Revisiting Riehl’s Melanosis in Korean Patients: Clinicopathological Features, Blood Chemistry, and Immunohistochemistry / 대한피부과학회지

Background@#Riehl’s melanosis of the face and neck has been reported in middle-aged women who have darker skin types. Recently, cases of Riehl’s melanosis have been on the rise in Korea, which might reflect the increased use of various cosmetic products and procedures. @*Objective@#This study was designed to analyze the clinicopathological characteristics and treatment outcomes of Riehl’s melanosis in Korean patients. @*Methods@#We closely observed 80 patients with Riehl’s melanosis diagnosed in Asan Medical Center and Hanyang University Medical Center between 2005 and 2015. A skin biopsy was analyzed in 51 patients, and a patch test was carried out in 16 patients. @*Results@#Patients with chronic Riehl’s melanosis (＞12 months) had an increased frequency of previous laser treatments. Patients with acute Riehl’s melanosis (＜3 months) reported a previous history of dry skin, itching, or irritation as a result of the use of hair dye. Patients older than 50 years, with darker skin type, and with a longer disease duration (＞12 months) had poor response rates. Chronic Riehl’s melanosis may be preceded by repeated irritation of barrier-compromised skin, and acute Riehl’s melanosis seems to be an allergic form of Riehl’s melanosis. @*Conclusion@#Riehl’s melanosis has different clinical manifestations according to disease duration and different treatment responses based on disease duration.

Case Reports of Spitz Nevus with a Halo Phenomenon / 대한피부과학회지

Halo nevus clinically presents as a nevus with a surrounding ring of depigmentation that histopathologically demonstrates a dense lymphocytic reaction to the melanocytic component of the epidermis. While melanocytic nevi with halo phenomena are common, a halo reaction is uncommon in Spitz nevus. When a halo reaction develops around a Spitz nevus, differential diagnosis from melanoma arising from pre-existing nevus is difficult due to the presence of dense inflammatory components. A halo reaction itself can increase the cytologic atypia of melanocytes and can obscure nest maturation. Herein, we report rare cases of Spitz nevus combined with a halo reaction. It is important to note that the halo phenomenon can occur without a clinically evident white patch and that the architectural features of the nevus components can be used to distinguish Spitz nevus from malignant melanoma.

A Case of Pseudomyogenic Hemangioendothelioma of the Lower Extremity

Pseudomyogenic hemangioendothelioma (PMH) is a rare vascular tumor and was recently recognized as a distinct entity. It has a predilection for young male adults and it frequently occurs in distal extremities. Although it is known to follow an indolent course, multi-focal presentation and local recurrence are common. PMH should be differentiated from epithelioid sarcoma, epithelioid hemangioendothelioma, dermatofibrosarcoma protuberans, and rhabdomyosarcoma. Its characteristic immunohistochemical staining pattern and recurrent translocation t(7:19)(q22:q13) are the basis for its diagnosis. Surgical excision is the mainstay treatment, although chemotherapy can be considered in non-operable patients. We present a rare case of a 40-year-old Korean male patient diagnosed with PMH through an excisional biopsy to facilitate the recognition PMH in the clinical practice.

A Case of Lymphomatoid Contact Dermatitis Secondary to Hair Dye / 대한피부과학회지

Lymphomatoid contact dermatitis is a subset of cutaneous pseudolymphoma that clinically and histopathologically resembles both allergic contact dermatitis and cutaneous lymphoma. A variety of allergens have been reported since the first description of this entity in 1976. Lymphomatoid contact dermatitis is typically related to T cell hyperplasia. We herein describe a case of cutaneous B-cell lymphoid contact dermatitis caused by hair dye. This case demonstrates that lymphomatoid contact dermatitis can present with various clinical features and emphasizes the importance of thorough history-taking and examination for diagnosis.

