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Primary localized cutaneous nodular amyloidosis (PLCNA) is the rarest form of cutaneous amyloidosis, characterized by nodular deposits of light chain amyloids in the dermis and subcutaneous tissue, without apparent systemic involvement. One or several nodules are preferably located on the extremities, trunk, or face. The most useful stain for detecting amyloid fibrils is Congo red, which, when combined with polarized light, makes amyloid proteins appear apple-green under a microscope. Immunohistochemical staining can help identify the exact type of amyloid proteins. Although the exact etiology of PLCNA is unclear, removal of nodules by shaving or surgical excision has shown good results. To the best of our knowledge, only seven cases of PLCNA have yet been reported in the Korean literature. In three of these cases, the patients had lesions on the scalp. Herein, we present a case of a 34-year-old male with PLCNA on the scalp with all the results of immunohistochemical evaluation.
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Background@#Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. @*Objective@#To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. @*Methods@#Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. @*Results@#A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest followup visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. @*Conclusion@#Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.
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Purpose@#This study aimed to identify the risk factors associated with the occurrence and prognosis of hypertrophic scarring following thyroidectomy. @*Materials and Methods@#A total of 4238 patients who underwent thyroidectomy were included in this study. A multivariable logistic regression model was developed to identify the risk factors for hypertrophic scar development and its prognosis. @*Results@#Our analysis revealed that hypertrophic scar development was associated with younger age [odds ratio (OR)=0.949, p<0.0001], male sex (OR=0.562, p<0.0001), higher body mass index (OR=1.137, p<0.0001), prominent sternocleidomastoid muscles (OR=2.522, p<0.0001), scarring located within 1 cm of the sternal notch (OR=4.345, p<0.0001), and a history of keloid development (OR=2.789, p=0.0031). Additionally, scar location within 1 cm of the sternal notch (beta=4.326, p=0.0429) and a history of keloid development (beta=23.082, p<0.0001) were found to be associated with the prognosis of hypertrophic scarring. @*Conclusion@#The findings of this study provide valuable insights into the risk factors associated with hypertrophic scarring following thyroidectomy. Clinicians can use this information to predict the occurrence of hypertrophic scarring and its prognosis, and take preventative measures accordingly.
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Background@#Melanoma arising from the scalp is rare and often diagnosed at advanced stages due to difficulty in detection. @*Objective@#This is the first study that aimed to analyze the clinicopathological findings of scalp melanoma among Korean patients at a single institution. @*Methods@#In this single-centered retrospective study, medical records were used to review data of patients with scalp melanoma between 2006 to 2021. Chronic sun damage (CSD) was evaluated by reviewing histopathological findings of scalp melanoma. @*Results@#Fifteen patients were identified. Mean age at diagnosis was 53.93 years. In 14 cases, the tumors were located on hair-covered areas. Mean Breslow’s thickness was 6.06 mm. Nodular melanoma was the most common histologic type (n=9), followed by superficial spreading (n=5), and lentigo maligna (n=1). Ulceration was present in five cases. In nine cases, CSD was moderate. Elective neck node dissection was performed in 13 cases, with five revealing nodal involvement. At initial staging, three patients were in stage I, six were in stage II, four were in stage III, and two were in stage IV. Recurrence occurred in seven of the 15 cases. There were five confirmed mortalities during a mean follow-up period of 35 months. @*Conclusion@#In this study, the Breslow’s thickness of scalp melanoma was relatively deep, and the most frequent type was nodular melanoma. Since detection can be affected by black hair among Koreans, it may result in delayed diagnosis and poor prognosis. Therefore, more caution is needed when examining suspicious lesions on the scalp.
