Incidence and survival rates of primary cutaneous malignancies in Korea, 1999-2019: A nationwide population-based study.

Primary cutaneous malignancies are among the most commonly diagnosed types of cancer worldwide. We aimed to examine the incidence and 5-year survival rates of all types of primary cutaneous malignancies in the Korean population. Data from the Korean Nationwide Cancer Registry from 1999 to 2019 were analyzed. The crude incidence rates, age-standardized incidence rates, and 5-year relative survival rates of each type of skin cancer were calculated. A total of 89 965 patients were diagnosed with primary cutaneous malignancies, which was a 7-fold increase from 1999 to 2019. The age-standardized incidence rates increased 3.4-fold in basal cell carcinoma (3.7/100 000 person-years), 2.0-fold in squamous cell carcinoma (1.6/100 000 person-years), 12.0-fold in Bowen disease (1.2/100 000 person-years), and 1.8-fold in malignant melanoma (0.7/10 000 person-years) in 2019. Average annual percentage changes in age-standardized incidence rates were statistically significant in basal cell carcinoma (15.8%), Bowen disease (5.8%), squamous cell carcinoma (5.1%), malignant melanoma (1.2%), melanoma in situ (1.1%), dermatofibrosarcoma protuberans (1.2%), mycosis fungoides (0.5%), primary cutaneous CD30+ T-cell proliferations (0.5%), adnexal and skin appendage carcinoma (0.4%), extramammary Paget's disease (0.2%), and Merkel cell carcinoma (0.2%). The 5-year relative survival rates were the highest in basal cell carcinoma (103.3%), followed by dermatofibrosarcoma protuberans (99.7%) and mycosis fungoides (96.6%), and lowest in angiosarcoma (24.7%). The 5-year relative survival rates steadily increased in extramammary Paget's disease (23.6%), cutaneous B-cell lymphoma (21.3%), mycosis fungoides (20.2%), extranodal NK/T-cell lymphoma, nasal type (18.1%), and malignant melanoma (16.1%) from 1996-2000 to 2015-2019. Most primary cutaneous malignancies have increased in incidence and survival rates in the Korean population, but to varying extents depending on the type of skin cancer.

Metastatic Histiocytic Sarcoma with Secondary Involvement of the Skin: A Case Report.

Histiocytic sarcoma (HS) is a rare malignant neoplasm of presumed hematopoietic origin, showing morphologic and immunophenotypic evidence of histiocytic differentiation. A 61-year-old woman presented with an abdominal mass. She had a history of HS in both adrenal glands. The tumour cells of the left adrenal gland were very large epithelioid cells with abundant eosinophilic cytoplasm and large, round-to-oval nuclei. Similarly, the cutaneous lesion of the skin was composed of polygonal cells with well-defined cell borders and high nuclear/cytoplasm (N/C) ratios. Immunohistochemically, both tumours were positive for histiocyte-associated antigens but negative for epithelial, melanocyte, lymphoid, dendritic, and Langerhansl nuclei. Similarly, the cutaneous lesion of the skin was composenose correctly. It is important to recognise the morphological features and immunohistochemical characteristics of metastatic cells in order to achieve accurate diagnoses.

Long-Term Exposure to Air Pollution and Incidence of Venous Thromboembolism in the General Population: A Population-Based Retrospective Cohort Study.

To date, the relationship between air pollutants and venous thromboembolism (VTE) has not been well established. Our aim is to investigate the association between ambient air pollutants and the incidence of VTE using the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database. From 2003 to 2015, 338,616 subjects from the general population not previously diagnosed with VTE were included. The long-term average concentration of air pollutants before diagnosis for each subject was calculated. During the study period, there were 3196 incident cases of VTE. After adjusting for age, gender, economic status, body mass index, physical activity, smoking, alcohol consumption, comorbid diseases, and meteorological variables, the risk of VTE was observed to increase significantly with the long-term average concentration of particulate matter < 10 µm in diameter: PM10 (hazard ratio (HR) = 1.064 (95% confidence interval [CI] 1.053−1.074) for 1 µg/m3), SO2 (HR = 1.118 (95% CI 1.079−1.158) 1 ppb), and O3 (HR = 1.039 (95% CI 1.026−1.053) for 1 ppb), respectively. A difference between the date of the health screening and the date of diagnosis of the disease was observed. Long-term exposure to air pollutants including PM10, SO2, and O3 may be an independent risk factor for the development of VTE.

