Immediate Umbilical Reconstruction after a Mohs Micrographic Surgery for Primary Cutaneous Adenoid Cystic Carcinoma Arising in the Umbilicus

Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.ope

Cutaneous melanoma in women

Background : Gender disparity in melanoma outcome is consistently observed, suggesting that gender is as an important prognostic factor. However, the source of this gender disparity in melanoma remains unclear. Objective : This article reviews advances in our understanding of gender differences in melanoma and how such differences may contribute to outcomes. Methods : A broad literature search was conducted using the PubMed database, with search terms such as ‘gender differences in melanoma’ and ‘sex differences in melanoma.’ Additional articles were identified from cited references. Results : Herein, we address the gender-linked physiologic differences in skin and melanoma. We discuss the influence of estrogen on a woman’s risk for melanoma and melanoma outcomes with regard to pregnancy, oral contraceptives, hormone replacement therapy, and UV tanning. Conclusions : The published findings on gender disparities in melanoma have yielded many advances in our understanding of this disease. Biological, environmental, and behavioral factors may explain the observed gender difference in melanoma incidence and outcome. Further research will enable us to learn more about melanoma pathogenesis, with the goal of offering better treatments and preventative advice to our patients.ope

Localized Darier’s Disease Mimicking Lichen Simplex Chronicus on the Back

Darier’s disease is an autosomal dominant acantholytic skin disorder. The disease is characterized by symmetric distribution of hyperkeratotic papules in seborrheic regions of the skin and nail changes with potential for exacerbation by ultraviolet light, heat, occlusion, or stress. It presents as generalized (hypertrophic or vesiculobullous type) or localized (linear or zosteriform type) condition. A 53-year-old male patient presented with hyperkeratotic verrucous papules on the back that had an onset in childhood. Clinically, his condition resembled lichen simplex chronicus. The lesions were exacerbated by sun exposure or sweating. A 3-mm punch biopsy specimen revealed prominent acantholysis with hyperkeratosis and parakeratosis. Numerous corps grains and corps ronds were presentnear the granular layer. We report a case of localized Darier’s disease mimicking lichen simplex chronicus on the back. The skin lesion improved following treatment with a topical corticosteroid. Localized Darier’s disease should be considered as one of the differential diagnoses of lichen simplex chronicus on the back.ope

Primary Localized Cutaneous Nodular Amyloidosis on Scalp Successfully Treated with Excision

Primary localized cutaneous nodular amyloidosis (PLCNA) is the rarest form of cutaneous amyloidosis, characterized by nodular deposits of light chain amyloids in the dermis and subcutaneous tissue, without apparent systemic involvement. One or several nodules are preferably located on the extremities, trunk, or face. The most useful stain for detecting amyloid fibrils is Congo red, which, when combined with polarized light, makes amyloid proteins appear apple-green under a microscope. Immunohistochemical staining can help identify the exact type of amyloid proteins. Although the exact etiology of PLCNA is unclear, removal of nodules by shaving or surgical excision has shown good results. To the best of our knowledge, only seven cases of PLCNA have yet been reported in the Korean literature. In three of these cases, the patients had lesions on the scalp. Herein, we present a case of a 34-year-old male with PLCNA on the scalp with all the results of immunohistochemical evaluation.ope

Segmentally arranged hyperpigmented basaloid follicular hamartoma

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Reactivation of anti-human alpha-enolase antibody-positive Behçet's disease by carbon dioxide laser treatment.

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Genetics of melanocytic nevi

Melanocytic nevi are a benign clonal proliferation of cells expressing the melanocytic phenotype, with heterogeneous clinical and molecular characteristics. In this review, we discuss the genetics of nevi by salient nevi subtypes: congenital melanocytic nevi, acquired melanocytic nevi, blue nevi, and Spitz nevi. While the molecular etiology of nevi has been less thoroughly studied than melanoma, it is clear that nevi and melanoma share common driver mutations. Acquired melanocytic nevi harbor oncogenic mutations in BRAF, which is the predominant oncogene associated with melanoma. Congenital melanocytic nevi and blue nevi frequently harbor NRAS mutations and GNAQ mutations, respectively, while Spitz and atypical Spitz tumors often exhibit HRAS and kinase rearrangements. These initial 'driver' mutations are thought to trigger the establishment of benign nevi. After this initial phase of the cell proliferation, a senescence program is executed, causing termination of nevi growth. Only upon the emergence of additional tumorigenic alterations, which may provide an escape from oncogene-induced senescence, can malignant progression occur. Here, we review the current literature on the pathobiology and genetics of nevi in the hope that additional studies of nevi promise to inform our understanding of the transition from benign neoplasm to malignancy.ope

