Onychopapilloma: its clinical, dermoscopic and pathologic features.

BACKGROUND: Onychopapilloma is a benign tumour of the nail bed and distal matrix and commonly presents as longitudinal erythronychia, longitudinal leukonychia or longitudinal melanonychia. Because onychopapilloma is rare, its clinical characteristics and dermoscopic findings have not been well investigated in Asia. OBJECTIVES: This study aimed to investigate the clinical characteristics and dermoscopic and pathologic findings of onychopapilloma in Korea. METHODS: We retrospectively reviewed the medical records and clinical/dermoscopic photographs of 39 patients diagnosed with onychopapilloma in the Pusan National University Hospitals (Busan and Yangsan) for 11 years (2010-2021). RESULTS: Among 39 patients, 23 (59.0%) were men, and 16 (41.0%) were women. The mean age was 46.1 (16-77) years. All lesions were single, and most of them were located on the fingers (92.3%), especially the thumb (66.7%). The most common clinical feature was longitudinal erythronychia (56.4%), and the most common dermoscopic finding was distal subungual hyperkeratosis (100%). We found two new dermoscopic features: macrolunula and trailing lunula along the longitudinal band. Among 18 patients who underwent surgical excision, only 6 (33.3%) showed typical acanthosis and papillomatosis on the nail bed. CONCLUSIONS: We found that Asian onychopapilloma has similar clinicodermoscopic findings to the Caucasian one, that is to say, longitudinal erythronychia and distal subungual hyperkeratosis were the most common nail change and dermoscopic finding, respectively. We propose two new dermoscopic features of onychopapilloma: macrolunula and trailing lunula along the longitudinal band.

Comparison of dermoscopic features between congenital and acquired acral melanocytic nevi in Korean patients.

BACKGROUND: The dermoscopic patterns of acral melanocytic nevi (AMNs) are crucial in differentiating them from acral melanoma. Several studies have reported the dermoscopic patterns of acquired acral melanocytic nevi (AAMNs). However, few have investigated the dermoscopic patterns of congenital acral melanocytic nevi (CAMNs). OBJECTIVE: To compare the clinical and dermoscopic features of CAMNs and AAMNs. METHODS: The present study included 43 patients with CAMNs and 40 with AAMNs. We reviewed their medical records as well as their clinical and dermoscopic findings. RESULTS: Congenital acral melanocytic nevis were more asymmetrical than AAMNs (P = 0.002) and presented more frequently as comma-shaped (P = 0.005). Regarding dermoscopic findings, globular pattern (55.8%) was the most common feature of CAMNs, while parallel furrow pattern (37.5%) was the most common feature of AAMNs. The presence of fibrillar, globular, and parallel ridge patterns, and diffuse multi-component pigmentation differed significantly between the groups (P < 0.05). Furthermore, CAMNs showed melanoma-specific dermoscopic patterns, such as parallel ridge (18.6%) and diffuse multi-component pigmentation (25.6%). CONCLUSION: The dermoscopic patterns of CAMNs and AAMNs differed markedly. In terms of dermoscopic patterns, CAMNs resembled acral melanoma more often than AAMNs did.

The clinical and histopathological characteristics of early-onset basal cell carcinoma in Asians.

BACKGROUND: Basal cell carcinoma (BCC) is by far the most common cancer in white populations. In addition, recent reports have demonstrated an increasing incidence of BCC in Korea. We have observed a significant number of early-onset BCC cases in which the disease occurred in patients younger than 50 years. OBJECTIVE: To investigate the clinicopathological characteristics of early-onset BCC in an Asian population, specifically in Koreans. METHODS: One hundred and five patients with early-onset BCC were enrolled from a total of 1047 BCC patients who underwent surgery between January 1997 and December 2014 (942 patients over the age of 50 years were designated as the control group). RESULTS: Early-onset BCC accounted for 10.03% of all 1047 cases and the incidence over time displayed an incremental trend. The early-onset group displayed similar results as the control group, with a predominance of female BCC patients and the majority of tumours displaying the following characteristics: small in size, occurring in sun-exposed areas and belonging to the noduloulcerative clinical subtype and nodular histopathological subtype. In comparison with a previous study in a Western population, the incidence of the disease in non-exposed areas of the body, as well as the proportion of tumours of the superficial histological subtype, were lower in Asian patients. CONCLUSION: Although the clinicopathological characteristics of BCC are well-known, these characteristics have not been determined for early-onset BCC in an Asian population. Therefore, this study is the first report on early-onset BCC in Asians, specifically in a Korean patient group.

Dermoscopy of subungual haemorrhage: its usefulness in differential diagnosis from nail-unit melanoma.