Primary Cutaneous Solitary Fibrous Tumor on the Back.

Solitary fibrous tumors (SFT) are uncommon mesenchymal tumors. SFT have several synonyms including localized fibrous tumor, benign mesothelioma, localized fibrous mesothelioma, and submesothelial fibroma. SFT usually occur in the pleura or other serosal surfaces, but SFT can also develop in extrapleural areas including the nasal cavity, orbit, retroperitoneum, and pelvis. Cutaneous SFT is extremely rare, and more likely to occur in the head and neck region. Histologically, this tumor can mimic a variety of benign and malignant tumors such as dermatofibroma, dermatofibrosarcoma protuberans, spindle cell lipoma or other mesenchymal tumors. Most cases of SFT show non-aggressive clinical courses, with low recurrence rates. Herein, we describe a case of primary cutaneous SFT which presented with huge mass on the back.

Treatment of Recalcitrant Viral Warts with Combination Therapy of Systemic Acitretin and Diphenylcyclopropenone Immunotherapy.

Viral warts are benign proliferations of the epithelium caused by human papilloma virus (HPV) infection. Diverse therapeutic options are available for viral warts, depending on extension and severity of the disease. We report a case of a 19-year-old man who presented with multiple viral warts on hands and feet for 5 years. He was treated at other clinics before visiting our hospital, but there was no improvement. We treated the lesions with a combination therapy of systemic acitretin and diphenylcyclopropenone (DPCP) immunotherapy for 6 months. A significant improvement was observed during the 12th week of therapy. Herein, we report a case of recalcitrant viral warts showing complete regression when a combination therapy of oral acitretin and immunotherapy was administered.

Markedly Reduced Risk of Internal Malignancies in Patients With Vitiligo: A Nationwide Population-Based Cohort Study.

PURPOSE: Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS: We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained from January 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS: A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P < .001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P < .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P < .001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P < .001). CONCLUSION: Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.

The risk of alopecia areata and other related autoimmune diseases in patients with sleep disorders: a Korean population-based retrospective cohort study.

Study Objectives: The aim of our study was to investigate the risk of alopecia areata occurrence in patients with sleep disorders. Methods: This study was a retrospective cohort study based on the National Health Insurance Service-National Sample Cohort database of patients with a sleep disorder, along with age- and sex-matched control subjects from 2003 to 2013. The hazard ratio (HR) of alopecia areata was compared between the patients with sleep disorders and control subjects adjusting comorbid diseases which could affect the incidence of alopecia areata. We also compared the prevalence of comorbid diseases in the patients with sleep disorders and control subjects. Results: Among the 25,800 patients with sleep disorders and the 129,000 control subjects, patients with sleep disorders were at a significantly increased risk for alopecia areata when compared with control subjects (adjusted HR 1.651 [95% CI 1.382-1.974]), especially in younger age groups (0-24 and 25-44 years). In a multivariate logistic analysis, sleep disorders were not only associated with alopecia areata (OR 1.913 [95% CI 1.717-2.171]), but also with other comorbid diseases, including solid-organ cancers (OR 1.099 [95% CI 1.049-1.151]), Graves' disease (OR 1.717 [95% CI 1.562-1.886]), Hashimoto thyroiditis (OR 1.641 [95% CI 1.413-1.905]), vitiligo (OR 1.539 [95% CI 1.236-1.917]), and rheumatoid arthritis (OR 1.886 [95% CI 1.780-1.998]). Conclusions: This study demonstrated that sleep disorder is an independent risk factor for alopecia areata, especially in individuals under the age of 45 years old.

Serum Zinc Status and Its Association with Allergic Sensitization: The Fifth Korea National Health and Nutrition Examination Survey.

