Clinical Analysis of Serial (Staged) Excision for Congenital Melanocytic Nevi: A Single-center Experience / 대한피부과학회지

BACKGROUND: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.OBJECTIVE: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.METHODS: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.RESULTS: The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium–aluminum–garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.CONCLUSION: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.

Pigment Induction with a Fractional Laser for Vitiligo: A Preliminary Study / 대한피부과학회지

BACKGROUND: Numerous modalities of treatment for vitiligo have been introduced and have been proposed; however, treatment for vitiligo remains challenging with no adequate solution. OBJECTIVE: This study was designed to examine the capability of the use of a fractional laser to induce pigmentation for vitiligo and to investigate the therapeutic and clinical parameters that affect therapeutic outcome. METHODS: A total of 30 lesions in 12 patients with vitiligo were treated clinically with three fractional laser systems with a four-week interval. Simultaneously, all patients were treated with narrow-band UVB (NBUVB) light twice a week. The pigmentation rates were graded based on the use of a five-point scale by a dermatologist. We also investigated the patient satisfaction level and compared the pigmentation rates of the lesions treated with a fractional laser plus NBUVB with control areas treated only with NBUVB. In addition, we analyzed the mean grade of pigment induction for various therapeutic and clinical parameters. RESULTS: A total of 30 lesions were treated with a fractional laser. The pigmentation grade and satisfaction score were higher in the areas treated with a fractional laser, especially with an Nd:YAG fractional laser, as compared to the control areas. The degree of pigmentation was better achieved for small-sized lesions (<2 cm2). Other clinical parameters that affected the therapeutic outcome were the duration of vitiligo and the existence of poliosis. However, the anatomical location of lesions and the type of vitiligo did not affect the therapeutic outcome. No significant side effects were observed. CONCLUSION: A fractional laser system offers an increase of overall pigmentation with a minimal risk of discomfort and side effects, especially for a small-sized patch of vitiligo without poliosis and for patients with vitiligo of a short duration (less than one year).

Treatment of Hypertrophic Scars and Keloids Using Intense Pulsed Light / 대한피부과학회지

BACKGROUND: Hypertrophic scars and keloids are prevalent and emotionally debilitating dermatologic diseases. Various treatment modalities have been advocated to treat hypertrophic scars and keloids. OBJECTIVE: This study prospectively assessed the safety and efficacy of using intense pulsed light (IPL) on scars that originate from surgery. METHODS: A total 22 patients with surgically induced hypertrophic scars and keloids were treated with IPL. Treatment was administrated at 4-week intervals, with an average of 3.5 sessions (range=1~10). The scars were evaluated for pigmentation, pliability, height, vascularity, pain and pruritus by using the modified Vancouver Scar Scale (MVSS). The subjective assessment of satisfaction was scored by the patients on a 25% increment of satisfaction scale. Evaluations were performed monthly during the follow-up period. RESULTS: There was overall clinical improvement for the appearance of the scars. Although statistically significant improvement was not shown (p=0.47), the average MVSS showed a trend for favorable effects on the scars with the successive IPL treatments. The patients who had higher baseline MVSS (> or =10) demonstrated statistically significant improvements with the successive IPL treatments (p<0.05). The degree of the patient's satisfaction also improved with the treatment for all of the patients (p<0.05). The adverse effects were negligible. CONCLUSION: IPL is one of the effective, safe methods to improve the clinical appearance of surgically induced hypertrophic scars and keloids and this treatment had high patient satisfaction and relatively few side effects.

Two Cases of Annular Skin Defects Repaired with Quadruple Fan Flaps (O-X Flap)

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.

