Recent Trends (1991-2010) of Metastatic Skin Cancers in Korea

The incidence of overall cancer has increased over time. The incidence of top-ranking cancers has changed in the 1990s and the 2000s. However, few studies have evaluated the trends in metastatic skin cancers during this period. We evaluated the recent trends in incidence, peak age and location of metastatic skin cancers from 1991 to 2010. This 20-yr survey was divided into two decades to determine the trends by comparing the statistics. Out of 694,466 outpatients (1991-2010), 174 (0.025%) were diagnosed with metastatic skin cancer. The incidence of metastatic skin cancer increased significantly from 20.64 per 100,000 outpatients in the 1990s to 28.70 per 100,000 outpatients in the 2000s (P = 0.030). The peak age of skin metastasis shifted from the 40s to the 50s in women, and from the 50s to the 60s in men. The percentage of metastatic skin cancers originating from intra-abdominal organs increased from 10% in the 1990s to 23.1% in the 2000s (P = 0.027). The percentage of metastatic skin cancers located on the abdomen increased from 7.1% in the 1990s to 15.4% in the 2000s (P = 0.011). The higher proportion of metastatic skin cancers located on the abdomen may be related to the increase in skin metastases from intra-abdominal organs.

A Clinical Study of 35 Cases of Pincer Nails

BACKGROUND: Pincer nail is a nail deformity characterized by transverse overcurvature of the nail plate. Pincer nail can affect a patient's quality of life due to its chronic, recurrent course; however, there have been no clinical studies on the pincer nail condition in Korean patients. OBJECTIVE: The purpose of this study was to characterize the clinical findings and treatment of pincer nail. In addition, possible etiological factors were considered, and treatment efficacy was evaluated. METHODS: The medical records and clinical photographs of 35 patients (12 males, 23 females) who were diagnosed with pincer nail between August 1, 2005 and July 31, 2009 were studied. RESULTS: Patient age ranged from 10 to 77 (52.09+/-17.26) years, and there was a predominance of female (23 out of 35 patients, F:M=2:1). The mean duration of the disorder was 7.45 years (range 0.25~40); 85% had pincer nail for at least 1 year. In addition, 40% had a history of previous treatment and recurrence. There were 82.8% patients with the common type of pincer nails. The most commonly involved nails were both great toenails. Among 35 patients, nail grinding was started in 30 patients, and 25 patients showed clinical improvement with nail grinding. The width index increased and the height index decreased after treatment. The mean follow up period was 8.42 months (range 1~27), and 7 patients showed recurrence after 8.8 months (range 2~20). Among 35 patients, 5 patients were treated with nail extraction with matricectomy, and the symptoms resolved immediately. The mean follow up period was 7.6 months (range 0~19), and recurrence was not observed. Onychomycosis was also present in 37.1% of patients, and itraconazole pulse therapy for 3 months was added. CONCLUSION: The results of this study demonstrate the clinical features of pincer nail in Korean patients. The findings show that the common type of pincer nail was most common, and nail grinding as a conservative treatment greatly improved pincer nails despite a risk of recurrence. When onychomycosis was also present, oral antifungal therapy added to nail grinding resulted in a more rapid change in nail thickness and clinical improvement.

A Case of Scalp Metastasis from Follicular Thyroid Carcinoma / 대한피부과학회지

Cutaneous metastases from follicular thyroid carcinoma are extremely rare. A 59-year-old woman presented with a 1 month history of a slowly enlarging scalp nodule. Ten years earlier, the patient had been received total thyroidectomy for anterior neck mass, and diagnosed as poorly differentiated follicular thyroid carcinoma. The patient had developed pulmonary metastases 4 years after the initial surgery and concurrent chemotherapy. A biopsy from the scalp nodule showed an intradermal tumor composed of mostly thyroid follicular structures with colloid material. The tumor cells were monomorphic with scant pale cytoplasm and uniform nuclei, and stained positive for thyroid transcription factor-1 and thyroglobulin. We report a cutaneous metastasis from the follicular thyroid carcinoma as a rare case.

A Case of Total Dystrophic Onychomycosis Caused by Candida albicans in Diabetes Mellitus / 대한의진균학회지

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.

A Case of Plantar Erythema Nodosum / 대한피부과학회지

Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs and malignancies. Lesions of erythema nodosum usually appear symmetrically on the extensor aspects of the legs with occasional involvement of the thighs or forearms. Unilateral or plantar involvement uncommonly occurs. A 26-year-old man presented with bilateral, painful, multiple, confluent, erythematous, firm nodules confined to the both plantar skin for 7 days. Histopathologic examination revealed fibrosis of and a lymphohistiocytic infiltrate within the septae of fat lobules, consistent with erythema nodosum. We, herein, report an unusual case of plantar erythema nodosum, which was successfully treated with nonsteroidal antiinflammatory drugs for 2 weeks.

A Case of Necrotizing Sialometaplasia / 대한피부과학회지

Necrotizing sialometaplasia is a rare, benign, variably ulcerated, self-limiting disease of minor salivary glands. It may be frequently confused both clinically and histologically with squamous cell carcinoma or a minor salivary gland neoplasm. We present a case of necrotizing sialometaplasia on the inner surface of the lower lip developed in a 16-year-old man. To our knowledge, this is the first case repoit of necrotizing sialometaplasia in the Korean literature.