Clinical and Histopathological Study of Cutaneous Melanoma in Korea / 대한피부과학회지

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.

Clinical and Histopathological Study of Cutaneous Lymphomas in Korea / 대한피부과학회지

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.

Comparative Histopathologic Study of Drug eruption and Rubella / 대한피부과학회지

BACKGROUND: Dermatologists frequently see morbilliform rash in the clinic, drug eruptions and viral eruptions. Due to close clinical similarities, it is difficult to differentiate them. OBJECTIVE: The purpose of this study was to review the histopathologic differences between drug eruption and viral eruption. METHOD: In this study, 13 patients diagnosed as rubella and 13 patients diagnosed as drug eruption in Department of Dermatology, Presbyterian Medical Center from 1995 to 1997 were included. We reviewed the epidermal changes such as vacuolopathy, dyskeratotic cells, spongiosis and exocytosis and dermal changes by light microscopy. RESULTS: 1. Vacuolopathy of basal layer was observed in 92.3% of patients in both diseases. 2. Dyskeratotic cells, spongiosis and exocytosis were observed significantly highly in drug eruption. 3. Perivascular lymphohistiocytic infiltration was mild in both diseases, but eosinophilic infiltration was significantly higher in drug eruption(84.6%) than viral eruption(15.4%). 4. Atypical lymphocytes were observed in both diseases. 5. Red blood cell extravasation was observed only in viral eruption. 6. Perivascular edema was significantly higher in drug eruption(76.9%) than viral eruption(38.4%) CONCLUSION: There were statistically significant differences in dyskeratotic cells, spongiosis, dermal eosinophilic infiltration and Red blood cell extravasation. Considering these observation, histopathologic findings may be helpful in differentiating between drug eruption and viral eruption.

A Case of Angiosarcoma on the Scalp in a Teenage Girl / 대한피부과학회지

Angiosarcoma is a rare and highly malignant vascular tumor of endothelial cell origin. Cutaneous angiosarcoma usually occurs on the scalp and face of the elderly person, frequently in the sixth and seventh decade. Unusually, we experienced a case of angiosarcoma of the scalp in a 12-year-old girl. The patient had a solitary, well-demarcated 0.7X0.7cm sized, non-tender, blue-violaceous to gray-black colored, crusted papule on the vertex for 2 months. She was treated by wide surgical excision only but no recurrence in the last eight years after excision.

A Case of Multiple Verruciform Xanthoma of Oral Cavity and Gastrointestinal tract / 대한피부과학회지

Verruciform Xanthoma(VX) is a rare disease of unknown etiology that is typically solitary and predominantly located within the oral cavity. It is usually not associated with other lesions or metabolic abnormalities. Histologic features include acanthosis with uniform elongation of the rete ridges and xanthomatous cells that lie in are and typically confined to the papillary dermis. We report a rare case of multiple verruciform xanthoma that occurs in oral cavity and gastrointestinal tract simultaneously.

Epidemiologic and Clinical Survey of Behcet's Disease in Korea: the First Multicenter Study

The prevalence of Behcet's disease is the highest in the East Asian and the Medi-terranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.