Benign Symmetric Lipomatosis in Korean Patients / 대한피부과학회지

Background@#Madelung’s disease (MD) is characterized by multiple symmetric deposits of unencapsulated adipose tissue in the head, neck, and upper trunk. However, the etiology of lipoma tissue in MD remains controversial. @*Objective@#This study determined the clinicopathological and epidemiological features of Korean patients with MD and re-examined the hypothesis that lipomas of MD originate from brown fat. @*Methods@#We performed a single-institution, retrospective medical record review of 20 patients diagnosed with MD between January 1997 and August 2017. Biopsy slides were stained with nuclear factor IA (NFIA) and uncoupling protein 1 (UCP-1). @*Results@#The patients included were 2 women and 18 men with an average age of 64 (range, 27∼75) years. Ten patients reported heavy alcohol intake, and the remaining 10 reported some degree of alcohol intake. Hepatic disease was present in 47.7% of patients, only 16.7% had a body mass index ＞30 kg/m2, and 80% underwent surgical intervention. @*Conclusion@#MD affected mainly alcoholic men in the fourth decade. Alcoholism, hepatic disease, or severe obesity accounted for less than half of the Korean patients with MD. Immunohistochemical staining supported the hypothesis that MD lipomas originate from brown fat. Although the adipose tissue of all patients was stained with NFIA and UCP-1, the staining intensity varied. NFIA, which is a transcription factor required for the induction and maintenance of brown fat-specific gene expression, was more sensitive than UCP-1 for the detection of brown fat.

Coincidence of Dermal Melanocyte Hamartoma and Becker's Nevus in a Patient with Neurofibromatosis Type 1 / 대한피부과학회지

Dermal melanocytosis is characterized by an increased number of ovoid to elongated melanocytes situated between collagen fibers in the dermis, including blue nevus, Mongolian spots, nevus of Ota and Ito and dermal melanocyte hamartoma. Herein, we present a rare case of a 15-year-old boy presented with both dermal melanocyte hamartoma and Becker's nevus in conjunction with neurofibromatosis. A shared pathophysiologic mechanism between neurofibromatosis and other nevi in the context of organoid hamartoma has been reviewed.

A Skin Metastasis from a Gastric Signet-Ring Cell Carcinoma in an Adolescent that Mimicked Steatocystoma Multiplex / 대한피부과학회지

Cutaneous metastases of internal malignancies are relatively rare and originate most frequently from tumors of the breast and lung. Herein, we present an unusual clinical presentation of a skin metastasis from a gastric signet-ring cell carcinoma in an adolescent. A 19-year-old boy presented with asymptomatic subcutaneous nodules on his abdomen and back. Histopathological examination revealed signet-ring cells with cytoplasmic mucin in the dermis. A diagnosis of cutaneous metastasis of a signet-ring cell carcinoma was made and the patient died 12 days after his initial visit to our dermatology clinic. Gastric carcinomas have infrequently been reported in adolescents, and cutaneous metastases from carcinomas in this group are extremely rare. Clinicians should be aware that skin metastases of adolescent gastric carcinoma can be similar in presentation to steatocystoma multiplex and that a skin biopsy is necessary for suspicious skin lesions.

A Case of Nasal-type Extranodal Natural Killer/T-cell Lymphoma Presenting as a Non-healing Ulcer / 대한피부과학회지

No abstract available.

A Case of Subcutaneous Leiomyosarcoma of the Scalp / 대한피부과학회지

Leiomyosarcoma is a rare and aggressive soft tissue sarcoma originating in smooth muscle cells. There are two forms of primary superficial leiomyosarcomas depending on the origin and prognosis, one derived from the dermis and the other from the subcutaneous tissue of the skin. Middle-aged to elderly men are particularly affected by this type of cancer. Leiomyosarcomas of the head and neck are quite rare, accounting for approximately 3%~10% of all cases. We report herein a case of subcutaneous leiomyosarcoma of the scalp in a 47-year-old female patient.

