A Case of Squamous Cell Carcinoma of the Ear Helix Successfully Treated with Rhombic Transposition Flap

Approximately 6% of all head and neck skin cancers arise from the external ear, of which squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common. Acquired helical rim defects can be caused by injury or after excision of a tumor. Since many patients feel that the auricle has a functional and cosmetic importance, it is crucial to consider the esthetics. In cases where the defect exposes bare cartilage, second-intention healing is usually not achieved. Therefore, full-thickness skin grafts have been adopted, but the healing time is long and in many cases, mismatch of color between the grafted skin and the surrounding ear has been observed. Alternatively, reconstruction with flaps may provide optimal coverage. Among the many possible flap designs, the rhombic transposition flap has become widely utilized in dermatologic surgery, due to its simplicity and versatility. Herein, we report a case of SCC on the superior helical rim (of which the cartilage was spared) successfully managed with a rhombic transposition flap. The surgical procedure had been relatively simple and the resultant ear helix was free from deformity. In future, we recommend that defects of the ear helix, which have an intact cartilage, should be treated with a rhombic transposition flap to give a successful cosmetic and functional outcome.

The Study of Wound Healing Using Cultured Autologous Dermal Fibroblast of Guinea Pig / 대한피부과학회지

BACKGROUND: Autologous cultured dermal fibroblasts can be transplanted to the full thickness of skin wounds and this successfully accelerates the early wound healing of epidermis and dermis with less inflammation and scarring than allogeneic transplantations. The wound-healing effect of dermal fibroblasts is thought to be due to their growth factor and extracellular matrix releasing effects. Fibroblasts could therefore help chronic wound healing, where lower concentration of growth factors have been observed. OBJECTIVE: The purpose of this study was to examine the early wound healing effects of the autologous cultured dermal fibroblasts and to confirm that several growth factors and fibroblasts are closely associated in the mechanism of wound healing. METHODS: Suspensions of cultured autologous dermal fibroblasts were transplanted to full thickness wounds in 15 guinea pigs, and the wounds were then covered with transparent membrane. Wound biopsy materials were excised and collected from 9 guinea pigs at 7, 14, 21 and 28 days after wounding. Comparisons of the clinical wound healings between the experimental and control groups at the 3rd, 7th and 14th day after fibroblast transplantations were made in 8 guinea pigs, in which continuous clinical observation was possible in the same guinea pigs. Samples were processed for routine hematoxylin and eosin stains, immunohistochemical stains for fibroblast growth factor (FGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factors (VEGF), and insulin like growth factors (IGF). RESULTS: The experimental groups showed decreased wound surface area at 3 and 7 days after transplantations, and more vascular, granulomatous wounds and fibroplasia responses compared with the control groups. Immunohistochemal stains revealed increased positive staining for FGF, TGF beta, and VEGF at the 1st, 2nd and 3rd weeks, compared with the controls. CONCLUSION: Transplantations of autologous cultured dermal fibroblasts proved to be clinically effective in the early wound healing of full thickness wounds of guinea pigs, and growth factors such as FGF, TGF VEGF must have some role in the mechanism of wound healing by autologous dermal fibroblasts.

A Case of Leukemia Cutis Showing Rosacea-like Cutaneous Lesions / 대한피부과학회지

Leukemia cutis, the specific infiltration of leukemia, can be seen in any leukemia, but, are especially common in the acute myelogenous leukemia M4 and M5 variants. It may clinically mimic many inflammatory dermatoses. We herein report a case of a 59-year-old man with acute monocytic leukemia who concurrently presented with various cutaneous manifestations that clinically resembled benign skin lesions such as rosacea, contact dermatitis, and milium. Histologic study of all the lesions revealed leukemia cutis of the monocytic type. We presented this case to illustrate how leukemia cutis can masquerade as clinically benign-appearing, cutaneous eruptions.

A Case of Nevus Sebaceus, Accompanied by Syringocystadenoma Papilliferum, a Basal Cell Carcinoma-like Tumor, Sebaceous Epithelioma, Apocrine Adenoma and Tumor of Follicular Infundibulum, with Repair by Subgaleal-periosteal Fixation / 대한피부과학회지

Nevus sebaceus is well-known for its potential to develop both benign and malignant neoplasms of epidermal and adnexal origin. We found 5 tumors including syringocystadenoma papilliferum, a basal cell carcinoma-like tumor, sebaceous epithelioma, a tumor of follicular infundibulum and apocrine adenoma within a single nevus sebaceus lesion in a 37-year-old man. This is a rarely reported case of a nevus sebaceus lesion containing a basal carcinoma-like, trichoblastoma-like skin tumor and tumors of follicular infundibulum. The lesion was treated by wide excision and repaired with subgaleal-periosteal fixation which resulted in good wound healing.

