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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@#Refractory warts remain unresponsive to a variety of treatment modalities. A questionnaire survey that includes information regarding patients’ symptoms and history can provide a deeper understanding of the discomfort and difficulties experienced by patients. @*Objective@#We used a questionnaire to investigate the clinical characteristics, treatment methods, and discomfort experienced by patients diagnosed with recalcitrant warts. @*Methods@#This survey was performed in patients with warts who first visited the Dermatology Department at Severance Hospital between March 1, 2018 and March 31, 2020. The questionnaire included information regarding age, sex, family history, disease onset, location and number of lesions, treatment history, and effectiveness. @*Results@#Among the 116 patients with recalcitrant warts included in this study, the mean number of lesions was 6.73; most lesions were observed on the hands and feet. The most common treatment performed previously included cryotherapy (89/116, 76.7%), followed by topical application of medications (69/116, 59.5%), and laser therapy (47/116, 40.5%). Of the total respondents, 60.3% (70/116) of patients admitted that previous treatment was ineffective, and 83.6% (97/116) of patients had one or more complaints secondary to the warts. @*Conclusion@#Treatment of recalcitrant warts should focus on selection of an optimal therapeutic option based on patients’ treatment history, discomfort, and effects on their quality of life. This study would serve as a guideline to establish a future classification and treatment algorithm for recalcitrant warts.
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Extramammary Paget’s disease (EMPD) is a rare malignant neoplasm of the apocrine sweat gland-bearing skin in the genital, perianal, or axillary region. EMPD may simultaneously occur in the genital and both sides of the axillae, termed as “triple EMPD,” which was first reported by Kawatsu and Miki in 1971. Since its first description, 28 Japanese and only 4 Caucasian cases of triple EMPD have been reported. Here, we present the first Korean case of triple EMPD in the groin and bilateral axillae in a 46-year-old female patient whose axillary lesions appeared consistent with seborrheic keratosis. This case emphasizes the need to consider EMPD in differential diagnosis when evaluating acanthotic axillary lesions since it can mimic benign lesions.
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Background@#A novel treatment method is required for recalcitrantcommon warts. @*Objective@#This study aimed tocompare the complete wart removal rate of cidofovir, abroad-spectrum antiviral agent, intralesional injection andsodium tetradecyl sulfate intralesional injection. @*Methods@#This retrospective study included 45 patients with recalcitrantcommon warts on the hands and/or feet, treated with cidofoviror sodium tetradecyl sulfate intralesional injection. @*Results@#The treatment results were evaluated in three groupsas follows: (1) failure - recalcitrant common warts remainingdespite three or more injections, (2) success - free from wartsfor more than 6 months after the injection, and (3) recurrence.The cidofovir group (n=22) showed significantly highertreatment success rates than the sodium tetradecyl sulfategroup (n=23) (90.91% vs. 26.09%, p＜0.001). Two immunosuppressedpatients in the cidofovir group had recurrentlesions after 2 months of being declared free from warts.Considering adverse effects, two patients in the cidofovirgroup complained of bulla formation with severe pain requiringnarcotic painkillers. @*Conclusion@#Although this studyhas the limitations of a small sample size and retrospectivedesign, patients with recalcitrant common warts showed adramatic response to the treatment with cidofovir intralesional injection, with minimal complications.
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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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No abstract available.
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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.
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Humanos , Estudos de Coortes , Heterogeneidade Genética , Genótipo , Incidência , Melanoma , Fenótipo , Características da População , PrognósticoRESUMO
The incidence of skin cancer has continuously increased in Korea, probably due to sun exposure and increases in the aging population. Ultraviolet light, a well-known risk factor for skin cancer, can cause DNA damage, mutation, and immune suppression, followed by abnormal proliferation. To prevent photocarcinogenesis, the appropriate use of sunscreen should be emphasized. Using broad-spectrum sunscreens with sun protection factor values of 15 or higher and frequent reapplication are recommended. Controversy exists about whether vitamin D synthesis is inhibited by the use of sunscreen. However, considering that skin cancer most commonly develops on the head and neck area, applying it to the face and neck is reasonable in terms of balancing the risk-benefit ratio.