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Background@#Acral melanoma occurs on glabrous skin or the nail apparatus and is distinct from ultraviolet-related melanoma due to differing genetic alteration patterns. Although the pathogenesis of acral melanoma is not well understood, mechanical stress is thought to induce acral melanoma. The incidence of gene mutation and promoter methylation has been reported in tumors from acral melanoma; however, an association between genetic/epigenetic alterations and mechanical stress in acral melanoma remains unclear. @*Objective@#To investigate the relationship between clinical/genetic factors and mechanical stress in acral melanoma. @*Methods@#A retrospective review of 52 patients diagnosed with acral melanoma was performed. We reviewed the clinical characteristics of patients, tumor status, and tumor location. Mutations in BRAF, NRAS, and the TERT promoter, along with KIT amplification and PTEN promoter methylation were analyzed in the tumors. @*Results@#The heel (34/52, 65.4%) was the most common anatomical tumor site. Mutations in BRAF (6/48, 12.5%), NRAS (6/49, 12.2%), and the TERT promoter (4/33, 12.1%), along with KIT,/i> amplification (3/37, 8.1%) and PTEN promoter hypermethylation (12/48, 25.0%) were ob-served in the tumors. On the forefoot, heel, and hallux, PTEN promoter hypermethylation was significantly associated with Breslow thickness (p=0.001) and ulceration rate (p= 0.042). On the midfoot and lesser toes, there was no significant difference in Breslow thickness or ulceration rate regardless of PTEN promoter hypermethylation (p＞0.05). @*Conclusion@#PTEN promoter hypermethylation is associated with Breslow thickness and tumor ulceration on the forefoot, heel, and hallux in acral melanoma in Korean patients.
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Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory condition presenting with painful, deep-seated abscesses and sinus tracts in multifocal locations. Rarely, longstanding inflammation in HS may lead to serious complications, such as cutaneous squamous cell carcinoma (SCC) (also termed Marjolin ulcer). Herein, we report a case of invasive cutaneous SCC arising from chronic ulcers of a HS patient. A 40-year old Korean male, a current smoker with 20 pack-year history, presented with a history of painful, recurrent, deep-seated abscesses and ulcers on the buttocks since his late teens, thus classified as Hurley stage III. A large purulent ulcer developed on the right buttock several months ago. Initial treatment was focused on controlling infection and facilitating wound healing. The lesion showed 50% reduction of size in 6 weeks, but also developed foul odor and showed fungating margins. Multiple skin biopsies were consistent with invasive SCC. Magnetic resonance imaging revealed a few enlarged lymph nodes on the right inguinal area, which was confirmed as metastasis on frozen biopsy.Slow Mohs micrographic surgery and radical right inguinal lymph node dissection was done. Incidence rates of SCC aris-ing from HS have been reported up to 4.6%. To our knowledge, this is the first report of cutaneous SCC arising from HS in Korea. Our case emphasizes that the diagnosis of cutaneous SCC in HS should not be delayed, and early surgical intervention is crucial for better outcomes.
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Background@#Pityriasis lichenoides et varioliformis acuta (PLEVA), a type of pityriasis lichenoides disease, is an uncommon inflammatory cutaneous disorder of unknown etiology. PLEVA presents as acute inflammatory papules that progressively develop into erosions or necrotic crusts all over the body. @*Objective@#This study aimed to analyze the clinicopathological findings of 39 patients with PLEVA at a tertiary referral center in Seoul, Korea. @*Methods@#This was a retrospective and single-center study with a longitudinal section. Medical records and telephone interviews were used to review the data of patients diagnosed with PLEVA between 2006 and 2019. @*Results@#This study included 39 patients with PLEVA (male: female=2.9:1). The mean age of onset was 30.1 years, and 20/39 (51%) patients were children or young adults (＜30 years old). The mean duration of the disease course was 8.9 months. The disease was associated with a wide spectrum of clinical features ranging from erythematous inflammatory papules to diffusely progressing ulcers or crusted lesions. Treatment modalities involved topical corticosteroids (67%), low-dose systemic corticosteroids (44%), systemic antibiotics (33%), narrow-band ultraviolet B treatment (18%), and observation (13%). Except in one case, there were no reports of intolerable comorbidity or severe side effects within the follow-up period. @*Conclusion@#PLEVA showed a male predominance and primarily occurred during childhood or young adulthood in our study cohort. PLEVA could be associated with cutaneous T-cell lymphoma. Various treatment modalities may be used according to the clinical severity, and most patients exhibited a good response to treatment.
