Experience in 102 Non-melanoma Skin Cancer with Mohs Micrographic Surgery / 대한피부과학회지

BACKGROUND: Mohs micrographic surgery (MMS) is a specialized type of minimal marginal surgery, which offers superior cure rates to other options in the treatment of non-melanoma skin cancers. OBJECTIVE: The aim of this study is to investigate the clinical characteristics and recurrence rate of the non-melanoma skin cancer and to estimate the safeties of MMS. METHODS: We retrospectively evaluated 102 patients who had been diagnosed with non-melanoma skin cancer and treated by MMS from May 2008 to September 2011. RESULTS: The most common cancer was basal cell carcinoma (63.72%), followed by squamous cell carcinoma (31.38%). The local flap was the most common method to repair surgical defects (74.5%), followed by primary closure (17.64%). Cervical lymph node metastasis was confirmed in 1 case (0.98%). Recurrence after MMS was observed in 1 of 102 patients (0.98%). CONCLUSION: MMS is a safe method for the treatment of non-melanoma skin cancer.

Cutaneous Granulomas Associated with Common Variable Immunodeficiency / 대한피부과학회지

Common variable immunodeficiency (CVID) is one of the primary immunodeficiency disorders, which is characterized by hypogammaglobulinemia, defect in antibody synthesis and recurrent sinorespiratory bacterial infections. Granuloma is an uncommon skin manifestation in primary immunodeficiency disorders. Here we present a 5-year-old girl who had asymptomatic erythematous plaques on the face and legs. She had a past medical history of recurrent sinorespiratory and gastrointestical bacterial infections since 2 years old. The histopathologic findings of the skin lesions showed sarcoid-like granulomas with focal necrobiosis. No specific organism was found with evaluation. Cells forming granulomas were strongly positive for CD3 or CD68. CD4/CD8 ratio was estimated less than 1. Laboratory examination showed low hemoglobin, low B cell and normal T cell number, low IgA and IgG levels.

Inflammatory Disseminated Superficial Porokeratosis Successfully Managed by Oral Isotretinoin / 대한피부과학회지

Disseminated superficial porokeratosis is a keratinization disorder characterized by multiple brown, atrophic patches with sharply demarcated and hypertrophic ridges. Atypical cases of disseminated superficial porokeratosis with acute exacerbation accompanied by severe pruritus have been reported as "eruptive pruritic papular porokeratosis" or "inflammatory disseminated superficial porokeratosis." We report a case of inflammatory disseminated superficial porokeratosis in a 53-year-old man who was successfully treated with oral isotretinoin.

Acromegaloid Facial Appearance Syndrome with Generalized Hypertrichosis Terminalis / 대한피부과학회지

Acromegaloid facial appearance (AFA) syndrome is a rare autosomal dominant disease, consisting of an acromegaloid face, a bulbous nose, and narrowing of the palpaebral fissure. In 1996, Irvin first reported a case of a combination of acromegaloid facial appearance syndrome and congenital hypertrichosis, and reported this case as a new disease of acromegaloid facial appearance with generalized hypertrichosis terminalis, which is differentiated from both AFA syndrome and congenital hypertrichosis/gingival hyperplasia. We report herein the first Korean case of acromegaloid facial appearance with generalized hypertrichosis terminalis.

Acantholytic Squamous Cell Carcinoma on the Right Foot / 대한피부과학회지

Acantholytic squamous cell carcinoma is a well-defined, rare variant of squamous cell carcinoma in which significant portions of the neoplastic tissue show, on microscopy, a pseudoglandular or tubular pattern. It usually presents in aged patients as an erythematous nodule with scales, crust, and ulceration on sun-exposed areas. Herein we report a case of acantholytic squamous cell carcinoma that occurred on the Rt 4th toeweb of a 70-year-old man.

A Case of Cicatricial Alopecia Associated with Erlotinib

Erlotinib is a small-molecule tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR). Erlotinib has been used primarily to treat non-small cell lung cancer. In addition to its role in tumor cells, EGFR is also an important regulator of growth and differentiation in the skin and hair. Therefore, EGFR-TKIs have been associated with a number of cutaneous side effects including follicular acneiform eruptions, cutaneous xerosis, chronic paronychia, desquamation, seborrheic dermatitis, and hair texture changes. Herein, we report a rare case of a 61-year-old woman who was treated with erlotinib and experienced cicatricial alopecia.