Clinical Study on Malignant Fibrous/Fibrohistiocytic Tumors / 대한피부과학회지

BACKGROUND: Malignant fibrous/fibrohistiocytic tumors are uncommon soft tissue tumors which gives dermatologists special attention on differential diagnosis. However, there has not yet been a multicenter study on these tumors in Korea. OBJECTIVE: The aim of this study was to investigate the epidemiology and clinical features of malignant fibrous/ fiborhistiocytic tumors. METHODS: A total of 62 patients from 11 training hospitals who had been confirmed with malignant fibrous/ fibrohistiocytic tumor were studied. A retrospective analysis of hospital records served as the data source for this study. RESULTS: Among patients with malignant fibrous/fibrohistiocytic tumors, the most common tumor type was dermatofibrosarcoma protuberance followed by malignant fibrohistiocytic. The male to female ratio among subjects was 1.38 to 1 and the mean age was 44 years old. Of the common complaints recorded, asymptomatic mass was the most frequent. The mean size of the subjects' tumors was 2.9 cm in the long axis and 2.3 cm in the short axis with a mean tumor thickness of 2.1 mm. The most common site for tumors was the back followed by the thigh. The recurrence rate after primary treatment was 14.5% and metastasis developed in 5 of 62 patients. CONCLUSION: This study is expected to be helpful for understanding the clinical and pathological characteristics of malignant fibrous/fibrohistiocytic tumors.

A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.

A Combination of Dual-mode 2,940 nm Er:YAG Laser Ablation with Surgical Excision for Treating Medium-sized Congenital Melanocytic Nevus

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.

A Case of Acantholytic Squamous Cell Carcinoma

Acantholytic squamous cell carcinoma is a well-defined variant of squamous cell cancer in which significant portions of the neoplastic proliferation show a pseudoglandular or tubular microscopic pattern. It usually presents as a nodule with various colors, and it is accompanied by scaling, crusting, and ulceration on the sun-exposed areas of older aged individuals. Histologically, the tumor consists of a nodular, epidermal-derived proliferation that forms island-like structures. At least focally or sometimes extensively, the tumor cells shows a loss of cohesion within the central gland-like or tubular spaces. This tumor resembles the structure of eccrine neoplasms, but it is negative for dPAS, CEA and mucicarmine and it is only positive for EMA and cytokeratins. Herein we report a case of acantholytic squamous cell carcinoma that occurred on the face of an 82-year-old woman.

Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side

BACKGROUND: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. OBJECTIVE: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. METHODS: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. RESULTS: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. CONCLUSION: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.

A Comparison of ALA-IPL Photodynamic Therapy and Acne Mode IPL Phototherapy in the Treatment of Acne Vulgaris / 대한피부과학회지

BACKGROUND: Acne vulgaris is one of the most prevalent and emotionally debilitating dermatologic diseases. Emerging problems with conventional acne treatments, such as the resistance of Propionibacterium acnes to antibiotics and the safety of oral isotretinoin, create a demand for other treatment modalities for acne. An evolving understanding of the Propionibacterium acnes-produced porphyrins and the development of a number of light sources have led to the application of photodynamic therapy for the treatment of acne. OBJECTIVE: To study the effect of light therapy on the treatment of Acne Vulgaris using acne mode intense pulsed light (IPL), and photodynamic therapy with a combination of topical 5-Aminolevulinic acid (ALA, 20%) and acne mode IPL. A comparison of the two treatment modalities would then be made to examine the effect on inflammatory acne lesions and sebum excretion. METHODS: Thirteen patients with varying degrees of acne were included in the study after a 4 week washout period. ALA (20%) was applied to half of the face on each patient. After one hour, the whole face was exposed to intense pulsed light (DECA(R), Italia) using an acne mode (400~1,200 nm) starting at a fluence of 11 J/cm(2). The procedure was carried out three times with 2 week intervals, and the patients were evaluated on post-op 2nd, 4th, and 6th weeks. Histologic changes were observed before and after treatment. RESULTS: After the first and second treatment, there was a statistically significant reduction in inflammatory acne lesion counts and the amount of sebum production from baseline, in both the ALA-PDT group and the IPL group (p<0.05). However, no statistically significant reduction was shown after the third treatment in both groups. There was a slightly higher reduction in the count of inflammatory lesions and the amount of sebum production in the ALA-PDT site compared to the IPL site, but it was not statistically significant. On histologic examination, dermal inflammatory cell infiltrations around the perivascular and periappendageal area were significantly reduced and sebaceous glands became smaller after the 3rd treatment. The adverse effects were negligible. CONCLUSION: ALA-PDT using acne mode IPL, and light therapy using acne mode IPL alone were effective in the reduction of inflamed lesions and sebum secretion in patients with mild to moderate acne vulgaris. Furthermore, no significant adverse effects were observed with both treatments. However, no remarkable contrast of therapeutic effect was statistically observed between the two therapies either.