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The incidence of skin cancer has continuously increased in Korea, probably due to sun exposure and increases in the aging population. Ultraviolet light, a well-known risk factor for skin cancer, can cause DNA damage, mutation, and immune suppression, followed by abnormal proliferation. To prevent photocarcinogenesis, the appropriate use of sunscreen should be emphasized. Using broad-spectrum sunscreens with sun protection factor values of 15 or higher and frequent reapplication are recommended. Controversy exists about whether vitamin D synthesis is inhibited by the use of sunscreen. However, considering that skin cancer most commonly develops on the head and neck area, applying it to the face and neck is reasonable in terms of balancing the risk-benefit ratio.
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Envelhecimento , Dano ao DNA , Cabeça , Incidência , Coreia (Geográfico) , Pescoço , Fatores de Risco , Neoplasias Cutâneas , Pele , Sistema Solar , Fator de Proteção Solar , Protetores Solares , Raios Ultravioleta , Vitamina DRESUMO
BACKGROUND: Currently, physicians from different medical specialties treat patients' skin conditions, especially for cosmetic purposes. Although diagnosis and treatment made by non-dermatologists may sometimes be improper, many patients are unable to distinguish a non-dermatologist from a dermatologist. OBJECTIVE: The aim of this study was to evaluate public's perception of dermatologists. METHODS: A total of 515 participants completed the online survey. The questionnaire consisted of three main parts: information regarding respondents, experience of dermatological treatments, and awareness of skin treatments performed by dermatologists, and by medical specialties. RESULTS: Overall, 48% of respondents were unable to distinguish a dermatologist from a non-dermatologist; however, 93% of respondents responded that they were willing to visit a dermatologist for treatment. A fair number of respondents identified dermatologists by signboards, professional biographies, and licenses. However, some non-dermatologists' signboards and biographies were considered misleading and confused patients. CONCLUSION: Many patients intend to visit a dermatologist for their dermatological treatments. However, half could not distinguish dermatologists from non-dermatologists. For this reason, we underline the importance of increasing public awareness of the dermatologist's expertise in helping patients in choosing their clinics.
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Humanos , Diagnóstico , Licenciamento , Pele , Inquéritos e QuestionáriosRESUMO
Syringomas are common benign neoplasms that are derived from the intradermal eccrine duct and frequently manifest in adult females as 1~3-mm flesh-colored papules on the face, especially on the lower eyelid. There are two hypotheses about their pathogenesis: ductal obstruction by keratin plugs and reactive eccrine proliferation following an inflammatory condition. The patient was a 66-year-old man with multiple erythematous papules and nodules on both periorbital areas after 7-day sorafenib (Nexavar®) treatment. A skin biopsy of the Rt. periorbital lesion revealed multiple cysts and tadpole-shaped tubular structures in the dermal layer. Inflammatory cell infiltration was seen throughout the dermis. Based on the clinical features and histological findings, we diagnosed the patient with syringoma-like eccrine duct proliferation. The indications for and use of Sorafenib have increased recently. Although sorafenib-associated cutaneous side effects have increased, no cases of syringoma-like eccrine duct proliferation have been reported to date. Here we report a case of sorafenib-induced syringoma-like eccrine duct proliferation in a patient with hepatocellular carcinoma.
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Adulto , Idoso , Feminino , Humanos , Biópsia , Carcinoma Hepatocelular , Derme , Pálpebras , Pele , SiringomaRESUMO
No abstract available.
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Humanos , Cicatriz , Hepatite C Crônica , Hepatite Crônica , Interferons , RibavirinaRESUMO
Kerion celsi is an inflammatory infection, caused by a vigorous T-cell mediated host response to the dermatophyte infection. In the case of severe inflammation, it can be misdiagnosed as other disease like cellulitis, impetigo, furuncle and epidermal cyst. Microsporum(M.) canis is most likely transmitted by contact of animal hosts such as cats and dogs with humans. We report the 75-year-old female who presented two months history of tender erythematous scaly plaques with pustules, crusts on right scalp area. At first, from the histopathologic findings of the lesion, the patient was diagnosed epidermal cyst because of cyst-like structure in mid-dermis. But the fungal culture revealed M. canis as the causative fungus. Herein we report a educational case of kerion celsi mistaken for ruptured epidermal cyst.
