Primary Eccrine Adenocarcinoma of the Skin: A Single-centre Experience of 10 Years

ope

Occupational differences in standardized mortality ratios for non-melanotic skin cancer and melanoma in exposed areas among individuals with Fitzpatrick skin types III and IV

OBJECTIVE: The objective of this study was to identify subpopulations vulnerable to skin cancer by occupations, among individuals with Fitzpatrick skin types III and IV. METHODS: Data were retrieved from the national mortality registry of Korean National Statistical Office (KNSO) from 1993 to 2012, including all medical certificates of death written and confirmed by physicians. Medical certificates of death from 1993 to 2012 were obtained from the national mortality registry of Korean National Statistical Office. These completed medical certificates are verified by the Korean Ministry of Government Administration and Home Affairs and formatted using 103 main and 236 specific causes of death as recommended by the World Health Organization. We calculated direct standardized mortality rate and standardized mortality ratio (SMR) using the indirect standardization method. The entire population as reflected in the 2005 national census was used as a reference population. RESULTS: Of 594 deaths from skin cancer, 227 (38.2%) were from non-melanotic skin cancer (NMSC) and 367 (61.8%) from cutaneous melanoma (CM). Compared to office workers, agriculture/fishery/forestry workers had significantly higher SMRs for NMSC in men [SMR: 461, 95% confidential interval (CI): 329-583] and women (SMR: 575, 95% CI: 317-864). SMR was also increased in men who worked in exposed area (SMR of NMSC:553, 95% CI:222-1018, SMR of CM:453, 95% CI: 133-1009). CONCLUSION: This is the first Asian study to suggest that agriculture/fishery/forestry workers have increased SMRs for NMSC and CM in exposed areas. Early diagnosis of skin cancer in this group is important.ope