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Purpose@#We investigated the clinical efficacy of immune checkpoint blocker (ICB) therapy for metastatic or advanced melanoma in Korean patients. As well, we assessed whether the effects of ICBs can be enhanced by combination therapy with palliative radiotherapy (RT). @*Materials and Methods@#We retrospectively reviewed the records of 127 patients with metastatic melanoma who received ICB with or without palliative RT between 2014 and 2018. The melanoma subtypes were classified as follows: chronic sun-damaged (CSD), acral, mucosal, and uveal. The primary endpoint was the objective response rate (ORR). @*Results@#The overall ORR was 15%, with 11 complete and eight partial responses. ORRs for CSD, acral/mucosal, and uveal melanomas were 50%, 16.5%, and 0%, respectively (p=0.009). In addition to the subtype, stage at treatment, total tumor burden at treatment, and ICB type were significantly associated with ORR (all p < 0.05). Palliative RT was administered in 44% of patients during the treatment, and it did not affect ORR. Clinical responders to ICB therapy exhibited significantly higher 1-year progression-free and overall survival rates than nonresponders. @*Conclusion@#ORR for ICB monotherapy in Korean patients with melanoma is relatively modest compared with that in Western patients because the non-CSD subtypes are predominant in the Korean population. Our findings regarding combination therapy with ICB provided a rationale for the initiation of our phase II study (NCT04017897).
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Canalicular adenoma is a rare benign tumor that arises in the minor salivary gland. Clinically, it usually presents as an asymptomatic nodule on the upper lip or buccal mucosa. It is necessary to histopathologically differentiate canalicular adenoma from basal cell adenoma and adenoid cystic carcinoma. Canalicular adenoma shows tubular structures composed of 1 or 2 layers of columnar cells and intraluminal hemorrhage. Squamous morules, which seem to represent metaplasia, are a unique finding for this tumor. Immunohistochemical staining is often helpful for the diagnosis of canalicular adenoma, which is positive for S-100 and CK (AE1/3). Herein, we report a case of canalicular adenoma in a 71-year-old man who presented with an asymptomatic nodule on the upper lip. As far as we know, this is the first report of canalicular in Korean Dermatology Journal.
Subject(s)
Aged , Humans , Adenoma , Carcinoma, Adenoid Cystic , Dermatology , Diagnosis , Hemorrhage , Lip , Metaplasia , Mouth Mucosa , Salivary Glands, MinorABSTRACT
Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.
Subject(s)
Aged , Humans , Male , Adenoids , Biopsy , Carcinoma, Adenoid Cystic , Diagnosis , Follow-Up Studies , Mohs Surgery , Neoplasm Metastasis , Rare Diseases , Recurrence , Salivary Glands , Skin , Sutures , UmbilicusABSTRACT
Eosinophilic annular erythema (EAE) is a rare, recurrent disease of unknown etiology with tissue eosinophilia that was initially reported in a pediatric patient. It is debatable whether EAE is a distinct disease entity or a subtype of Well's syndrome. Clinically, EAE is characterized by annular erythematous plaques lasting for 4 to 12 months that predominantly affect the trunk and proximal extremities. Histologically, dense superficial and deep perivascular inflammatory infiltrates composed of lymphocytes and abundant eosinophils are observed. Herein, we report a case of EAE in a 21-year-old Korean female. The patient visited our clinic with a 1-year history of multiple erythematous annular patches on both legs that became worse during the summer and between seasons. Histopathologic examination demonstrated superficial and deep perivascular, periadnexal, and interstitial infiltrates of lymphocytes and eosinophils in the dermis and the subcutaneous fat layer. Based on the clinical and histological features, the case was diagnosed as eosinophilic annular erythema.