BACKGROUND: Subungual haemorrhages are characterized by well-circumscribed dots or blotches with a red to red-black pigmentation, but some cases can be difficult to distinguish from subungual melanoma by the naked eye alone. Dermoscopy has proven to be a useful, noninvasive tool in the diagnosis of pigmented lesions in the nail; however, few dermoscopic studies of subungual haemorrhages have been reported. OBJECTIVES: To investigate characteristic dermoscopic patterns of subungual haemorrhages, and to find distinctive features that can differentiate them from nail-unit melanomas. METHODS: Patients with a confirmed diagnosis of either subungual haemorrhage or nail-unit melanoma at a tertiary university hospital were included in the study. Clinical features and dermoscopic patterns were evaluated. RESULTS: Sixty-four patients with a total of 90 lesions of subungual haemorrhage were enrolled in the study. The majority of cases (84%) showed combinations of more than one colour, while 16% had only one colour. The most common colour of the subungual haemorrhages was purple-black, in 37% of cases. A homogeneous pattern was observed in 92% of cases, globular patterns in 42% and streaks in 39%. Peripheral fading and periungual haemorrhages were found in 54% and 22% of cases, respectively. Destruction or dystrophy of the nail plate was observed in 16% of cases. In the 16 cases of nail-unit melanomas, Hutchinson sign, longitudinal irregular bands or lines, triangular shape of bands, vascular pattern, and ulcerations were found in 100%, 81%, 25%, 6% and 81% of cases, respectively. In contrast, these features were not found in subungual haemorrhages. CONCLUSIONS: Dermoscopy provides valuable information for the diagnosis of subungual haemorrhage and aids in the differential diagnosis from nail-unit melanoma.

The use of dermatoscopy to monitor therapeutic response of Bowen disease: a dermatoscopic pathological study.

BACKGROUND: Dermatoscopy is a noninvasive technique that can be helpful in the diagnosis of pigmented and nonpigmented skin tumours. The dermatoscopic evaluation of Bowen disease (BD) improves diagnostic accuracy. OBJECTIVE: To evaluate the usefulness of dermatoscopy as a tool for assessing responses to therapy and recurrence of BD. METHODS: Patients with histopathologically diagnosed BD were prospectively enrolled. In all lesions, 3 months after the end of treatment (photodynamic therapy or 5% imiquimod cream), dermatoscopic and histopathological examinations were repeated to evaluate and correlate changes in dermatoscopic features and histopathological results. Cured lesions were monitored using dermatoscopy during the follow-up period. RESULTS: A total of 23 patients with 29 histopathologically diagnosed BD lesions were included in this study. After treatment, dermatoscopic examination revealed the disappearance of pre-existing vascular structures in 16 lesions, and remaining vascular structures in 13 lesions. Histopathological evaluation of the treated lesions showed remnant intraepithelial neoplasms and increased dermal vascularity in lesions with persistent dermatoscopic vascular structures. However, normal epidermis and decreased dermal vascularity were observed in all but one of the lesions without previous dermatoscopic vascular structures. During the follow-up period, one lesion showed reappearance of previous vascular structures on dermatoscopy 9 months after treatment. Histopathological examination confirmed the recurrence of BD. CONCLUSIONS: Our study demonstrates that the persistence of dermatoscopic vascular structures of BD appears to be associated with residual disease, and disappearance of vascular structures suggests that the disease has been cured. In addition, reappearance of previous dermatoscopic vascular structures indicates the recurrence of BD. Therefore, we suggest that dermatoscopy can be a useful, reliable and noninvasive tool in the therapeutic follow-up of BD.

Structural correlations between dermoscopic and histopathological features of juvenile xanthogranuloma.

Juvenile xanthogranuloma(JXG) is the variant of non-Langerhans' cell histiocytosis. The orange-yellow background coloration with clouds of paler yellow deposits is the most characteristic dermoscopic finding of JXG. Other dermoscopic features include erythematous border, subtle pigment network and white linear streak. The objective of this study was to present the structural correlation between dermoscopic features and histopathological findings of JXG and to find the different dermoscopic features in various stages of JXG. Eleven patients with histologically proven JXG were examined with polarized light dermoscopy. Histopathological findings were assessed and dermoscopic features including setting sun appearance, clouds of paler yellow globules, whitish streak, and branched and linear vessels were evaluated. Among 11 patients, five patients were in early evolutionary stage, four patients in fully developed stage and two in late regressive stage. The setting sun appearance was found in all patients in different stages except one in late regressive stage (90.9%). The clouds of paler yellow globules were present in nine patients (81.8%) and were constant features in fully developed stage and late regressive stage. The whitish streak was present in four patients (36.4%) and telangiectasia in 10 patients (81.8%). The setting sun appearance may hold diagnostic value in early evolutionary stage to fully developed stage, but not in late regressive stage. The clouds of paler yellow globules are more predominant in fully developed stage and late regressive stage. In addition to the use of dermoscopy as an accurate diagnostic tool for differential diagnosis, it could be applied in evaluation of histopathological maturation of JXG.

Dermoscopic features of Bowen's disease in Asians.