Zinc (Zn) is an essential trace element that plays important roles in the immune system. There is little known about the role of trace elements in allergic diseases, and previous reports have shown conflicting results. The aim of this study was to investigate the relationship between serum Zn levels and total or allergen-specific immunoglobulin E (IgE) levels. The initial candidates for this study were those who participated in the 5th Korean National Health and Nutrition Examination Survey 2010 (n = 8,958), and 1,867 adults who had serum total and allergen specific-IgE levels measured were included. Upon adjusting for covariates, mean total IgE, Dermatophagoides farinae and dog-specific IgE levels increased significantly as the Zn levels decrease from the highest to the lowest quartile (p = 0.009, 0.004, and < 0.001, respectively). The multiple logistic regression analyses showed significant negative linear correlations between serum Zn levels and total, D. farinae-, cockroach-, and dog-specific IgE levels (p-value for linear trend = 0.004, 0.006, 0.027, and < 0.001, respectively). This study demonstrated that total/allergen specific IgE and Zn levels are significantly inversely related.

Nodular extramammary Paget disease with fibroepitheliomatous hyperplasia.

Extramammary Paget disease (EMPD) is a rare skin condition usually found in the anogenital region. Histologically, EMPD may be associated with varying degrees of epidermal hyperplasia classified as squamous, papillomatous, or fibroepitheliomatous. We report a case of EMPD in a 90-year-old man who presented with well-demarcated plaques and a nodule in the pubic area with fibroepitheliomatous hyperplasia.

Merkel Cell Carcinoma Concurrent with Bowen's Disease.

Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy of the elderly and immunocompromised patients. It is occasionally found coexisting with other diseases, such as squamous cell carcinoma, basal cell carcinoma, actinic keratosis, miscellaneous adnexal tumors, and rarely Bowen disease. A 75-year-old woman presented with a 6-month history of an irregularly shaped erythematous patch on the left mandibular angle. Three months later, a 1.5×1.0 cm sized painless and rapidly growing erythematous nodule developed on the patch. Microscopically, the patch lesion was consistent with that of Bowen disease. The nodular lesion showed a number of small uniform hyperchromatic cells with scanty cytoplasm. It showed dense small-cell like nodular infiltration in the dermis. Immunohistochemical staining for cytokeratin 20 showed a positive result with a dot-like perinuclear pattern. Additionally, the result for thyroid transcription factor-1 was negative, which is positive in small cell neuroendocrine carcinoma. From these findings, we diagnosed this lesion as MCC concurrent with Bowen disease.

A case of myopericytoma on the lower leg.

Myopericytoma (MP) is a benign tumor composed of cells that show apparent differentiation towards putative perivascular myoid cells called myopericytes. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults. The most common presentation is a well-circumscribed, slow-growing painless firm mass. A 45-year-old woman presented with a 2-year history of a painless, slowly growing 0.9×0.7 cm sized firm mass in the subcutaneous tissue of the posterior side of the right lower leg. We presumed this lesion to be an epidermal cyst, pilomatricoma or calcinosis cutis and performed an excisional biopsy. The histologic examination showed that it was composed of spindle-shaped myoid-appearing cells in a concentric arrangement, intimately associated with thin-walled vascular channels. Lesional spindle cells were diffusely positive for smooth muscle actin and were negative for CD34, desmin and S100 protein. From these findings, we diagnosed this lesion as a myopericytoma.

Childhood lichen planus with palmoplantar involvement.

Lichen planus (LP) commonly involves the flexor aspects of the wrists, legs, and oral and genital mucous membranes. But it rarely occurs on the palms and/or soles. It mainly affects people in the age range 30~60 years. Childhood LP is reported to constitute only 1~4% of total cases of LP. In the literature, a few cases of LP on the palms and soles of pediatric patients have been reported. Here we report an interesting case of childhood LP with palmoplantar involvement. The patient was a 7-year-old boy who for 6 months had variously sized and shaped, pruritic, violaceous, polygonal papules and plaques on the whole body. The skin biopsy specimens taken from four sites of the patient (dorsum of the hand and foot, sole and chest) showed typical features of LP on histopathology. A diagnosis of generalized LP with palmoplantar involvement was made.