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Idoso , Animais , Gatos , Cães , Feminino , Humanos , Arthrodermataceae , Celulite (Flegmão) , Cisto Epidérmico , Fungos , Furunculose , Impetigo , Inflamação , Couro Cabeludo , Linfócitos T , Tinha do Couro CabeludoRESUMO
No abstract available.
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Criança , Humanos , Anemia Aplástica , Fator Estimulador de Colônias de Granulócitos , Granulócitos , Síndrome de SweetRESUMO
BACKGROUND: Surgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern. OBJECTIVE: To describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment. METHODS: We performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO2) laser. RESULTS: Among the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90+/-1.56 vs. 5.61+/-1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision. CONCLUSION: Surgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.
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Humanos , Dióxido de Carbono , Cicatriz , Fasciite , Mãos , Injeções Intralesionais , Terapia a Laser , Recidiva , Estudos Retrospectivos , Sarcoma , TriancinolonaRESUMO
BACKGROUND: In cases of early stage subungual melanoma (SUM), conservative treatment with non-amputative wide excision of the nail unit and subsequent skin graft is preferred over amputation to preserve the involved digit. OBJECTIVE: We report a series of patients with SUM treated with conservative surgery and suggest an effective supplementary treatment process. METHODS: We retrospectively reviewed 10 patients (2 males, 8 females) who were diagnosed with in situ or minimally invasive SUM on the first biopsy and underwent non-amputative wide excision of the nail unit. All patients underwent secondary intention healing during the histopathological re-evaluation of the entire excised lesion, and additional treatment was administered according to the final report. RESULTS: In two of 10 patients, amputation was performed because of the detection of deep invasion (Breslow thickness: 4.0, 2.3 mm) from the final pathologic results, which differed from the initial biopsy. In six patients who received delayed skin graft, the mean total time required for complete healing after secondary intention healing and the skin graft was 66.83+/-15.09 days. As a result of this delayed skin graft, the final scarring was similar to the original shape of the nail unit, scored between 5 and 10 on a visual analogue scale. Most patients were satisfied with this conservative surgery except one patient, who had volar portion involvement and received an interpolated flap instead of a skin graft. CONCLUSION: Our treatment process can reduce the risk of incomplete resection and improve cosmetic outcomes in patients with SUM.
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Humanos , Masculino , Amputação Cirúrgica , Biópsia , Cicatriz , Intenção , Melanoma , Estudos Retrospectivos , Pele , TransplantesRESUMO
BACKGROUND: The incidence of skin tumors has been increasing over the past few years due to an aging population, environmental changes, and improved access to medical institutions. OBJECTIVE: To report the rate of relapse and complications after surgical treatment, and suggest appropriate ways of treating benign skin tumors. METHODS: We performed a retrospective review of 846 patients with benign skin tumors who were diagnosed and treated by a single dermatosurgeon. RESULTS: Of the 846 patients, 18 (2.1%) developed local recurrence. Epidermal cysts (15/390) were the most common skin condition, followed by lipomas (2/149). The recurrence rate of epidermal cysts showed no statistical difference when treatment options and the presence of inflammation or suppuration at the first visit were considered. Six patients (0.7%, 6/846) had one of the complications such as persistent inflammation over one month, severe pain, secondary infection, or skin necrosis. All the lipomas following recurrence or those with complications were located in the intramuscular or submuscular area of the forehead, which were easily localized by sonography. CONCLUSION: Surgery is a valuable method for the treatment of benign skin tumors with low rates of complication and relapse. For better outcomes after treatment, dermatologists should attempt to remove these tumors completely and consider the use of imaging studies before treatment.