[P378] Correction of vermilion lip retraction after mucosal advancement flap: A counter-traction technique

( Je Byeong Chae ),( Jee-woong Choi ),( Je-ho Mun ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 61-year-old woman presented with 32x11mm sized verrucous mass on the lower lip. Histopathological examination was consistent with squamous cell carcinoma. We performed Mohs surgery and the lesion was completely removed after 3 stages of Mohs surgery, leaving a large defect. The defect was reconstructed with a mucosal advancement flap. We undermined the plane below minor salivary glands and above the orbicularis oris muscle. Then, the mucosal part of the lip was advanced to the vermilion border. Due to the tension of remaining mucosal lip, this resulted in a near-complete loss of the lower vermilion lip and flattened cutaneous lip. For better cosmetic outcomes, we made a crescent shaped excision of skin along the mental crease. This technique helps enhance the concavity of the cutaneous lip and protrusion of the vermilion lip. After 3 months, the scar buried within mental crease was nearly inconspicuous, and the patient reported satisfaction of cosmetic outcome The lower lip is a common site for squamous cell carcinoma. Mucosal advancement flap is a useful method yielding satisfactory results. However, when a significant amount of lip is resected, retraction of the vermilion border and loss of normal curvature of the lower cutaneous lip occurs. This results in disappearance of the mucosal lip. Herein, we suggest a useful surgical technique for improving cosmetic result of the lower lip reconstruction after mucosal advancement flap.

A case of eruptive xanthomas

( Je Byeong Chae ),( Hae Young Lee ),( Kwang Hyun Cho ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 27-year-old woman was visited the clinic with complaining of multiple erythematous and yellowish papules and nodules on her both elbows and legs. The skin lesion started 1 month ago, and it seemed to be in progress. She reported no history of other systemic symptoms like fevers, chills, or myalgia, nor had close contact with anyone with similar skin lesions. She also denied any history of diabetes mellitus or other underlying diseases. The blood triglyceride level was 5554 mg per deciliter, while the total cholesterol level was 171mg per deciliter and others were all within normal range. The histopathologic examination revealed foamy histiocytic collection in the dermis, which is consistent with the microscopic view of xanthomas. The patient was then referred to department of internal medicine for lowering the triglyceride level by oral medication combined with diet restriction. Two weeks later, the triglyceride level dropped to 816mg per deciliter and the eruptive lesion were getting improved. Eruptive xanthoma is usually occurred in patient with history of diabetes mellitus and high cholesterol level. However, the patient had no underlying diseases and only triglyceride is extremely high on blood test. Herein, we reported a case of eruptive xanthomas which is rarely reported in Korea.

A case of tamoxifen induced androgenetic alopecia treated with dutasteride

( Je Byeong Chae ),( Ji Young Choi ),( Jung Won Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

A 59-year-old woman visited our clinic complaining of hair loss on anterior hairline and vertex. She had diagnosed as breast cancer and underwent surgery 18 months ago. After surgery, she got 8-times of chemotherapy, and then has been taking Tamoxifen for 8 months. During the chemotherapy, her hair was totally fallen out and it is slowly regrown after termination of chemotherapy. However, fronto-temporal hairline and vertex scalp was not fully recovered. She had no past medical history or family history of androgenetic alopecia(AGA). On physical examination, hair density and diameter in bilateral temporal area and vertex were remarkably decreased. Hair pull test was positive and the pulled hairs were all vellus. Based on clinical manifestation, the patient was diagnosed as AGA. She was taken skin biopsy and started dutasteride. Biopsy revealed follicular miniaturization with mild dermal fibrosis and lymphocytic infiltrations. After 10-weeks of dutasteride treatment, the alopecia got much improved. Tamoxifen acts as an estrogen receptor antagonist and is used in anti-estrogen therapy for hormone receptor-positive breast cancer. Rarely, male pattern or female pattern hair losses developed after tamoxifen therapy have been reported. Dutasteride is a 5α-reductase inhibitor and have been used for the treatment of AGA. Herein, we report a rare case of AGA possibly developed after tamoxifen therapy and improved by dutasteride medication.