A Clinicopathological Analysis of Cutaneous Metastasis from Gastric Cancer in Korea / 대한피부과학회지

BACKGROUND: Cutaneous metastasis from an internal malignancy is uncommon and it usually arises from the breast and lung. Cutaneous metastasis from gastric cancer is rarely seen, although gastric cancer is the most common internal cancer in Korea. OBJECTIVE: The purpose of this study was to analyze the clinical and histopathological characteristics of cutaneous metastasis from gastric cancer in Korea. METHODS: Twenty-seven cases of cutaneous metastasis from gastric cancer were included in the study among the 14,053 patients who were diagnosed with gastric adenocarcinoma over a 20 year period. Their medical records and pathology slides were retrospectively reviewed. RESULTS: The incidence of cutaneous metastasis was 0.19% (27/14,053). The age of the 27 patients ranged from 28 to 75, and the mean age was 53.9 with no significant difference in gender. The most frequently involved site was the abdomen followed by the face and scalp. Nodular lesion was most common (55.6%, 17/27) and inflammatory and indurated lesions were 25.9% (7/27) and 7.4% (2/27), respectively. Histopathologically, poorly differentiated adenocarcinoma (13/27) and signet-ring cell carcinoma (10/27) were common, which comprised 85.1% of the total tumor. In 7 cases (25.9%), skin lesion was the first presenting sign of gastric cancer or metastatic gastric cancer. The mean survival of the patients was 4.7 months. CONCLUSION: Cutaneous metastasis from gastric cancer is rare despite gastric cancer's high prevalence as a primary cancer in Korea. It was frequently observed in patients with an advanced disease stage, yet it may represent the initial manifestation of the disease. Dermatologists can contribute to the management of patients with cutaneous metastasis by performing early detection and recognition of skin lesions.

Psoriasis Aggravated by Adalimumab: A Paradoxical Adverse Reaction / 대한피부과학회지

Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks tumor necrosis factor-alpha (TNF-alpha) and has been successfully used in the treatment of immune-mediated diseases. In particular, its efficacy has been proven in the treatment of rheumatoid arthritis, spondylarthritis, lymphoproliferative diseases and inflammatory bowel disease. Its use has also been studied for the treatment of psoriasis and yet, paradoxically, cases of new onset or exacerbation of psoriasis continue to increase in patients undergoing treatment with anti TNF-alpha agents. A 51-year-old woman had arthritis for a year and was diagnosed with psoriatic arthritis. After she had received adalimumab for psoriatic arthritis five times during one year, erythematous eruptions were found on her entire body. She then stopped adalimumab therapy for two months, although her skin lesions did not resolve. The patient was diagnosed with psoriasis through biopsy and began using cyclosporine, a topical steroid used for treatment of psoriasis.

A Case of Disseminated Nocardiosis Secondary to the Skin Nodules in an Elderly Woman

Nocardiosis refers to a locally invasive or disseminated infection associated with the Nocardia species. Most infections enter through the respiratory tract and then disseminate systemically. Rarely can a primary nocardial infection of the skin spread to contiguous structures or disseminate to other internal organs in immunocompromised hosts. We describe a 70-year-old woman who suffered from recurrent nodular skin lesions on her right hand, forearm and elbow following inoculation of a traumatic injury. Analysis of the purulent exudates obtained from the nodule revealed Nocardia species. After 20 days, a chest X-ray showed newly developed multiple nodules in both lungs. The diagnosis of systemic nocardiosis was established, and we treated this case with trimethoprim-sulfamethoxazole.

A Case of Dermatomyositis Associated with Scarring Alopecic Patches / 대한피부과학회지

Dermatomyositis is a rare disease of unknown origin that combines an inflammatory myopathy with characteristic cutaneous findings. Scalp disease has rarely been considered as a manifestation of dermatomyositis and is often misdiagnosed as being scalp paosiasis or seborrheic dermatitis. We report a case of 27-year-old woman who presented with brownish alopecic patches on the scalp, and chronic proximal muscle weakness.

