A Case of Primary Cutaneous Adenoid Cystic Carcinoma / 대한피부과학회지

Adenoid cystic carcinoma of the skin is the rarest type of eccrine sweat gland carcinoma. Although it is mostly known as a neoplasm of the salivary gland, it could occur as a primary tumor of the skin. We report a case of primary cutaneous adenoid cystic carcinoma in a 75-year-old male patient with two local recurrences. It was a lobulated tender erythematous nodule on the scalp measuring 2.5x1cm. Histopathologic examination after total excision showed cribriform, tubular, and solid masses of various size and shape involving dermis and the upper part of subcutis including perineural invasion. They consisted of almost uniform basaloid cells surrounded by myxoid or slightly fibrotic stroma. Adjacent organ such as salivary gland, bronchus, esophagus, and regional lymph nodes were examined with no evidence of neoplasm. Systemic evaluation for metastasis were also negative.

Two Cases of Nodular Cystic Fat Necrosis Possibly Related to Previous Trauma

Nodular cystic fat necrosis, first described by Przyjemski and Schuster, is a peculiar form of encapsulated necrosis of subcutaneous fat characterized by totally or near-totally encapsulated necrosis of fatty tissue in which clusters of nonviable adipocytes are surrounded by condensed fibrous tissue. We report two cases of nodular cystic fat necrosis associated with history of trauma about the site of the lesion. Each lesion was a subcutaneous movable nodule on buttock (case 1) and shin (case 2) which has evolved over months. Both cases showed possible relation to multiple intramuscular injection or direct trauma injury. Pathologically, encapsulated nodule showed a characteristic feature of nodular cystic fat necrosis which composed of the ghosts of anucleated adipocytes showing fairly well-preserved outline.

Two Cases of Generalized Pustular Psoriasis Improved with Combination Treatment of Mycophenolate Mofetil / 대한피부과학회지

Mycophenolate mofetil(MMF) is a new immunosuppressant which non-competitively and reversibly blocks the de novo synthesis of guanine nucleotides required for DNA and RNA synthesis during lymphocyte proliferation. So MMF selectively inhibits lymphocyte proliferation and it has less side-effects than other immunosuppressants. We described 2 cases of generalized pustular psoriasis improved with MMF. We administered MMF combined with cyclosporin in case 1 and acitretin in case 2. Both patients markedly improved with MMF administration 3 days after and had no severe side-effects. Thus the authors thought that MMF appears to be an effective therapeutic alternative in the treatment of generalized pustular psoriasis.

Subepidermal Calcified Nodule of the Finger / 대한피부과학회지

Subepidermal calcified nodule is a rather uncommon, but peculiar subtype of calcinosis cutis. It presents as a single asymptomatic, hard, yellowish white nodule which commonly occurs on the face of children. Histopathologic examination reveals the multifocal various-sized papillary dermal collection of dark blue amorphous globular deposits confirmed by von Kossa stain for calcium. We report a 42-year-old man who had small white hyperkeratotic papule on finger tip for more than 20 years. He could recall neither preceding trauma nor systemic illness. Excisional biopsy, with the clinical impression of verruca or corn, showed typical histopathologic features of the subepidermal calcified nodule.

Ganglioneuroma Associated with Von Recklinghausen Neurofibromatosis / 대한피부과학회지

Ganglioneuroma is the benign tumor exclusively composed of fully differentiated mature ganglion cell, Schwann cells and fibrous tissue. It develops most commonly in the posterior mediastinum and retroperitoneum but cutaneous involvement is exceedingly rare. Cutaneous tumor showing ganglion cells includes the following three entities: 1) primary ganglioneuroma, 2) well differentiated cutaneous metastasis from neuroblastoma, and 3) ganglioneuroma associated with von Recklinghausen's neurofibromatosis. Among them, the third has been considered as a neurofibroma with entrapment of ganglion cell. We described 2 cases of ganglioneuroma associated with von Recklinghausen neurofibromatosis and reviewed the histopathological and immunohistochemical findings.

A Case of Symplastic Glomus Tumor / 대한피부과학회지

Glomus tumor is a benign lesion characterized by vessels and glomus cells in the varying proportion and it classically presents as a solitary, painful papule or nodule. Occasionally it displays unusual histopathologic features diagnosed as "atypical" glomus tumor, including malignant glomus tumor, glomus tumor of uncertain malignant potential, glomangiomatosis, and symplastic glomus tumor. Glomangiomatosis and symplastic glomus tumor reveal benign biologic behavior. We report herein a typical case of symplastic glomus tumor showing marked nuclear atypia, its only unusual feature comparing with classical one, in addition to the typical clinical and pathological features.

Usefulness of Nasal Splints (Aquaplast(R)) for Securing Full Thickness Skin Graft (FTSG) / 대한피부과학회지

BACKGROUND: For securing FTSG, bolus tie-over dressing is a universally accepted method, but it has some definite disadvantages. For example, bulky dressing inhibits the drainage from graft bed and can lead to maceration by occlusion. Time and effort is necessary to secure dressing and the help of an assistant is also mandatory to tie the suture much easier. OBJECTIVES: In an attempt to find a better dressing material, we evaluated the usefulness of thermoplastic nasal splints (Aquaplast(R)) for securing graft in FTSG reconstruction. METHODS: Thirteen patients with surgical defects following tumor excision from the nose(9 patients), forehead(1), lip(1), hand(1), shin(1) ranging from 12mm to 40mm in the largest diameter were reconstructed with a FTSG. For securing FTSG, a heat-moldable nasal splint was heated, contoured in place over sutured graft on recipient area with/without suture of the splint with skin. RESULTS: All of the 13 FTSG secured with nasal splints showed a good take with a satisfactory cosmetic results. Except hypertrophic scars in 4 patients, which were not significant and improved with several times intralesional injection of triamcinolone, there were no other complications. CONCLUSION: We have found a heat-moldable nasal splint to be useful material to secure FTSG, especially for the complex contoured area such as nose or ear. This technique saves time and effort and there is no need of an assistant.

The Management of Diabetic Foot Ulcer by Corporation of Dermatologists and Internists: Preliminary Report / 대한피부과학회지

BACKGROUND: Recently, the prevalence of diabetes mellitus and its complications have been increased in Korea and they cause many socioeconomic losses in both patients and their families. But, there are neither sufficient medical assistance including concern of medical personnel nor social assistance in Korea nowadays. OBJECTIVES: In this study, we tried to reduce the risk of amputation and preserve the function of the foot by an early evaluation, proper treatment and consultation by dermatologists. METHODS: We randomly chose 18 cases of diabetic foot ulcer and took care of them with proper and earlier debridement, dressing, antibiotics and cooporation with departments of internal medicine, especially endocrinology, nephrology and division of infectious disease. After healing of the ulcer, we recommended specially designed shoes and foot care products to prevent the recurrence of the foot problems. RESULTS: The average duration of diabetes was 18 years and preexisting complications were neuropathy, nephropathy, vasculopathy and/or foot deformities. The precipitating factors of foot ulcer were burn, callus, fungal infection, bony deformity or trauma. Three cases underwent toe amputation and one case with severe vasculopathy was transferred to the vascular surgery. Average healing time was 14 weeks. CONCLUSION: Proper evaluation and management of diabetic foot ulcer patients with multidisciplinary approach should achieve good wound healing. Consequently, it can reduce the risk of amputation and improve the quality of life in the patient with diabetic foot ulcer. Among them, dermatologists who has a point of view of both a medical and surgical doctor may play a pivotal role in the management of diabetic foot ulcer.