Grouped eruptive pyogenic granulomas on chin following tooth implant

( Je Byeong Chae ),( Bo Ri Kim ),( Jung Won Shin ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Pyogenic granuloma (PG) is a common benign acquired vascular proliferation of skin and mucous membrane. Classically, it presents as a solitary friable nodule on face or distal extremities though rare multiple lesions which are grouped or eruptive and disseminated also have been reported. A 60-year-old male developed multiple grouped easily bleeding papules and plaques on his left chin during the last month. He put a tooth implant into periodontium under the skin lesion two months ago. Histopathological examination revealed marked lobular endothelial cell proliferation which is consistent with pyogenic granuloma. There was no malignant feature including cellular pleomorphism and mitosis or nuclear hyperchromatism. The patient was successfully treated with electrocauterization combined with pulsed dye laser. The exact pathophysiology of pyogenic granuloma is still obscure but several pathogenic mechanisms have been suggested, including production of angiogenic factors that stimulate endothelial proliferation and formation of minute arterovenous fistulas by trauma. Herein, we present a rare case of grouped eruptive pyogenic granulomas on chin associated with previous dental procedure.

[P076] A case of porokeratosis ptychotropica

( Je Byeong Chae ),( Jung Won Shin ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 47-year-old man presented with a 1-year history of verrucous plaques affecting buttocks. Histological examination revealed psoriasiform hyperplasia with cornoid lamellae. He was treated with 40% salicylic acid ointment and methylprednisolone cream. However, they had no beneficial effects and the patient was lost to follow-up. Four months later, he revisited and the lesion had become more extensive and verrucous. In addition, many satellite lesions had developed around the buttocks and in both forearms. The second skin biopsy was done and the results were similar with those of the previous one. Considering clinical and histopathologic findings together, a diagnosis of porokeratosis ptychotropica (PP) was made. We have tried various treatment including cryotherapy, triamcinolone injection, CO₂ laser, and dermabrasion. However, they had only limited effect. He is now under observation after changing the treatment with oral isotretinoin. PP is a rare variant of porokeratosis and it usually presents as symmetrical distribution on erythematous scaly papules on buttocks. Careful examination in necessary, since PP might be difficult to differentiate clinically from PRP, psoriasis, and ILVEN. To our knowledge, approximately 30 cases had been reported in the literatures. Herein, we report a case of recalcitrant PP with extensive satellite lesions.

[P375] A case of diagnosing renal cell carcinoma through cutaneous metastasis

( Je Byeong Chae ),( Jung Tae Park ),( Ji Young Choi ),( Seungkeol Yang ),( Chang Hun Huh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 61-year-old man visited our clinic with huge mass on scalp. He weight dropped by 10kg with anorexia. Laboratory test showed severe anemia (Hemoglobin level was 5.5) and hypercalcemia. The histopathologic results revealed poorly differentiated malignant neoplasm with cytokeratin and vimentin expression. Whole body PET-CT showed that there was malignant tumor in the right retroperitoneum which possibly was originated from the right kidney and metastasis to both adrenal glands, lungs, brain and right temporal skin. He referred to the hematology, urology and neurosurgery. He received kidney biopsy and diagnosed with clear cell type renal cell carcinoma and with metastasis. After diagnosis, he received right radical nephrectomy and excision of scalp mass and consecutive chemotherapy. Cutaneous metastasis of renal cell carcinoma is rare. Moreover, as is the case in this patient, it is very unusual to diagnose renal cell carcinoma primarily in lesions that have metastasized to the skin. Therefore, we reported the firstly detected renal cell carcinoma via huge scalp mass case due to its rareness