Subject(s)
Female , Humans , Young Adult , Dermis , Eosinophilia , Eosinophils , Erythema , Extremities , Leg , Lymphocytes , Seasons , Subcutaneous FatABSTRACT
Yonsei Dermatology celebrated its centennial in 2017, marking 100 years since Kung Sun Oh established the first Department of Dermatology and Urology in Korea in 1917. Following the footsteps of Kung Sun Oh, a pioneer of Korean dermatology, its members united and worked to provide the best medical service and achieve academic milestones in dermatology. Over the past hundred years, Yonsei Dermatology has played a pivotal role in the advancement of medical science and academia in Korea. The main activities of the department include medical care, education, and dermatologic research. Its research activities have encompassed a wide spectrum of dermatologic manifestations from skin immunology and pathology to introduction of newly developed treatment technologies. As Kung Sun Oh was the first Korean professor of dermatology at Severance Medical School and a passionate educator, we continue to serve his will by nurturing medical students and dermatology specialists to serve as global medical leaders. The Kung Sun Oh Memorial Lecture, first hosted in 1977, was the beginning of mutual international academic exchange in the field of dermatology in Korea. The memorial lecture has played a major role in advancing the academic status of Korean dermatological science by inviting distinguished dermatologists from around the world as guest lecturers. Yonsei Dermatology has played a key role in the history of modern medicine and dermatology in Korea over the last 100 years and continues to make an impact.
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Humans , Allergy and Immunology , Dermatology , Education , History, Modern 1601- , Korea , Pathology , Schools, Medical , Skin , Solar System , Specialization , Students, Medical , UrologyABSTRACT
PURPOSE: Melanoma is a highly heterogeneous neoplasm, composed of subpopulations of tumor cells with distinct molecular and biological phenotypes and genotypes. In this study, to determine the genetic heterogeneity between primary and metastatic melanoma in Korean melanoma patients, we evaluated several well-known genetic alterations of melanoma. In addition, to elucidate the clinical relevance of each genetic alteration and heterogeneity between primary and metastatic lesions, clinical features and patient outcome were collected. MATERIALS AND METHODS: In addition to clinical data, BRAF, NRAS, GNAQ/11 mutation and KIT amplification data was acquired from an archived primary Korean melanoma cohort (KMC) of 188 patients. Among these patients, 43 patients were included for investigation of tumor heterogeneity between primary melanoma and its corresponding metastatic lesions. RESULTS: Overall incidence of genetic aberrations of the primary melanomas in KMC was 17.6% of BRAF V600, 12.6% of NRAS mutation, and 28.6% of KIT amplification. GNAQ/11 mutation was seen in 66.6% of the uveal melanoma patients. Patients with BRAF mutation were associated with advanced stage and correlated to poor prognosis (p < 0.01). Among 43 patients, 55.8% showed heterogeneity between primary and metastatic lesion. The frequency of BRAF mutation and KIT amplification significantly increased in the metastatic lesions compared to primary melanomas. GNAQ/11 mutation showed 100% homogeneity in uveal melanoma patients. CONCLUSION: Our data demonstrated heterogeneity between primary melanomas and corresponding metastatic lesions for BRAF, NRAS mutation and KIT amplification. However, GNAQ/11 mutation was genetically homogeneous between primary and metastatic melanoma lesions in uveal melanoma.
Subject(s)
Humans , Cohort Studies , Genetic Heterogeneity , Genotype , Incidence , Melanoma , Phenotype , Population Characteristics , PrognosisABSTRACT
Scar sarcoidosis is a cutaneous manifestation of sarcoidosis arising on old cutaneous scars. We report four cases of scar sarcoidosis after blepharoplasty. Lesions were seen to manifest as erythematous, firm, and non-tender nodules diffusely palpable along an upper eyelid scar. Histologically, numerous non-caseating granulomas with multinucleated giant cells were seen. No other evidence of systemic sarcoidosis was observed in any patient. Although rare, sarcoidosis may occur in an eyelid scar after a blepharoplasty. Therefore, scar sarcoidosis should be considered in the differential diagnosis in patients presenting with unusual nodules in blepharoplasty scars.