A Clinical and Histopathologic Study of Rubella / 대한피부과학회지

BACKGROUND: Although rubella is a mild exanthematous viral infection and its incidence has been greatly decreased after effective vaccination, epidemics of rubella has been noted at 5- to 7-year intervals. But there has been few report about the clinical and histopathologic study of rubella in Korean literatures. OBJECTIVE: The purpose of this study was to review the clinical and histopathologic characteristics of rubella of 1996 outbreak. METHODS: We reviewed the clinical features and histopathologic findings in 50 patients diagnosed as rubella in Department of Dermatology, Presbyterian Medical Center from January 1996 through to May 1996. RESULTS: 1. The male-female ratio was 1: .17. The age distribution was 13-32 years and 72% of patients were aged 16-25 years. 2. Erythematous maculopapular rash on whole body was developed in all patients. Eighty two percent of the patients had fever and lymphadenopathy, and 36% of the patients had petechiae of soft palate. The main prodromal symptoms were sore throat(50%), headache(34%), and upper respiratory symptoms(22%), as order of frequency. 3. Positive serologic test for rubella IgM antibody was 79.5%. 4. The most common abnormal laboratory finding was leukopenia(58%), and followed by positive ASO(34%), the presence of atypical lymphocytes(21%), and thrombocytopenia(8%). 5. Histologically, epidermal changes were mild to moderate vacuolopathy(92.3%), the presence of dyskeratotic cells(30.8%), spongiosis(23.1%), and exocytosis(15.4%). Dermal findings were mild superficial perivascular lymphohistiocytic infiltration(100%), upper dermal edema(53.8%), perivascular edema(38.4%), pigmentary incontinence(30.8%), and the presence of extravasated RBC(23.1%). Eosinophil infiltration(15.4%) and the presence of large nucleated lymphocytes(92.3%) were also observed. Conclusions: According to the results of our study about rubella outbreak in 1996, clinical signs and symptoms were similar to those of previously described. Histologically, superficial perivascular dermatitis with mild to mederate vacuolar interface change was a main feature and large nucleated lymphocytes were frequently noted.

Four Cases of Cutaneous Sinus Tract of Dental Origin / 대한피부과학회지

The most common cause of chronic cutaneous sinus tract in the face and neck is chronically draining dental infection. The diagnosis is easily confirmed by dental examination and dental roentgenogram of the involved area, but this disease is frequently misdiagnosed and incorrectly treated in dermatologic department. We report four cases of cutaneous sinus tract of dental origin. First patient had a painful nodule with chronically draining pus and a dimple on the left cheek. Second patient had a dimple with draining bloody fluid on the right chin. Third patient had a pea-sized papule with draining serous fluid on the left chin. Fourth patient had a fluctuant erythematous plaque with draining pus and a dimple on the left buccal area. In all four patients radiologic examination of the maxillary and mandibular regions demonstrated radioluency at the apex of tooth consistent with periapical abscess.

Stimulation of melanogenesis by glycyrrhizin in B16 melanoma cells

Glycyrrhizin (GR), triterpenoid saponin composed of one glycyrrhetinic acid (GA) and two glucuronic acids, is a main constituent of the hydrophilic fraction of licorice (Glycyrrhiza glabra) extracts and is known to have a wide range of pharmacological actions. In this study, we investigated the mechanism of GR effect on melanogenesis in B16 murine melanoma cells. The cellular levels of tyrosinase mRNA, protein, enzyme activities and melanin contents were increased by GR in a dose dependent manner. Expression of tyrosinase-related protein-2 (TRP-2) mRNA was also increased by GR, however, no significant change was observed on TRP-1. No cytotoxicity was observed at the effective concentration range of GR. GA showed no effect on melanogenesis at the equivalent nontoxic concentrations, indicating that glycoside structure is important in the stimulatory effect of GR on melanogenesis. These results indicate that GR-induced stimulation of melanogenesis is likely to occur through the transcriptional activation.

A Case of Toxic Epidermal Necrolysis Due to Contact of Paraquat(Gramoxone(R)) / 대한피부과학회지

Occasionally, erythema multiforme has been reported to occur in association with allergic contact dermatitis to various substances including paraquat(Gramoxone(R)). In these cases the erythema multiforme has ranged from mild localized exanthem to life-threatening toxic epidermal necrolysis. We report a case of toxic epidermal necrolysis developed from erythema multiform due to contact of paraquat.

A Case of Lentigo Maligna Melanoma / 대한피부과학회지

Lentigo maligna melanoma(LMM) is the least common type of melanoma and most commonly affects the sun-exposed skin of the elderly. We herein report a case of LMM evolved from lentigo maligna(LM). A 71-year-old female presented with a longstanding irregular brown patch containing two black papules on the left cheek which developed 8 months ago. Histopathologic findings were consistent with LM and LMM. We performed a wide excision and dufourmental flap for reconstruction with no recurrence for 30 months. Sun exposure has been known as the most important etiologic factor for the development of malignant melanoma including LMM and the incidence has an increasing tendency. Thus, skin biopsy is recommended in the evaluation of a longstanding irregular brown patch on the face to prevent LMM.

