A case of annular elastolytic giant cell granuloma after amiodarone medication

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Gun-wook Kim ),( Ki-ho Kim ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Annular elastolytic giant cell granuloma (AEGCG) is an uncommon condition belonging to the family of elastolytic granuloma disease. Almost always it occurs on sun-exposed area, such as the face, neck, dorsa of hands, arms, hence previously named as actinic granuloma. Objectives: A 59-year-old man presented with erythematous annular plaques on both dorsa of hands. Patient has history of implantable cardioverter defibrillator insertion after acute MI 2 years ago and was taking amiodarone, an antiarrhythmic agent. A total of 85 to 90 g of amiodarone was administered to him, and so phototoxicity by amiodarone was considered. Methods: Histopathologic examination revealed annular elastolytic giant cell granuloma. Results: Histopathologic examination revealed a finding of annular elastolytic giant cell granuloma. The skin lesions improved clinically after 3 month of systemic & topical steroid treatment. Conclusion: AEGCG, as a relatively rare disease, is clinically similar to granuloma annulare. This case is very interesting at the point of development after chronic medication of phototoxic drug such as amiodarone. Despite some possibilities of co-occurrence of AEGCG and amiodarone phototoxicity, we suspect that medication of amiodarone may cause phototoxicity that initiated the granulomatous cascade after fragmentation of elastic fiber. We report herein this case as an AEGCG caused by Amiodarone.

Importance of Immunophenotyping Markers such as MUM-1 in the Patients with ALK Negative and CD30 Positive Anaplastic Large Cell Lymphoma of the Skin

( Yeo-rye Cho ),( Ho-jin Kim ),( Jeong-wan Seo ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Anaplastic large cell lymphomas (ALCLs) represent a subset of peripheral T-cell lymphomas (PTCLs), defined by a proliferation of large lymphoid cells, referred to as hallmark cells, with strong expression of CD30. If the Immunohistochemistry (IHC) result for ALK is positive, it corresponds to systemic ALCL. If the IHC result for ALK is negative, it can be divided into systemic ALCL (sALCL) and primary cutaneous ALCL (cALCL). We report a case of a 66 - year - old man with solitary erythematous mass in his arm who was diagnosed with ALCL as a histologic examination and was diagnosed with systemic ALCL as a radiological and nuclear medical examination. The IHC test of the patient’s tissues showed ALK negative and MUM positive lymphomas. MUM-1 is known as a marker for identification of B cell lineages. However, this case confirmed that MUM-1 could be positive in ALCL. In addition, we found through literature reviews the fact that although ALK negative sALCL and ALK negative cALCL cannot be distinguished in MUM-1, it is possible to distinguish between ALK negative sALCL and ALK negative cALCL by FISH on IRF-4, a gene expressing MUM-1.

A comparison of efficacy in ablative fractional laser assisted photodynamic therapy according to the density of ablative laser channel in treatment of actinic keratosis

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Jeong-wan Seo ),( Ki-ho Kim ),( Ki-hoon Song ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: The pretreatment of Er:YAG ablative fractional laser(AFL) has known to be beneficial in performing photodynamic therapy(PDT) for actinic keratosis. And it is needed to find the optimal settings of AFL, including the density of the ablative laser channel. Objectives: The aim of this study is to evaluate whether different laser densities make different results in efficacy, side effects, cosmetic outcomes, and protoporphyrin IX(PPIX) accumulation of AFL-PDT for facial AK. Methods: 246 AK lesions were randomized to 5.5%, 11%, 22% of AFL channel density groups respectively and treated with one session of PDT after AFL treatment with each density. Treatment efficacy was determined by the regression of lesions over time and side effects, cosmetic outcomes, and accumulated levels of PPIX were assessed. Results: The treatment of AK with 22% density was more significantly effective than that of the 5.5% density groups after 9 months(complete response rates: 94.5% vs.73.3%). Especially, the treatment outcome of AK with severe hyperkeratosis (Olsen grade III) was more affected with different laser density, in which the higher(22%) density groups showed significantly better CR rate (89.5%) than the lower(5.5%) density groups (53.3%). There were no difference in PPIX accumulation, side effects, cosmetic outcomes and safety among the groups. Conclusion: AFL-PDT with higher laser channel density showed better CR rate with lesser recurrence, especially in AK with severe hyperkeratosis.