Two cases of bullous erythema ab igne and review of literatures

( Je Byeong Chae ),( Jung Tae Park ),( Jung Won Shin ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Erythema ab igne is a skin condition characterized by reticulated erythema or hyperpigmentation, epidermal atrophy, and telangiectasia that is usually produced bylong-term exposure to excessive heat without the production of a burn. It generally occurs in individuals habitually using heaters in the winter. A 50-year old man presented with erythematous-brown reticulated patches with bullae on both lower legs. Recently, he had been using an electronic heater frequently. Histopathological examination revealed subepidermal separation with perivascular lymphocytic infiltration and extravasated red blood cells. There was no deposition of immune complex. The patient was diagnosed with the bullous form of erythema ab igne and instructed to stay away from heat sources. Another patient, a 43-year old man developed bullae with reticulated erythema on his right lower leg during the last week. His legs had repeated close exposure to a heater over the previous 1 month. Histopathological examination of the lesion showed subepidermal separation of the epidermis and increase elastic fibers in dermis. There was no immune deposit on direct immunofluorescence of perilesional skin. Bullous erythema ab igne is considered as a rare variant of erythema ab igne. We describe two cases of bullous erythema ab igne and review of previous literatures.

A Case of Bowen`s Disease Successfully Treated with Ingenol Mebutate Gel

( Je-byeong Chae ),( Jung-tae Park ),( Bo-ri Kim ),( Chang-hun Huh ),( Kyoung-chan Park ),( Jung-won Shin ) 대한피부과학회 2017 Annals of Dermatology Vol.29 No.4

Quantitative comparison of histological subtypes in seborrheic keratosis using computer-aided image analysis

( Je Byeong Chae ),( Bo Ri Kim ),( Chong Won Choi ),( Sang Woong Youn ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Seborrheic keratosis (SK) is traditionally classified into 4 major histological subtypes: hyperkeratotic, acanthotic, adenoid, and irritated. This classification, however, is based on visual characteristics, which can be subjective, rather than on objective criteria based on quantified parameters. Objectives: The aim of our study was to describe the histological features of each subtype of SK with quantified values, using computer-aided image analysis and to objectively compare the differences in histopathological findings among the SK subtypes. Methods: We retrospectively collected histological photographs of 181 biopsy-proven SK lesions. The major histopathological findings of SK were quantitatively assessed using Image J software. Results: Hyperkeratosis (708.43±1095.27 μm) and papillomatosis (26.39±9.27 /μm) were predominant in the hyperkeratotic subtype, while acanthosis (489.44±346.89 μm) was relatively mild among the subtypes. Conversely, the acanthotic subtype showed pronounced acanthosis (749.25±375.13 μm) with slight hyperkeratosis (99.57±81.69 μm) and papillomatosis (6.35±7.39 /μm). The characteristic feature of the irritated subtype was prominent inflammatory cell infiltration (11.23±3.86 %). Conclusion: Our study introduced a method of computer-aided image analysis to quantify the histopathologic findings of SK and objectively proved the difference between each histological subtype.

Two cases of Bowen`s disease successfully treated with ingenol mebutate (PICATO®)

( Je Byeong Chae ),( Jung Tae Park ),( Jung Won Shin ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Bowen’s disease is an intra-epidermal squamous cell carcinoma in situ of skin. When surgical approach is unaffordable, nonsurgical therapies (e.g. topical agents) can provide alternative treatment options. Ingenol mebutate is a novel topical agent extracted from Euphorbia peplus, which has been approved by the FDA for the field therapy in actinic keratosis. We report two cases of Bowen’s disease successfully treated with ingenol mebutate gel. The first case is a 68 year old woman woman presented with gray-to-red irregular shaped plaque on her shin. Histopathologic findings were consistent with Bowen’s disease. The patient was treated with 0.05% ingenol mebutate gel combined with CO2 fractional resurfacing laser. Follow-up skin biopsy revealed no evidence of remnant lesion. The second case is an 82 year old woman with Bowen’s disease on her left cheek. Even after four times of cryotherapy the lesion was not completely removed. After applying 0.015% ingenol mebutate, the lesion was cleared and no recurrence was observed after one year. Until now, there have been few reports demonstrating the efficacy of ingenol mebutate for the treatment of BD. We suggest that ingenol mebutate might useful and effective treatment option for BD, leading to optimal cosmetic result.