Subject(s)
Humans , Blepharoplasty , Cicatrix , Diagnosis, Differential , Eyelids , Giant Cells , Granuloma , SarcoidosisABSTRACT
BACKGROUND: Melasma is a common acquired hyperpigmentation disorder that predominantly affects the face. It frequently occurs in women with darker skin types and severely impacts quality of life. OBJECTIVE: To characterize the clinicoepidemiological features and triggering or aggravating factors of melasma in Korean patients. METHODS: This cross-sectional study was conducted at the dermatology clinics of five university hospitals in Korea. Between January 2011 and August 2012, 411 patients with melasma completed a questionnaire about the clinical and aggravating factors associated with their melasma. RESULTS: The study population consisted of 400 women and 11 men aged 22~73 years (mean age, 42.8±9.92 years). Triggering or aggravating factors were sun exposure (68.4%), pregnancy (27.0%), and emotional stress (24.8%). Interestingly, 61.1% of patients complained of sensitive/inflammatory features such as erythema, itching, and a stinging sensation. Dryness was the most common aggravating factor, followed by erythema/redness and itching/stinging. Concomitant pigmentary disorders included post-inflammatory hyperpigmentation in 15.1% of patients, followed by pigmented contact dermatitis, and acquired bilateral nevus of Ota-like macules. CONCLUSION: It is well known that sun exposure and hormonal changes are the most common triggers of melasma; however, sensitive/inflammatory features may aggravate melasma in East Asian patients. Therefore, these individual and racial differences should be considered in the prevention and treatment of melasma.
Subject(s)
Female , Humans , Male , Pregnancy , Asian People , Bites and Stings , Cross-Sectional Studies , Dermatitis, Contact , Dermatology , Erythema , Hospitals, University , Hyperpigmentation , Korea , Melanosis , Nevus , Pruritus , Quality of Life , Sensation , Skin , Solar System , Stress, PsychologicalABSTRACT
Interstitial granulomatous dermatitis (IGD) is a rare disease that has been associated with multiple systemic diseases, particularly autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus. IGD has a variable clinical presentation and highly characteristic histological features of interstitial infiltrate of histiocytes between the degenerated collagen bundles. Here we report the case of a 63-year-old woman who presented with a 3-month history of multiple asymptomatic erythematous papules on the bilateral aspects of the trunk. A histopathological examination of the lesion showed an interstitial lymphohistiocytic infiltrate in the dermis. There were also foci of palisading histiocytes along with degenerating collagen bundles.
Subject(s)
Female , Humans , Middle Aged , Arthritis, Rheumatoid , Collagen , Dermatitis , Dermis , Histiocytes , Immunoglobulin D , Lupus Erythematosus, Systemic , Rare DiseasesABSTRACT
BACKGROUND: Lentigo maligna melanoma (LMM) is a subtype of melanoma that typically develops on sun-damaged skin. LMM is estimated to comprise 4~15% of melanomas, but the prevalence is known to be relatively lower in the Korean population than in the Caucasian population. OBJECTIVE: To review the clinico-pathologic features and treatment outcomes of Korean patients with LMM. METHODS: Nineteen patients diagnosed with LMM during 2003~2015, in the Yonsei University Health System, were included in this study. The age and sex of the patients, lesion location, thickness (Breslow), stage, treatment methods, BRAF, NRAS, and KIT mutation status, and survival rates were analyzed. RESULTS: Among the 19 Korean patients, 11 were male and 8 were female. The median age was 59.2 years. The most common site was the cheek (47.4%), followed by the scalp, eyelid, nose, forehead, lip, and neck. At the time of diagnosis, 13 patients were in localized stages (5 patients, stage 0; 3 patients, stage I; and 5 patients, stage II) and 6 patients were in advanced stages (3 patients, stage III; and 3 patients, stage IV). Patients in the localized stages showed better overall survival (OS) than those in the advanced stages (p=0.012). Nine patients were treated with a wide excision, and 6 using Mohs micrographic surgery. Three patients received high-dose interferon-α therapy; 6, chemotherapy; and 4, radiotherapy. Two patients in stage 0 were treated with topical ingenol mebutate. Two patients had BRAF V600E mutation; 1, NRAS G12R mutation; and 1, KIT mutation. Median OS of the patients was 40.8 months. CONCLUSION: Our analysis provides additional information about clinical characteristics, treatment, and prognosis of LMM in Korean patients.