A Case of Microvenular Hemangioma / 대한피부과학회지

Microvenular hemangioma is an uncommon acquired vascular tumor of young to middle-aged adults of both genders. It usually presents as a small, solitary, purple to red papule or plaque on the extremities or trunk. Histologically, the tumor is composed of small branching venules with collapsed lumina and conspicuous pericytes infiltrating the full thickness of the reticular dermis. Because of histological similarity to a Kaposi's sarcoma, the awareness of microvenular hemangioma is important. We report a case of microvenular hemangioma in a 9-year-old girl.

The Effect of 5% Imiquimod Cream on C57BL/6 Mouse Melanoma Growth / 대한피부과학회지

BACKGOUND: Imiquimod enhances both acquired and innate immune responses by inducing the synthesis of IFN-alpha and other cytokines (TNF-alpha, IL-1, 6, 8, 12, GM-CSF). Imiguimod was investigated in relation to melanoma, a highly resistant cancer in its immunogenic nature, but also an attractive target for immunotherapy. OBJECTIVE: The purpose of this study was to investigate the anti-tumor effect of 5% imiquimod cream in vivo. METHOD: C57BL/6 mice were inoculated intradermally into the left flank with 2X103 murine B16 melanoma cells. Five groups (including vehicle only, imiquimod cream, imiquimod cream with dimethyl sulfoxide (DMSO), vehicle with ultrasound, and imiquimod cream with ultrasound) were treated once daily at the inoculation site of the melanoma cells. The tumor growth was evaluated daily by using a caliper. RESULTS: The difference in tumor growth was seen around day 12 of treatment, and only the group of 5% imiquimod cream with ultrasound showed a decrease in tumor growth when compared to the control group. CONCLUSION: These results indicate that topical application of 5% imiquimod cream on mouse skin melanomas induces inhibition of tumor growth, and imiquimod cream could be used for the combination treatment of malignant melanoma.

A Case of Congenital Triangular Alopecia in Infancy / 대한피부과학회지

Congenital triangular alopecia is an uncommon nonscarring form of alopecia. It presents with isolated alopecic patch at the frontotemporal area of the scalp. Although previously considered congenital, this condition usually is discovered after 2 years of age and, more recently, is thought to be acquired. We report a case of congenital triangular alopecia in a 12 month old female who had the lesion since birth.

A Case of Acantholytic Dyskeratotic Epidermal Nevus / 대한피부과학회지

Acantholytic dyskeratosis is a regular histologic feature in Darier's disease, transient acantholytic dermatosis and warty dyskeratoma. It is also occasionally observed as an incidental histological finding in linear epidermal nevus. We report a case of acantholytic dyskeratotic epidermal nevus in an 11-month-old boy. The patient showed unilateral, brown colored verrucous plaque on the right shin. Histological finding showed hyperkeratosis, irregular acanthosis & focal acantholytic dyskeratosis.

A Cases of Erythema Elevatum Diutinum / 대한피부과학회지

Erythema elevatum diutinum(EED) is a rare chronic skin disease characterized by red, purple, and yellowish papules, plaques, and nodules that are usually distributed acrally and symmetrically over extensor surface. It is characterized histologically by a leukocytoclastic vasculitis. Although no treatment has shown a complete response, dapsone is reported to be effective to EED. We report a rare severe case of EED with good response to dapsone treatment.

A Case of Transient Acantholytic Dermatosis / 대한피부과학회지

Transient acantholytic dermatosis was first described by Grover in 1970. It is characterized by pruritic, discrete papules and papulovesicles distributed mainly on the trunk. The histologic hallmark of the disorder is focal acantholysis, several patterns of which have been described. The etiologic factors and pathogenesis remain unclear. We report a 45-year-old male patient with multiple severely pruritic, discrete papules and papulovesicles on the trunk. There were no oral cavity, palm and sole involvement. Histopathologic findings revealed epidermal acanthosis, acantholysis and hyperkeratosis with suprabasal splits. He showed good response to topical steroid and oral antihistamine.