A Case of Clear Cell Basal Cell Carcinoma / 대한피부과학회지

Basal cell carcinoma (BCC) is noted for its many histologic variants because of its pluripotential origin from epithelial germ cells. Clear cell BCC has been recognized as a distinct variant and has a clear cell component made up of cells which are either vacuolated or display a finely granular eosinophilic cytoplasm. We report a case of clear cell BCC in a 62-year-old man who had a well-demarcated, skin-colored nodule on the left nasal ala. It was treated by surgical excision with a Burow's graft and no recurrence has been observed.

A Case of Neurotized Nevus with Sclerotic Fibroma-like Change / 대한피부과학회지

We report a case of neurotized nevus with a sclerotic fibroma-like change in a 60-year-old female patient, who presented with a brown colored pedunculated nodule on the upper quadrant of the abdomen. The skin biopsy revealed a well-circumscribed, non-encapsulated nodule in the reticular dermis, which consisted of hypocellular hyalinized collagen bundles separated by clefts mixed with nevus cells. Nevus cells are small with a spindle appearance and contain Meissner corpuscle-like structures called nevic corpuscles. We suggest that a sclerotic fibroma-like change is an evolutionary end-point of a pre-existing lesion. This is supported further by the fact that neuroid change in the intradermal nevus represents the end stage of maturation of melanocytes of the nevi.

A Case of Reticulate Pigmented Anomaly of the Flexures (Dowling-Degos Disease) / 대한피부과학회지

Dowling-Degos disease is a rare autosomal dominant genodermatosis with a genetically determined disturbance of epidermal proliferation. The clinical symptoms of Dowling-Degos disease are characterized by the acquired reticulate pigmented anomaly of the flexures. We report a case of Dowling-Degos disease in a 27-year-old female, who presented with numerous small, hyperpigmented macules in reticular pattern, localized to the axillae, inframammary and inguinal areas, popliteal fossa, neck, and face.

A Case of a Symplastic Glomus Tumor / 대한피부과학회지

A glomus tumor is a benign neoplasm of neuromyo-arterial glomus, composed of vascular channels surrounded by proliferating glomus cells and nerve fibers. Occasionally it displays unusual histopathologic features such as a large size, deep location, infiltrative growth, mitotic activity, nuclear pleomorphism, or necrosis. It can be diagnosed as an "atypical" glomus tumor, including malignant glomus tumor, glomus tumor of uncertain malignant potential, symplastic glomus tumor, or glomangiomatosis. Glomangiomatosis and symplastic glomus tumors reveal benign biologic behavior. We report a typical case of a symplastic glomus tumor, showing only marked nuclear atypia, compared with a classical glomus tumor.

A Review of Mohs Micrographic Surgery and Reconstruction of Cutaneous Malignant Tumors over the Past 10 Years / 대한피부과학회지

BACKGROUND: Recent studies have shown that Mohs micrographic surgery (MMS) decreased the recurrent rate of tumors and conserved the normal, unaffected tissue. Therefore, MMS is accepted as the first choice treatment modality for cutaneous malignant tumors. OBJECTIVE: The purpose of this study was to review the use of MMS and reconstruction of cutaneous malignant tumors over the past 10 years. METHOD: We retrospectively evaluated 104 patients who had been diagnosed with cutaneous malignant tumors between January 1994 and December 2003, and had been treated with MMS and tumor reconstruction. RESULTS: There were 54 males and 50 females. The mean age was 62. Basal cell carcinoma was the most common skin tumor, and the most common anatomical site was the face. Mean number of stages of MMS were 1.91, and the mean size of the final defect after MMS was 19.46x25.4 mm. A local flap was most commonly used to repair the surgical defects (59%). Recurrent cases totalled 2 out of 104 over the 4-60 months of follow up. CONCLUSION: MMS and proper reconstruction are a reliable and effective method for the treatment of cutaneous malignant tumors and offers the lowest functional and cosmetic morbidity in skin cancer treatment.