Clinical Study of the Surgical Excision of Subcutaneous Tissue Combined with the Assistant Subcutaneous Shaver Method for treatment of Axillary Osmidrosis and Hyperhidrosis / 대한피부과학회지

BACKGROUND: Classical surgical treatment of axillary osmidrosis and hyperhidrosis results in many complications such as scarring, hematoma and necrosis, therefore, gentle skin flap cares is needed. OBJECTIVE: In order to lessen the complications and to obtain an improved clinical outcome, a new easy-learn, surgical excision method of treating subcutaneous tissue is required. METHOD: On 16 patients, We carried out a type-1 surgical method to treat axillary osmidrosis and hyperhidrosis. This invoved major removal of the subcutaneous tissue by scissor excision, and partial removal by the subwtaneous shaver method, to minimise trauma. We then analyzed the clinical efficiency, complications, patient satisfaction, and pathologic specimens according to clinical severity. RESULTS: All 16 patients showed an improved odor or sweating pattern, and a good or very good level of satisfaction. One patient also showed that hematoma was improved with proper post- operative care. Hyperactivity of the apocrine glands in osmidrosis and eccrine gland in hyperhidrosis was seen, and various morphologic features of apoeccrine glands were found in both osmidrosis and hyperhidrosis. We observed that apocrine and eccrine glands were completely excised by following the biopsy of 2 patients. CONCLUSION: Our present method of minimal skin incision and major removal of subcutaneous fat with manual scissor excision, in combination with partial excision with the subcutaneous shaver method, showed a good clinical outcome and few complications.

Clinicopathological Study of Actinic Keratoses in Korea / 대한피부과학회지

BACKGROUND: Actinic keratosis is one of the most common precancerous lesions, and its incidence in Western society has been reported to be up to 40%. However, few clinical and histopathologcial studies of actinic keratosis have been conducted in Korea. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of actinic keratosis in Koreans. METHODS: We reviewed the medical records and biopsy specimens of 63 cases previously diagnosed as actinic keratosis at St.Vincents hospital of Catholic Medical Center from January 1999 to June 2003. RESULTS: We were able to compile clinical data and histologic information on 63 cases of actinic keratosis 1. The mean age at diagnosis was 72.6 years, and all the patients were over 50 years old. Actinic kerotosis developed predominantly in females at the sex ratio of 1: 3.8. 2. The disease duration was more than 1 year in 69.8% of patients, and there were few associated cutaneous malignancies, except two basal cell carcinoma. 3. Half of the patients was asymptomatic, however, 34.9% and 15.9% of the patients complained of pruritus and pain, respectively. The lesions were usually solitary, less than 1cm, and erythematous. 4. Actinic keratosis was involved mostly in face, especially cheek, forehead, chin, and nose by decreasing order. 5. Histopathologically, hypertrophic type was noted in 30.2% of the cases, atrophic type in 44.4%, bowenoid type in 19.0%, acantholytic type in 3.2%, and pigmented type in 3.2%. The histopathological scores according to subtype were 5.00(1.76) in hypertrophic type, 3.54(1.82) in atrophic type, and 6.83(1.03) in Bowenoid type. 6. The most common treatment modality was cryotherapy with liquid nitrogen, and surgical resection, electrodessication, and CO2 Laser were also used for the treatment of actinic keratosis. The recurrence was observed in one patient treated by cryotherapy and two patients by electodessication. CONCLUSION: Actinic keratosis in Koreans was precancerous lesion usually present on the face of female patients over 50 years old. Various histopathologic types including hypertrophic, atrophic, Bowenoid, acantholytic and pigmented type were noted, and the most common type was atrophic type. Actinic keratosis could be treated by cryotherapy with liquid nitrogen, surgical resection, eletrodessication and CO2 laser. However, because of the possibility of recurrence, close follow-up is needed.

Rheumatoid Nodules on the Scalp

No abstract available.

A Case of Melanoma Arising from Acquired Nevus / 대한피부과학회지

Malignant melanoma is a tumor arising from melanocytes which originate in the neural crest. According to several reports, about 20-30% of all melanoma are associated with pre-existing nevi. Because early detection and intervention of aquired and congenital nevi is the only way to increase survival, the important risk factors should be carefully observed, especially if there are changes of to the number, size, and characteristic of the nevi. We present a 41 year-old man who has a superficial, spreading type of malignant melanoma, which arose from an acquired nevus following trauma to the right malleolar area. This case is interesting because of the clinical type and accompanying pathologic condition of the benign nevus.