study is to analyze the clinical and histopathological pattern of malignant melanoma in one institute. METHODS: Thirty patients with ages ranging from 33 to 80 years, diagnosed as malignant melanoma at our skin tumor department, were enrolled in a retrospective study over a 6 year period(2000. 9-2006. 7). The analyzed data included age, sex, location, duration before diagnosis, clinical type, level of invasion, and stage. RESULTS: The cases were identified and analyzed by clinical and histopathologic study. The male to female ratio was 1:1.7. Lower extremities(especially, feet) were favored sites. The majority of cases were acral lentiginous melanoma(40%), followed by nodular melanoma (36.7%), superficial spreading melanoma(20%) in this study. Clark level IV was predominant in histopathologic study. There was merely narrow gap among each stage by AJCC. CONCLUSION: The clinicopathological characteristic of melanoma in our patients is quite different with that in the West. In this retrospective study, primary lesions of the foot were predominant with melanoma, and a high percentage of these were classified pathologically as acral lentiginous melanomas. Patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than Western patients. These suggest that malignant melanoma has a worse prognosis in our patients than in the West. So, further organized prospective studies are needed to approach the prudent and accurate diagnosis and management of melanoma in Korea.

Clinical Experiences of Arteriovenous Fistula on The Face

PURPOSE: Arteriovenous fistula is one of high flow vascular malformations. Recently, arteriovenous fistula has been regarded as one of the type of arteriovenous malformations. The patients were diagnosed as arteriovenous malformation Schobinger clinical stage II. Even though arteriovenous fistula rarely occurs on head and neck, treatment of that is difficult due to frequent recurrence. In treating the arteriovenous fistula, chemical embolization, surgical excision and other treatment modalities were used, but the results were not satisfactory. The authors experienced three cases of arteriovenous fistula and treated them with surgical excision. METHODS: In cases, warmth, enlargement, pulsation, thrill, and bruit were found. For the accurate evaluation before the operation, angiography and MRI were checked in advance. Incision was made on the site of pulsation. The artery and vein connected to the arteriovenous fistula were dissected widely, individually ligated, and divided. And then the entire mass was totally removed. RESULTS: All surgical sites were healed well without complications and there was no evidence of recurrence in all cases up to for 2 years of follow-up examination. CONCLUSION: The arteriovenous fistula on face is a very rare disease and has difficulties in treatment. The authors experienced three cases of arteriovenous fistula with complete surgical removal and no recurrence was found in all cases.

Role of Protein Kinase C in Abnormal Proliferation of Vascular Endothelial Cell induced by 1,2-Dimethylhydrazine; Analysis of Isoform

PURPOSE: Protein tyrosine kinase(PTK), protein kinase C(PKC), oxidase, as a mediator, have been known to take a role in signal transduction pathway of angiogenesis. The authors confirmed that PKC is the most noticeable mediator for abnormal proliferation of vascular endothelial cells through in vitro study model using the inhibitors, targeting the formation of three co-enzymes. In this study, we would investigate which isoform of PKC play an important role in abnormal angiogenesis of vascular endothelial cell. METHODS: In 96 well plates, 10(4) HUVECs(human umbilical vein endothelial cells) were evenly distributed. Two groups were established; the control group without administration of DMH(1,2-dimethylhydrazine) and the DMH group with administration of 7.5x10(-9)M DMH. RNA was extracted from vascular endothelial cell of each group and expression of the PKC isoform was analyzed by RT-PCR(reverse transcriptase-polymerase chain reaction) method. RESULTS: RT-PCR analysis showed that PKCalpha, -betaI, -betaII, -eta, -micron and -zeta were expressed in vascular endothelial cells of each group. DMH incresed the expression of PKCalpha and PKCmicron, and decreased PKCbetaI, PKCbetaII expression dominantly. CONCLUSION: Based on the result of this study, it was suggested that PKCalpha and PKCmicron may have significant role in abnormal proliferation of vascular endothelial cell.