A Clinicopathological Study of Basal Cell Carcinoma in Korean Patients / 대한피부과학회지

BACKGROUND: Basal cell carcinoma(BCC) does not commonly occur in dark-skinned people, although it is the most common cancer of light-skinned people. So it has been known that incidence of BCC is lower than that of squamous cell carcinoma(SCC) in Asian and Africans. However, several recent Korean articles have reported the reversal of the ratio of SCC to BCC. There has been no report about BCC following a nationwide survey in Korea. OBJECTIVE: Our purpose was to confirm the trends in BCC and SCC, and to identify the clinical and histopathological characteristics of BCC. METHODS: A clinical and histopathological analysis was done retrospectively with patients diagnosed as BCC from the Department of Dermatology of 15 University Hospitals or General Hospitals during the last 20 years(1977-1996). Annual incidence of BCC was compared with that of SCC at the same situation. We compared the results with those in other races statistically. RESULTS: 1. Incidence of BCC was 0.16% compared with 0.11% of SCC. The increasing incidence of BCC was more pronounced than that of SCC, although they were increased gradually. 2. The male-female ratio was 1:1.07, and the most frequent age group was the 6th decade(30.1%). 95% of the patients were older than the age of 40 years with the mean age of 62.7 years. 3. The most commonly involved site was the face(84.9%), especially on the nose, cheek, and eyelids. 4. The most frequent histologic pattern was nodulocystic type(35.4%), followed by mixed(30.1%), infiltrative(9.3%), superficial(6.7%), micronodular(6.2%), adenoid(5.9%), metatypical(4.0%), morpheaform(2.1%), and fibroepithelioma type(0.3%). 5. Histologically, 45.3% of BCC contained pigment. The histologic pattern most frequently associated with pigmented BCC was mixed type(53.1%) followed by nodulocystic(51.2%), superficial(46.8%), micronodular(38.6%), and adenoid type(33.3%). 6. Overall recurrence rate was 6.3%. Morpheaform, infiltrative, and metatypical BCC have a high erincidence of recurrence(26.3%, 13.2%, 8.1%, respectively). Therapeutic modalities that showed high recurrence rate was 5-FU, curettage and electrodessication, and cryotherapy(33.3%, 28.6%, 16.8%, respectively). CONCLUSION: It was confirmed following a nationwide survey that increasing incidence of BCC was more pronounced than that of SCC since early 1980s and BCC was the most common skin cancer in Korea.

Subepidermal Calcified Nodule Arising in theLesion Of Clear Cell Syringoma / 대한피부과학회지

The subepidermal calcified nodule, also known as a form of calcinosis cutis, is characterized by solitary circumscribed deposits of insoluble calcium within the subepidermis. The disease is not associated with any systemic or cutaneous diseases, or any biochemical abnormalities. The pathogenesis is still unknown. A 55-year-old female presented with a 4-month history of solitary skin-colored, hyperkeratotic papule on the left upper eyelid. The lesion was asymptomatic and had increased slowly in size. It is interesting that excisional biopsy showed typical histopathologic features of the subepidermal calcified nodule and the clear cell syringoma.

Mask Phenomenon; Five Cases of Unusual Facial Purpura / 대한피부과학회지

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).

Mask Phenomenon; Five Cases of Unusual Facial Purpura / 대한피부과학회지

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).

A Case of Cutaneous Mycobacterium marinum Infection / 대한피부과학회지

Mycobacterium marinum is a photochromogenic and slowly growing acid-fast organism classified in Runyon's group I of atypical mycobacteria. Infection with M. marinum occurs when the organism is inoculated usually in association with exposure to contaminated water and the disease is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 43-year-old man with erythematous verrucous plaque on his right knee, which was caused by a shell wound on a beach 3 months ago. The skin biopsy specimen showed pseudoepitheliomatous hyperplasia and several small epithelioid granulomas in the dermis. Culture of the tissue specimen revealed slowly growing whitish colonies in the dark, which changed yellowish after exposure to light. The microorganism was identified as M. marinum by biochemical tests, and was confirmed by the DNA-DNA hybridization method. The skin lesion disappeared after 3 moaths of treatment with minocycline, 200mg daily.