Characterization and Prognostic Significance of Cutaneous Adverse Events to Anti-Programmed Cell Death-1 Therapy

BACKGROUND: Anti-programmed cell death-1 (PD-1) immunotherapy using antibodies such as nivolumab or pembrolizumab has shown promise for treating various types of cancer. In this study, we reviewed the frequency and spectrum of cutaneous adverse events (AEs) caused by PD-1 antibodies and their possible correlation with treatment response. METHODS: We reviewed records of all patients from a single institution treated with either nivolumab or pembrolizumab from August 1, 2014 to April 1, 2017. RESULTS: Of 211 patients included in the study, 134 (63.5%) were treated with nivolumab and 77 (36.5%) with pembrolizumab. Thirty-five patients (16.4%) developed cutaneous AEs. Cutaneous AEs were significantly associated with longer treatment cycles (P = 0.001). The prevalence of cutaneous AEs did not differ between nivolumab (17.2%) and pembrolizumab (15.6%). Patient age, gender, baseline Eastern Cooperative Oncology Group scale and underlying malignancy were not associated with development of cutaneous AEs. Median time until onset of cutaneous AEs was 50.0 days (range, 1–378 days). Anti-PD-1 therapy was tolerable in most of patients with grade 1 (65.2%) and grade 2 (23.9%) cutaneous AEs. Pruritus (32.6%) and eczema (21.7%) were the most commonly reported cutaneous AEs. In lung cancer patients, cutaneous AEs were not associated with better treatment outcomes after adjusting for the number of treatment cycles. CONCLUSION: Both pembrolizumab and nivolumab exhibited tolerable cutaneous safety profiles in a variety of cancer patients undergoing anti-PD-1 therapy. Cutaneous AEs of anti-PD-1 therapy were not associated with antibody type, underlying malignancy, patient characteristics, or improved response.

The face of CD4⁺ Hydroa Vacciniforme-Like Lymphoproliferative Diseases: The Shadow of Systemic T-Cell Lymphoma

No abstract available.

Metformin, an Activator of AMPK, Promotes the Growth of Hair Follicles via the AMPK/β-catenin Signaling Pathway / 대한피부과학회지

BACKGROUND: AMP-activated protein kinase (AMPK) is a serine/threonine protein kinase that plays a pivotal role in the balance of cellular energy metabolism. Recent studies have reported that AMPK has numerous roles in physiological conditions, and dysregulation of AMPK induces pathological processes and diseases. However, the role of AMPK and its activators have not yet been studied in the context of hair growth regulation. OBJECTIVE: To investigate the effects of metformin on dermal papilla (DP) and outer root sheath (ORS) cells, as well as the role of the AMPK pathway in hair growth. METHODS: We evaluated whether metformin, a well-known AMPK activator, had any beneficial effects on hair growth. In addition, to evaluate the molecular and cellular mechanisms that were involved, protein levels of AMPK and β-catenin were analyzed. RESULTS: Metformin increased the cellular proliferation of human DP and ORS cells. Ki-67 expression was also significantly increased after metformin treatment in the ex vivo hair follicle organ culture. Furthermore, DP and ORS cells treated with metformin had a significant increase in AMPK phosphorylation, which in turn suppressed β-catenin degradation and enhanced its nuclear accumulation. CONCLUSION: We demonstrated that metformin promoted hair growth via the AMPK/β-catenin signaling pathway in vitro with DP and ORS cells. The hair-promoting effects of AMPK activators may potentially be used for the treatment of alopecia, and further investigation will be needed in the future.

Metastatic Cutaneous Duodenal Gastrointestinal Stromal Tumor: A Possible Clue to Multiple Metastases

We report a case of a 69-year-old man with metastatic cutaneous duodenal gastrointestinal stromal tumor, which led to find multiple metastases on orbital muscle and scalp. The patient presented with a rapidly growing chest nodule with mild tenderness. He underwent surgical resection for duodenal gastrointestinal stromal tumor and had been treated with imatinib for three years. Histopathological examination of the chest nodule was consistent with gastrointestinal stromal tumor. A brain magnetic resonance imaging of follow work-up revealed multiple metastases at the left superior rectus muscle and occipital scalp. Under the diagnosis with imatinib-resistant duodenal gastrointestinal stromal tumors, a second-line therapy with sunitinib was tried. After six weeks, his skin lesion was completely improved and other metastatic cancers showed a response of stable disease. This is the first reported case of a cutaneous metastasis from duodenal GIST. This report emphasizes the importance of a full-skin examination in patients with a medical history of gastrointestinal stromal tumor which leads to find multiple metastases.