Activity of Protein Kinase C in Abnormally Proliferated Vascular Endothelial Cells

PURPOSE: To understand the pathogenesis of the disease that presents abnormally proliferated vascular endothelial cells, a model of DMH(1,2-dimethylhydrazine)-induced abnormal proliferation of HUVECs(Human Umbilical Vein Endothelial Cells) was made. We indirectly determined that Protein Kinase C(PKC) restricts the cellular proliferation and inhibits the manifestation of growth factor by using several inhibiting substances of the transmitter through our previous studies. Thereupon, we attempted to observe direct enzymatic activities of PKC and its correlation with the abnormal proliferation of vascular endothelial cells. METHODS: 10(5) HUVECs cells were applied to 6 individual well plates in three different groups; A control group cultured without treatment, a group concentrated with 0.75x10(-8)M DMH only, and a group treated with DMH & 5x10(-9)M Calphostin C, inhibitor of PKC. In analyzing the formation of intracellular PKC enzyme, protein separation was performed, and separated protein was quantitatively measured. PKC enzyme reaction was analyzed through Protein Kinase C Assay System (Promega, USA), and the results were analyzed according to Beer's law. RESULTS: Enzymatic activity of PKC presented the highest in all reaction time of a group concentrated only with DMH, and the lowest in the control group. The group treated with DMH and the inhibitor revealed statistically lower enzymatic activity than group only with DMH in all reaction time, although higher than the control group. CONCLUSION: From the enzymatic aspect, most active and immediate reaction of the PKC was observed in the group concentrated with DMH only. The group treated with DMH & PKC inhibitor showed meaningful decrease. Accordingly, PKC holds a significant role in DMH-induced abnormal proliferation of vascular endothelial cells.

Surgical Margins for Excision of Dermatofibrosarcoma Protuberans

Dematofibrosarcoma protuberans(DFSP) is a moderate-degree malignant tumor with high recurrence rate and low metastasis rate, from soft tissue. Principle of treatment is wide excision or Mohs micrographic surgery(MMS). Although wide excision has been performed with surgical margins of 2-5cm until nowadays, there are problems of preservation of surrounding normal tissue. Therefore the authors tried to identify desirable surgical margins and operative method. From January 1999 to April 2003, 12 patients with DFSP were operated. We applied different surgical margins and operative methods according to the location of lesions. On the face, we performed MMS with surgical margin of 3-4 mm in 2 cases although there are problems of operation time and expense. But on the extremities and trunk, we performed authors' method to begin excising with surgical margins of 1cm and excise extensively with MMS by 1cm in 4 cases after April, 2001 although we had performed wide excision with surgical margin of 3 cm in 6 cases before. There was no recurrence or metastasis in the follow-up period. So we think that author's method is effective in surgical excision of DFSP

Columellar Lengthening Using V-Y Advancement Flap or Central Lip Flap in Secondary Correction of Bilateral Cleft Lip Nose Deformity

Even though it is generalized to perform synchronous lip and nasal correction, there are some cases in need of secondary correction of cleft lip nose deformity. In these procedures, the lengthening of columella plays an important role. We performed eighteen cases of the secondary cleft lip nose deformity correction using two different methods from 1997 to 2003. The central lip flap was used in eight patients and V-Y advancement flap in ten patients. Additional procedures including reverse U-incision, interdomal fixation sutures and suspension sutures were used for correction of combined deformity. Silastic nasal retainers were kept in all patients for 6 months. Both of central lip flap and V-Y advancement flap seems to be a good technique for lengthening columellar soft tissue. But new columella after V-Y advancement flap appeared to be too narrow and a bit unnatural looking and central lip flap left additional scar on the upper lip although it was conspicuous. We think that central lip flap is a better technique in a case with wide philtrum and narrow columella and V-Y advancement flap can be another choice in a columella with sufficient width.

Selection Flaps in Chest Wall Reconstruction after Open Drainage for Empyema

The purpose of reconstruction of chest wall defect after open drainage in chronic empyema is the control and prevention of recurrent infection, obliteration of dead space in thoracic cavity, and coverage of open wound. For the obliteration of empyema cavities, latissimus dorsi, pectoralis major or rectus abdominis flaps are commonly used. Among them, latissimus dorsi flap based on thoracodorsal pedicle is most versatile and most reliable. If the latissimus dorsi flap can not be used, the author uses pectoralis major flap or rectus abdominis flap depending on the location and the size of dead space and skin defect. The author reports the results of eight patients who underwent reconstruction of chest wall defect with bronchopleural fistula in empyema using muscle flaps. The author performed 4 latissimus dorsi flaps, 3 pectoralis major flaps, 1 rectus abdominis flap according to various situations. According to the size of dead space and skin defect, the author also performed deepithelized musculocutaneous flap, musculocutaneous flap or muscle flap respectively. During the follow-up period, recurrence of empyema, flap survival, morbidity of donor site and patient's satisfaction were evaluated. There was no recurrence of empyema or wound complication. Also, patients were satisfied with the results of operation. The results demonstrate reliability of various muscle flaps and author's method in selection of reconstruction flap for the chest wall defect after open drainage in empyema.