Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

Usefulness of Dermoscopy in the Differential Diagnosis of Ruptured and Unruptured Epidermal Cysts

BACKGROUND: An epidermal cyst is a common keratin-filled epithelial-lined cyst. The treatment of choice for epidermal cysts is surgical excision. If the cyst becomes ruptured, incision and drainage with oral antibiotic therapy or intralesional steroid injection are required. OBJECTIVE: To analyze the dermoscopic features that can differentiate between ruptured and unruptured epidermal cysts. METHODS: The clinical and dermoscopic features of the pathologically confirmed epidermal cysts of two subgroups of 38 patients, 20 with unruptured cysts and 18 with ruptured cysts, were reviewed. RESULTS: With regard to the dermoscopic features, an ivory- white background color and punctum were commonly found in both groups (p>0.05). The unruptured-cyst group showed higher frequencies of pore sign (p0.05), no vascular structure, and arborizing telangiectasia (p0.05) and peripheral linear branched vessels (with an erythematous rim) (p<0.05). CONCLUSION: Dermoscopy is helpful in differentiating between ruptured and unruptured epidermal cysts.

A Case of Neurofibromatosis with Giant Pigmentation, Diffuse Neurofibromas and a Pigmented Neurofibroma / 대한피부과학회지

A 31-year-old man presented with an erythematous tumor within a giant pigmentation on the left arm, which was partially covered with hairs and had a few subcutaneous nodules within it. Also he had a bluish tumor on the left palm, multiple tumors and cafe au lait spots on the upper trunk. Histologic examination from the tumor, pigmentation and subcutaneous nodules on the left arm, and the tumors on the upper trunk and left palm all revealed neurofibromas. Interestingly, the rare types of the neurofibromas, diffuse and pigmented neurofibroma were included in these.

A Case of Verruca Vulgaris Treated with Imiquimod / 대한피부과학회지

Despite numerous therapeutic options the treatment of verruca vulgaris remains difficult and various treatment modalities are accompanied with substantial pain, tissue destruction and frequent recurrence. Recently imiquimod has been successfully used as topical immune response modifier for the treatment of external anogenital warts with less pain, destruction and fewer recurrent rate. We observed a case of verruca vulgaris on the left palm and the left second toe in a 57-year-old man. He had been treated with keratolytic agent and CO2 laser with little effect. So we tried to treat him with 5% imiquimod cream which was self-applied to the lesions and achieved complete clearance after 4 weeks of the therapy.

Expressions of Cytokeratin and Ki-67 in the Development of the Pilomatricoma / 대한피부과학회지

BACKGROUND: Pilomatricoma (PM) is benign follicular tumor composed of the basophilic cells, transitional cells, shadow cells, squamoid cells and keratin filaments/amorphous debris. At present, PM is assumed to differentiate toward hair-forming cells of hair follicles but definite direction is not clear. OBJECTIVES: This study was made in order to investigate the pathways of cell differentiation associated with sudden keratinization in PM. METHODS: In the present study, 19 cases of human PM was histopathologically examined and classified into 4 groups according to the chronological stages. RESULTS: In the chronological stages according to Kaddu's classification, there were 2 cases of early lesion, 6 cases of fully developed lesion, 7 cases of early regressive lesion and 4 cases of late regressive lesion. The basophilic cells changed into the shadow cells or amorphous debris through the transitional cells moving toward the exterior of the PM, as well as toward the interior. As keratinization occurs, some inner basophilic cells which had been located in marginal areas of keratinization lost their tight cell-cell bonding. These cells showed edematous/vesicular and squamoid changes. High molecular weight cytokeratin was expressed in a linear pattern in some early and fully developed lesions. There were fewer layers of basophilic cells between the stroma and squamoid cells/amorphous debris than between the stroma and shadow cells. Ki-67 was expressed strongly both basal and overlying basophilic cells. Apoptotic bodies were detected in most transitional cell layers and some amorphous debris zones. CONCLUSIONS: The present study suggests dual pathways of cell differentiation in PMs. In the sudden keratinization pathway, the basophilic cells, transtional cells, shadow cells, and squamoid cells are suddenly keratinized, and the basophilic cells become early the transitional cells or squamoid cells. Cytoplasmic expressions of Ki-67 and cytokeratin in the basophilic cells show that the basophilic cells differentiate toward the innermost layer of the outer root sheath cells.

A Case of Nevus Sebaceus associated with Syringocystadenoma Papilliferum, Trichoblastoma, Basal Cell Carcinoma, Sebaceous Adenoma and Sebaceous Epithelioma / 대한피부과학회지

Nevus Sebaceus is a hamartoma that has a well-documented neoplastic potential. Multiple tumors may occasionally arise, but the coexistence of 3 or more tumors is extremely rare. We report a case of nevus sebaceus in a 55-year-old female associated with syringocystadenoma papilliferum, trichoblastoma, basal cell carcinoma, sebaceous adenoma and sebaceous epithelioma.

A Case of Pigmented Basal Cell Carcinoma on the Scrotum / 대한피부과학회지

Basal cell carcinoma(BCC) is the most common cancer of the skin in Korea. The lesions are most frequently found in the head and neck regions. However, its appearance on the scrotal skin is rare. We observed a case of pigmented BCC on the scrotum in a 66-year-old man. He had a well circumscribed, brown-black plaque on the scrotum for 5 years and the history of prior vasectomy about 30 years ago. The cancer was excised widely.