(The) educational needs of Behcet's disease patient

간호학교육과/석사[한글]희귀질환중의 하나인 베체트병은 만성 재발성 염증성 질환으로 질환의 진단과 치료과정, 지속적인 관리 등을 포함한 전반적인 과정에 대한 정보가 알려져 있지 않다. 반면 베체트병 환자들은 베체트병의 진단과정, 치료과정 및 추후관리 과정을 포함한 전반적인 과정에 대해 계획적인 정보를 얻기 원하고 있다. 계획적이고 효율적인 교육을 제공하기 위해서는 대상자가 무엇을, 얼마나 알기 원하는 지를 파악해야 하며 환자의 교육요구에 맞추어 대상자가 이해할 수 있는 방법으로 교육이 제공되어져야 한다.이에 본 연구는 베체트병 환자를 대상으로 전반적인 과정에 대한 교육요구도를 파악함으로써 대상자가 요구하는 교육내용을 바탕으로 실제적인 교육프로그램의 개발에 유용한 기초자료를 제공하고자 시도되었다.본 연구의 연구대상은 국내에서 10,000명이상의 베체트병 환자들이 등록되어 외래 진료를 받고 있는 서울시 소재의 일 대학병원에서 베체트병 환자 117명을 대상으로 하였다.연구도구는 본 연구자가 개발한 4점 척도의 도구로 질병의 정보영역 11문항, 증상관리 13문항, 추후관리 8문항, 사회자원에 대한 정보 8문항으로 총 40문항으로 구성되었다. 도구의 신뢰도는 Cronbach’s Alpha 0.95이었다.또한 희귀질환인 베체트병 환자와 피부과의 일반질환인 백반증 환자, 여드름 환자와의 교육요구도의 차이를 비교하기 위하여 본 연구도구 중 질병영역 8문항에 대해 조사하였다.자료수집은 질문지를 통한 자가보고와 면담법으로 조사하였고, 기간은 2006년 4월 10일부터 5월 19일까지 40일간 조사하였다.자료분석은 SPSS 11.5 프로그램을 이용하여 실수와 백분율, 평균, 표준편차, t-test, one-way ANOVA로 분석하였다.연구를 통해 얻은 결과는 다음과 같다.1. 베체트병 환자의 교육요구도는 4점 만점에 2.71점에서 3.90점 범위로서 총 평균 3.57점으로 비교적 높게 나타났다. 교육요구도를 영역별로 살펴보면 질병 3.79점, 증상관리 3.66점, 추후관리 3.43점, 사회자원 3.42점 순으로 나타났다. 교육요구도가 가장 높은 문항은 베체트병의 완치가능성이었고, 베체트병 환자에게 도움이 되는 음식과 주의해야 할 음식, 베체트병의 증상 재발 방지법, 베체트병의 합병증, 베체트병의 원인에 대한 순으로 나타났다. 교육요구도 항목 중에 3점이하로 ‘알고 싶지 않다’로 나타난 항목은 임신계획시 관리방법과 술이나 담배의 허용여부였다.2. 베체트병 환자의 일반적 특성에 따른 교육요구도의 차이에서는 남자가 여자보다, 50세미만이 50세이상보다 추후관리영역에서 높은 교육요구도를 보여 유의한 차이를 보였다.(P=0.04, P=0.02) 결혼형태에서는 독신(미혼, 이혼,사별)이 기혼보다, 직업이 있는 환자가 직업이 없는 환자보다 추후관리영역에서 높은 교육요구도를 보였다.(P=0.05, P=0.01)3. 환자의 유병기간에 따른 교육요구도의 차이는 보이지 않았다.4. 베체트병 환자는 백반증 환자보다 교육요구도가 높게 나타났으며(t=-3.22 p=0.003), 여드름 환자와의 비교에서도 유의한 차이를 보여 교육요구도가 높은 것으로 나타났다(t=-7.10 p=0.000).이상의 결과를 종합해 볼 때 베체트병 환자는 높은 교육적 요구를 가지고 있음을 확인할 수 있다. 이 연구를 바탕으로 교육적 요구의 우선순위를 고려하여 교육프로그램의 개발이 필요하며 이를 이용하여 베체트병 환자를 위한 교육이 보다 활성화 되어야 할 것이다. [영문]Behcet’s disease is a rare illness characterized by systemic necrotizing vasculitis. Although the patients with Behcet’s disease hope to know the information on the general medical process including diagnosis, treatment, and follow-up management, the educational programs about them are not much. To provide systematic and efficacious education, it is essential to elucidate the content and degree of informations which patients want to know. It is also important to operate educational programs according to the need of patients. The aim of this study was to reveal the degree of educational need in patients with Behcet’s disease, and to investigate the factors associated with the need. By this study, it would be possible to provide the basic data to develope practical educational program for the Behcet patients.A total of randomly selected 117 patients diagnosed as Behcet’s disease in Severance Hospital, in which over 10,000 patients with Behcet’s disease are enrolled and followed-up, were included in this study. The research tool, 4-point scale answers to lists of question, was developed by investigator, and consisted of information of disease (11 lists), symptom management (13 lists), follow-up (8 lists), and information of social resources (8 lists). To compare the degree of educational need between the Behcet patients with vitiligo or acne patients, the 8 lists of information of disease were additionally used. From 10 April 2006 to 19 May, the collection of data was performed by self-reporting and interview. The statistical analyses were performed using the Statistical Program for Social Science (SPSS 11.5, Inc., Chicago, IL ), and the confidence degree of the tool was Cronbach’s alpha 0.95. Continuous variables were analyzed using Student’s t-test, and categorical data were analyzed by the Chi-square test. A P value of 0.05 was considered statistically significant.The results are as follows:1. The need for education in patients with Behcet’s disease was high. The average score was 3.47 point in full score of 4. The educational need about information of disease was highest (3.79 point), followed by symptom management (3.66 point), information of social resource (3.60 point), and follow-up (3.43 point). The possibility of Behecet’s disease being cured was the issue of which the patients wanted to most be informed, followed by helpful or harmful foods to Behcet patients, preventive methods for symptom recurrence, complications, and etiology of Behcet’s disease. The list given less than 3 point (‘not want to know’) was management in pregnancy and whether alcohol or smoking is to be acceptable.2. The male or younger (< 50 years) patients showed a significantly higher degree of educational need for follow-up management, compared with the female or older (≥ 50 years) patients (P=0.04 and 0.02, respectively). Also, the patients in state of bachelor or having a job had a statistically higher educational need compared to the marriaged or unemployed patients (P=0.05 and 0.01, respectively).3. There was no difference of the degree of educational need according to the duration of illness.4. The patients with Behcet’s disease showed significantly higher degree of educational need compared to the patients with vitiligo or acne (t=-3.22 and -7.10; P=0.003 and <0.001, respectively).This study demonstrates that the patients with Behcet’s disease have a high need for education about information of disease. It is necessitated to develope the educational program according to priority of need. Furthermore, more active education for patients with Behcet’s disease based on the program should be conducted.ope

Comparison of secondary intention healing and full-thickness skin graft after excision of acral lentiginous melanoma on foot

BACKGROUND : Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After wide excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Various repair methods are used to repair these defects, but secondary intention healing has not been evaluated in the repair of wounds of the foot. OBJECTIVE : To compare the functional and cosmetic results of secondary intention healing and full-thickness skin graft after wide excision of melanoma on the foot. METHODS : Retrospective review of 25 patients who were treated using excision for melanoma on the foot. The defects of 13 patients were healed by secondary intention (secondary intention healing group; SIHG), and those of 12 patients were repaired by full-thickness skin graft (skin graft group; SGG). RESULTS : The SGG showed more rapid healing than the SIHG, but the SIHG showed better functional and cosmetic outcomes at complete re-epithelialization than the SGG as evaluated by patients and independent physicians. CONCLUSIONS : Secondary intention healing after excision of melanoma from the foot is a therapeutic option with acceptable functional and cosmetic outcomes.restrictio

Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread

BACKGROUND: Owing to its potentially greater mechanical force on the implanted tissue, barbed thread is frequently used in face-lifting procedures. However, the long-term durability thereof remains controversial. Moreover, reports on underlying histologic and molecular changes resulting from face-lifting procedures are scarce. OBJECTIVE: To evaluate histologic and molecular changes induced by absorbable, barbed face-lifting thread in an animal model. MATERIALS AND METHODS: Fragments of monofilament, monodirectionally barbed polydioxanone thread were implanted in dorsal skin from 12 guinea pigs. Tissue samples were harvested at 1, 3, and 7 months thereafter. Histopathologic analysis and quantification of Type 1 collagen and transforming growth factor beta 1 (TGF-β1) levels were performed. RESULTS: Implantation of a single fragment induced fibrous capsule around the thread. Tissue reactions were strongest at 1 month after implantation, showing marked infiltration of inflammatory cells and fibroblasts, which gradually decreased. On molecular analysis, Type 1 collagen and TGF-β1 levels were significantly increased, compared to normal skin, throughout the 7-month study period. CONCLUSION: Our results suggest that implantation of barbed thread induces strong anchorage to skin tissue. Quantitative analysis of collagen and its downstream signaling molecule TGF-β supports the long-term durability of the thread. Therefore, the authors expect potential beneficial effect for rejuvenation on its clinical application.restrictio

Mohs micrographic surgery for dermatofibrosarcoma protuberans: comparison of frozen and paraffin techniques

BACKGROUND: Due to the propensity for local recurrence, Mohs micrographic surgery (MMS) has been suggested for the treatment of dermatofibrosarcoma protuberans (DFSP) and it has shown improved clinical outcomes. Recently, some authors suggested that MMS using paraffin-embedded sections (paraffin MMS) is superior in DFSP treatment compared with the conventional frozen MMS method. However, there have been no studies comparing frozen and paraffin MMS for the treatment of DFSP. OBJECTIVES: To compare the outcomes between DFSP patients who underwent frozen MMS and paraffin MMS. METHODS: Seventy-one DFSP patients treated with frozen MMS (n = 30) or paraffin MMS (n = 41) from 2003 to 2017 at a single institution were retrospectively reviewed. Recurrence rate and recurrence-free survival between frozen and paraffin MMS were assessed. RESULTS: During the mean follow-up duration of 25.4 months, four patients (frozen MMS, n = 1; and paraffin MMS, n = 3) showed recurrence after MMS. Although the local recurrence rate of the frozen MMS group (3.3%) was lower than that of the paraffin MMS group (7.3%), the difference was not statistically significant. In addition, recurrence-free survival was not significantly different between the two groups (P = 0.168). CONCLUSIONS: Frozen MMS, which has the advantages of shorter surgery time and immediate closure, is as effective as paraffin MMS in the treatment of DFSP.restrictio

해양수산연구개발 중장기 추진 전략 및 연구관리시스템 구축에 관한 working group 운영

해양수산

Application of secondary intention for the restoration of the apical triangle after Mohs micrographic surgery

Background: Restoring the apical triangle (AT) to maintain the symmetry of the face after Mohs micrographic surgery can be challenging. We have applied secondary intention (SI) after partial closure in cases with large defects. Objective: To compare the cosmetic results between immediate closure (IC) and SI. Methods & Materials: We retrospectively reviewed 24 patients (IC group: n = 15, SI group: n = 9). To evaluate the symmetry, the comparative ratio (CR; area of the AT of the involved side/area of the normal contralateral side) was calculated. Results: The defects were significantly larger in the SI group than in the IC group (588.89 ± 346.53 mm2 vs. 252.87 ± 196.52 mm2, p < .01). While there was no statistically significant difference in average CR, the standard deviation was higher in the SI group (0.95 ± 0.08 vs. 0.93 ± 0.31, p = .3359), indicating the difficulty in predicting the results of SI healing. The average visual analog scale score evaluated by two dermatologists was higher in the IC group, albeit without a significant difference (8.23 ± 0.96 vs. 7.78 ± 1.52, p = .5267). Conclusion: SI after partial closure can be an option for large defects in the AT arearestrictio

Checkmark rotation flap for nasal tip reconstruction in Asian patients

Background: Nasal tip reconstruction (NTR) of the Mohs defect is challenging, especially in Asians who have a relatively low nasal bridge and thin cartilages. Objective: To evaluate the usefulness of a new flap design, the checkmark rotation flap (CRF), for NTR in Asians Methods and materials: We retrospectively reviewed 31 cases of NTR. Among these, 15 cases underwent CRF, which uses skin from the columellar or infra-tip area with a checkmark v-shaped incision (CRF group). The remaining 16 cases underwent reconstruction with other flaps such as the bilobed or island pedicle flap (Others group). Results: The average defect area was larger in the CRF than in the Others group (1.85 ± 1.01 cm2 vs. 1.10 ± 0.72 cm2, p = .0499), but the visual analog scale score was significantly higher in the CRF group (7.97 ± 1.36 vs. 6.25 ± 1.62, p = .0059). For complications, a depressed scar was observed in four cases (26.7%) in the CRF group; nine cases (56.3%) in the Others group presented with a depressed scar, hypertrophic scar, or scarring similar to a trap door deformity. Conclusion: CRF may be a favorable option for the reconstruction of intermediate-sized nasal tip defects, providing good cosmetic outcomes.restrictio

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