BACKGROUND: Previously, dermoscopic features of Bowen's disease (BD) were extensively investigated in two studies, but there were some discrepancies. The dispute necessitated a further study concerning the dermoscopic features of BD. OBJECTIVE: To describe the dermoscopic features of BD in Asians and to assess dermoscopy as a post-treatment monitoring tool of BD. MATERIALS AND METHODS: Dermoscopic examinations of histopathologically diagnosed 26 BD lesions were performed to evaluate for the presence of various dermoscopic features. In addition, the correlating changes of dermoscopic features and histopathological results before and after treatments were assessed in five patients with BD. RESULTS: Dermoscopically, 10 lesions were pigmented and 16 lesions were non-pigmented. The most frequent dermoscopic findings of BD were vascular structures (96%) and a scaly surface (96%). Among vascular structure, glomerular vessels were most frequently observed (77%). The other vascular structures in our study were linear irregular vessels, dotted vessels, polymorphous/atypical vessels and arborizing vessels. Among five patients who had been treated with either photodynamic therapy or 5% imiquimod cream, four patients revealed disappearance of dermoscopic vascular structures, but one patient showed remaining vascular structures after treatment. Skin biopsy from treated lesions disclosed clearance of BD in four patients who had no vascular structures but remaining BD in the patient whose dermoscopic finding displayed no disappearance of vascular structures. CONCLUSIONS: Vascular structures, especially glomerular vessels plus a scaly surface, were common dermoscopic findings of BD in Asians. In addition, existence of dermoscopic vascular structures after treatment appears to be associated with residual disease.

Molecular genetic analysis of non-astrocytic gliomas.

AIMS: Oligodendroglial tumours follow genetic pathways different from but overlapping with those of astrocytic tumours. The aim of this study was to examine whether major genetic events such as loss of chromosome 10 and p53 mutation found in astrocytic gliomas are also involved in the development and anaplastic transformation of non-astrocytic gliomas and to correlate the findings with histopathological subtypes of these tumours. METHODS AND RESULTS: Sixty-one formalin-fixed, paraffin-embedded oligodendroglial and ependymal tumours (16 oligodendrogliomas, 12 anaplastic oligodendrogliomas, seven oligoastrocytomas, 24 ependymomas and two anaplastic ependymomas) were examined for allelic deletions on chromosome 10q23 and 10q25-26 regions, mutations of PTEN/MMAC1 and p53, MDM2 gene amplification and apoptosis. The frequencies of allelic deletions at marker D10S2491 (which mapped within PTEN/MMAC1) and between markers D10S209 and D10S587 (where DMBT1 was located) were found to be < 30% in both types of non-astrocytic gliomas. High frequency of allelic deletions was detected at marker D10S215 (80%) at the proximal 10q23 region in both oligodendroglial and ependymal tumours and between markers D10S216 (42%) and D10S169 (67%) at distal 10q25-26 region in oligodendroglial tumours. No mutations of PTEN/MMAC1 were found. p53 mutations were detected in three oligoastrocytomas and one ependymoma; three out of five mutations were found in exon 4. MDM2 gene amplification was found in one ependymoma harbouring wild-type p53. The apoptotic index was lower in p53-mutated tumours than in tumours with wild-type p53. CONCLUSION: The telomeric end of chromosome 10q could be involved in the development and anaplastic transformation of oligodendroglial tumours. Mutations of PTEN/MMAC1 and p53, amplification of the MDM2 gene and allelic loss on chromosome 10q do not play a major part in the pathogenesis or anaplastic transformation of oligodendrogliomas and ependymal tumours.

Construction of a screening inventory for major mental disorder in the Army.

The development of a 29-item self-report inventory to screen for non-adaptiveness with an episode or a history of major mental disorder in the army is described. Initially, a 58-item inventory was constructed. However, through a pilot study 46 items remained. The reliability and validity test of the 46-item inventory was then carried out on 357 patients and 126 controls. Firstly, item analyses were performed which showed 12 items that distinguished between schizophrenic patients and controls, 9 items that distinguished between depressive patients and controls and 8 items that distinguished between manic patients and controls. A final 29-item inventory was found to have satisfactory reliability, sensitivity and specificity. The analyses of the best cut-off scores using the receiver-operating-characteristic curve suggested a score of 3 for the Schizophrenia Scale, 2 for the Depression Scale, and 3 for the Mania Scale. The inventory can be completed in about 5 to 10 minutes and has a simple method of scoring. The use of this screening inventory in the army is discussed.

Cholangiocarcinoma in hepatolithiasis.

During the period of 1979-1982, 10 cases of cholangiocarcinoma associated with hepatolithiasis were seen. We report the clinical features of 10 cases of cholangiocarcinoma in association with hepatolithiasis, along with detailed histopathology from the four resected specimens. Our observations suggest that whenever intrahepatic stones are encountered in patients over 50 years of age with a long history of recurrent cholangitis and intractable pain, further examination including echo-guided aspiration cytology, liver scanning, and peritoneoscopy should be performed to rule out a coexisting cholangiocarcinoma.