A Case of Frontal Fibrosing Alopecia / 대한피부과학회지

Frontal fibrosing alopecia is considered to be a clinical variant of lichen planopilaris. This condition is characterized by progressive frontal hairline recession associated with scarring. Frontal fibrosing alopecia has become an increasingly recognized distinct clinical entity in recent years. We report a typical case of frontal fibrosing alopecia and review the pertinent literature.

The Clinical Effect of Topical Diphenylcyclopropenone (DPCP) Therapy in the Treatment of Atopic Dermatitis in Children and Adolescents / 대한피부과학회지

BACKGROUND: Atopic dermatitis is the most common chronic skin disease in childhood. Severe atopic dermatitis may require use of topical or systemic corticosteroids. These treatments are prone to several adverse side effects. This paper highlights the impressive effect of diphenylcycloprope none(DPCP) sensitization in some cases of childhood and adolescent atopic dermatitis. OBJECTIVE: The purpose of this study was to examine the effect of DPCP in treating severe atopic dermatitis of children and adolescents. METHODS: Twenty eight patients, who had moderate to severe atopic dermatitis, were recruited in the treatment of DPCP weekly for 10 weeks and followed up for another 4 weeks. Severity of atopic dermatitis was measured using SCORAD index. RESULTS: Sixteen of 28 patients had finished the treatment courses. After 10 weeks of therapy with DPCP, the patient's symptoms were improved and the mean SCORAD index was significantly reduced from 48.9+/-17.8 to 18.0+/-9.1 (p<0.01). During the follow-up period, patients could be managed by topical steroid and oral antihistamine and flare-up was not observed. CONCLUSION: According to our study, DPCP can be an effective, safe and well-tolerated therapy for moderate to severe atopic dermatitis in children and adolescents. We suggest that DPCP may be effective in the treatment of moderate to severe atopic dermatitis of children and adolescents without serious complications.

A Case of Zosteriform Cutaneous Metastasis from Transitional Cell Carcinoma of the Urinary Bladder / 대한피부과학회지

The usual sites of the bladder cancer metastases are lymph nodes, liver, lungs and bone. The incidence of metastases to the skin from bladder cancer has been reported to be between 0.2 and 2%. Cutaneous metastases from transitional cell carcinoma (TCC) of the bladder occur infrequently. Metastatic skin cancers vary in type, in rare instances, zosteriform metastases may occur. A 77-year-old man with transitional cell carcinoma of the bladder presented with multiple grouped erythematous papuloplaques and nodules which had developed on the right abdomen, flank and back in zosteriform distribution. Histopathologic examination revealed dermal pleomorphic cellular infiltration and tumor cells in lymphatic vessels. It represents a case of zosteriform cutaneous metastasis from transitional cell carcinoma of the urinary bladder.

A Review of Treatments of Keloids with Intramarginal Surgical Excision and Postoperative Irradiation to Prevent Recurrences

No abstract available.

A Case of Congenital Eruptive Vellus Hair Cyst / 대한피부과학회지

An eruptive vellus hair cyst is an uncommon, benign, epithelial tumor with hair differentiation. Clinically, it presents as asymptomatic, flesh-colored to yellowish, follicular papules, 1 to 4 mm in diameter, most commonly on the chest. It is usually seen in children and young adults but may be congenital. Histologically, it shows a middermal cyst lined by squamous epithelium containing keratinous material and vellus hairs. It has a tendency to clear spontaneously but may be persistent. We report a case of congenital eruptive vellus hair cyst in an 11-year-old girl who presented multiple pinhead-sized brown to black papules on her anterior chest since birth.