A Clinicopathologic Study of 15 Cases of Angiolymphoid Hyperplasia with Eosinophilia

Background: Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon distinctive vascular lesion characterized by proliferation of endothelial cells. Because of its rarity, the clinical and pathological aspects of ALHE have not been fully studied in Korea. Objective: The purpose of our investigation was to describe the clinical and pathological characteristics of ALHE. Methods: We reviewed the medical records, clinical photographs and histological slides of 15 patients who were diagnosed as ALHE at Severance hospital. Results: Of the 15 patients, 60% were men and 40% women. The average onset age of men was 53.7 years, women 33.2 years. Overall average onset age was 45.5 years. The scalp was the most frequently involved site in ALHE. Pruritus was the most common symptom. Two of four patients demonstrated peripheral blood eosinophilia and one patient showed elevation of serum IgE. The essential microscopic features of the fifteen lesions of ALHE were epithelioid proliferation of endothelial cells and perivascular inflammatory infiltration with eosinophils and lymphocytes. Four patients underwent surgery as their sole treatment modality and there were no recurrences. Other treatment modalities were topical steroid, intralesional injection of triamcinolone, systemic steroid, and 5% imiquimod cream. Conclusion: The clinical and pathological features of patients in this survey differ from previous studies in the age of onset, gender distribution, and anatomical distribution. Men were more affected (60%) than woman (40%), and the average age of onset was 45.5 years. The scalp and extremities were the most frequently involved sites. Surgery was the treatment of choice in ALHE. However, the clinical findings of ALHE need to be further evaluated in larger groups of patientsope

Enlarged pores treated with a combination of Q-switched and micropulsed 1064 nm Nd:YAG laser with and without topical carbon suspension: A simultaneous split-face trial.

Background and aims: Enlarged facial pores remain one of the major cosmetic concerns among Asian females. This study attempted to assess and compare the efficacy of a combination of the Q-switched and quasi long-pulsed (micropulsed) Nd:YAG laser to reduce the size of the enlarged pores with and without an exogenous photoenhancer. Methods: In twenty five female subjects mean age 34.04 yr and skin type II-IV, a carbon lotion as a photoenhancer was applied on one side of the face (Method 1) and the other side was used as the control (Method 2). The entire face was then treated with a single pass of the 1064 nm Nd:YAG laser in the micropulsed mode, pulse fluence and width of 2.3 J/cm(2) and 300 µsec, respectively. Multiple passes were then delivered in the Q-switched mode (2.5 J/cm(2) and 5 nsec). Results: Three weeks after the final treatment, 75% of the subjects showed improvement with method 1 whereas 67% showed improvement with method 2. No adverse side effects were reported with either method. Conclusions: Although histological confirmation was not performed, we were able to prove both subjectively and objectively that the use of the combination of the micropulsed and Q-switched modes of the Nd:YAG laser was useful in reducing pore size, and that the photoenhancer improved the efficacy.ope

Treatment of chronic idiopathic onychodystrophy with intake of carotene-fich food

Background: Onychodystrophy refers to the various abnormalities in nail morphology due to changes in the attachment of the nail plate, changes in nail surface or color. The treatment principle of onychodystrophy largely relies on the discovery and verification of the cause. However, preventive treatment methods offer little help to the patient due to poor compliance, and the effect of corticosteroid is only temporary. Objective: To evaluate the clinical efficacy of carotene-rich food intake in chronic idiopathic onychodystrophy. Methods: Ten patients with chronic idiopathic onychodystrophy were recommended to drink one or two cups of carrot juice daily. Results: Patients showed improvement of onychodystrophy after drinking carrot juice twice a day for at least 4 weeks. No specific adverse effects were noted. Conclusion: Since there are no reliable treatment methods for chronic idiopathic onychodystrophy, we suggest a simple and compliant treatment method consisting of taking carotene-rich food, such as carrot juice, for patients with chronic idiopathic onychodystrophyope