A Case of Angiomatoid Fibrous Histiocytoma Presenting as Subcutaneous Nodule in a 4-Year-Old Girl

No abstract available.

Scrotal Ulcer Probably Induced by All-trans Retinoic Acid Therapy in a Patient with Acute Promyelocytic Leukemia / 대한피부과학회지

No abstract available.

A Case of Acral Pseudolymphomatous Angiokeratoma of Children (APACHE) / 대한피부과학회지

No abstract available.

A Case of Plexiform Fibrohistiocytic Tumor on Finger

No abstract available.

Pancreatic Extraskeletal Osteosarcoma Metastasizing to the Scalp

Extraskeletal osteosarcoma (ESOS) is a rare mesenchymal soft-tissue neoplasm that accounts for approximately 1% of all soft-tissue sarcomas. Over 70% of these malignant tumor progress to local recurrence and metastasis. It commonly metastasizes to the lungs, lymph nodes, bone, and skin and has a poor survival outcome. Cutaneous metastasis is exceedingly rare and known to be a sign of widespread metastases. We present a 57-year-old woman who presented with a rapidly growing protuberant mass on the scalp that was finally diagnosed as metastatic ESOS from a primary pancreatic ESOS. To our knowledge, there has been no reported case of pancreatic ESOS metastasizing to the scalp.

The Incidence of Other Primary Cancers in Patients with Cutaneous Lymphoma

BACKGROUND: Skin cancer is the most common other primary cancer in patients with lymphoma. However, an intriguing association between cutaneous lymphoma and other primary cancers has been suggested in a few studies. OBJECTIVE: This study investigated other primary cancers in patients with cutaneous lymphoma to evaluate the risk for occurrence of each type of cancer. METHODS: We screened for other primary cancers in 428 patients with cutaneous lymphoma. Clinical features were analyzed according to the lineage and origin of the lymphomas. We calculated the standardized incidence ratio with statistical analysis for each group according to age. RESULTS: Among 330 patients with cutaneous T cell lymphoma and 98 with cutaneous B cell lymphoma, a total of 43 cancers in 38 patients were finally included. Other primary cancers were prevalent in patients with cutaneous B cell lymphoma and patients with secondary cutaneous lymphoma. However, those differences were not significant when the age was calibrated by multiple logistic regression. Metachronously higher standardized incidence ratios were observed for primary lung (standardized incidence ratio [SIR], 14.81; 95% confidence interval [CI], 3.05~39.54), skin (SIR, 68.05; 95% CI, 14.03~181.62), and breast (SIR, 12.91; 95% CI, 1.56~41.41) cancers with statistical significance. CONCLUSION: Other primary cancers more preferentially occurred in patients with cutaneous lymphoma. Clinicians should carefully examine patients with cutaneous lymphoma for other cancers, especially lung, skin, and breast cancers.

Two Cases of Postoperative Pyoderma Gangrenosum / 대한피부과학회지

Pyoderma gangrenosum (PG) is an uncommon ulcerating inflammatory neutrophilic dermatosis. Multifactorial pathogenesis has been reported because the underlying mechanism needs to be clearly elucidated. A pathergic reaction is a pathogenic aggravating factor of PG. The occurrence of postoperative PG (PPG) within and involving the borders of a surgical incision site suggests the role of a pathergic reaction in PG. Massive debridement should be avoided in PPG, and it should be immediately managed with oral prednisolone. We present 2 cases of PPG with different clinical courses according to the primary management.