A Clinical and Histologic Study of Pigmented Basal Cell Carcinoma / 대한피부과학회지

BACKGROUND: Pigmented basal cell carcinoma(PBCC) is a clinical and histological variant of BCC, which is known to show better prognosis than non-PBCC. There has been no report about the PBCC among Korean patients. OBJECTIVE: Our purpose was to identify the clinical and histologic characteristics of PBCC and to determine whether this correlated with prognosis. METHODS: A clinical and histological survey was done with 62 lesions of 56 cases of PBCC that visited the Department of Dermatology, Presbyterian Medical Center during the last 10 years(1988 - 1998). Some results were then compared with results of non-PBCC. RESULTS: 1. The frequency of BCC in the total number of new outpatients was 0.34%, and 83.6% of BCC contained pigment histologically. 2. The male-female ratio was 1.24:1, and 92.9% of the patients with PBCC were older than the age of 40 years with the mean age of 62.9 years. 3. 88.7% of the PBCC occurred on the face, especially on the nose(38.7%), cheek(19.4%), and eyelid(17.7%). Clinically, most of the tumors were noduloulcerative(77.4%) and diffuse pigmentation was more common than dotted. 4. The most frequent histologic types were nodulocystic(43.6%) and mixed(43.6%) type followed by superficial(6.4%), micronodular(1.6%), adenoid (1.6%), infiltrative(1.6%), basosquamous(1.6%) types. Histologically 51.6% of the tumors were associated with ulceration, and 71% of the tumors were associated with infiltration of inflammatory cells. 5. Fontana-Masson stains showed pigment is melanin and it was found in both tumor nests and surrounding dermis in most cases(95.0%). Hypertrophic melanocytes with prominent dendrites were seen in the tumor nodule(77.8%) and in the normal epidermis overlying tumor(22.2%). 6. Margins were examined for evidence of residual tumor in 48 lesions that were excised. In 4 lesions(8.3%) were the margin positive for tumor. This was statistically not significant (p>0.05) compared with 10 excisions of non-PBCC in which 2(20%) showed positive margins. CONCLUSION: High incidence of PBCC is a characteristic feature in Korean patients, and PBCC showed better prognosis than non-PBCC because it is more frequently excised with adequate margins.

A Case of Subcutaneous Sweet's Syndrome in MYelodysplastic Syndrome Showing Nuelear Segmentation Anomalies of Neutrophils / 대한피부과학회지

We encountered a case of Sweet's syndrome associated with myelodysplastic syndrome in a 60-year-old woman. The clinical presentation strongly suggested Sweet's syndrome. A skin biopsy specimen taken from her skin lesion on the leg showed an infiltration of numerous neutrophils in the subcutis instead of the dermis which is the main area of neutrophilic infiltration in Sweet's syndrome. Among infiltrating cells, many neutrophils(8%) showed nuclear segmentation anomalies, that is, hyposegmentation(pseudo-Pelger-Huet anomaly) or hypersegmentation. Peripheral blood neutrophils had similar anomalies. This subcutaneous variant of Sweet's syndrome, Sweet's panniculitis, is rare and nuclear segmentation anomalies of neutrophils are probably a good clue to underlying myelodysplastic syndrome.

A Case of Transient Acrodermatitis Enteropathica in a Full-Term Breast-Fed Infant / 대한피부과학회지

We herein report a case of transient acrodermatitis enteropathica in a 3-month-old, breast-fed, full-term infant. The patient was presented with a 2-month history of diarrhea and crusted erythema- tous patches on the periorificial area. Similar lesions were seen in his siblings. His serum zinc level and the zinc level in his mother's breast milk were markedly reduced. Diarrhea and skin lesions disappeared promptly with oral zinc supplementation and did not recur when zinc was discontinued after three weeks. Our case indicates that even full-term infants, who feed excl-usively on mothers milk, run a risk of developing zinc deficiency, if the concentration of zinc in the breast milk is very low.

Efficacy of Itraconazole Melt-Extrusion Tablet One-week Therapy in Treatment of Hyperkeratotic Type of Tinea Pedis and/or Tinea Manus / 대한피부과학회지

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.