The relationship between the clinico-histologic subtypes of actinic keratosis and the efficacy of ablative fractional laser-assisted photodynamic therapy: a five year retrospective analysis

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Jeong-wan Seo ),( Ki-ho Kim ),( Ki-hoon Song ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Actinic keratosis(AK) has various clinical and histopathological subtypes and it is needed to compare the efficacy of ablative fractional laser-assisted photodynamic therapy (AFL-PDT) in each subtypes for optimal treatment. Objectives: The aim of this study is to investigate the difference in the complete remission(CR) of the AFL-PDT according to the clinical and histopathological subtypes of AK. Methods: We evaluated the clinical and histopathological subtypes of AK in 133 patients who were treated by same protocol of AFL-PDT. Total 851 facial AK lesions were classified by clinical subtypes and 178 lesions that underwent biopsy were classified by histopathological subtypes. We assessed CR after a year of every lesions and investigate the relationship between clinical or histopathological and CR rate. Results: In clinical subtypes, erythematous type showed highest CR(91.3%) rate and cutaneous horn(56.2%) or hypertrophic type(72.5%) showed relatively lower CR rate. In histopathological subtypes, atrophic type(89.2%) showed highest CR rate and Bowenoid type(70.7%) showed lowest CR rate. Conclusion: The efficacy of AFL-PDT in the treatment of AK revealed to be different depending on the clinical and the histopathological types. The AK lesions of erythematous type in clinical subtypes and atrophic type in histopathologic subtypes showed higher CR rate. Therefore, it can be helpful to investigate the type of AK before AFL-PDT to predict treatment outcome and make treatment strategy.

Subunit refined reconstruction of medial canthal defect following mohs micrographic surgery

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Jeong-wan Seo ),( Ki-ho Kim ),( Ki-hoon Song ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Medial canthus is the unique facial esthetic unit composed of multiple cosmetic units including nose, glabella, eyelids, and cheek. Thus, medial canthal reconstruction to achieve not only the reservation of the function but also a better esthetic outcome is challenging for Mohs surgeon. Objectives: We retrospectively reviewed subunit refined reconstruction of medial canthal defects, including the complex cases reconstructed with multiple repairs in terms of subunit approach. And esthetic outcomes and side effects were evaluated. Methods: We retrospectively investigate total 126 medial canthal defects of NMSCs following MMS. Fifty eight cases (46.0%) were covered by multiple repairs in terms of subunit approach and representative cases were reviewed. Esthetic outcome of each case was subjectively evaluated by a 4-member panel. Results: Fifty eight defects reconstructed by using two(27.8%) or more(18.3%) repair methods were covered with adjacent skin that is similar in texture, thickness and color, with conserving the contour. It resulted in making lower side effects such as webbing(3.1%) and thickening(7.1%) of the skin and showed good to excellent esthetic outcomes(3.34 of rating scores) . Conclusion: Similar to the reconstruction of nasal area, medial canthal reconstruction with anatomical subunit refinement contributed to achieve esthetically excellent results and to lower side effects.

Early lymph node metastasis of squamous cell carcinomas on temple area after mohs surgery

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Hee-chul Eun ),( Ki-hoon Song ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

The risk for metastasis in squamous cell carcinoma (SCC) is reported to be approximately 4%. Cutaneous in-transit and regional lymph node metastases are the most common metastatic presentation, followed by distant metastasis. Mohs micrographic surgery (MMS) is recommended for high-risk SCC and show significantly low recurrence rate and lymph node metastasis. However, early lymph node metastasis of SCC after MMS can be occurred, and it is associated with increased risk of overall mortality. We report two cases of early lymph node metastasis of SCC after MMS. 83-year-old male patient, who underwent MMS for SCC on right temple, showed palpable mass on right neck after 2 months of surgery. 90-year-old female patient with SCC on right forehead also showed palpable mass on right neck after 3 months of surgery. Initial pre-operative radiologic studies including neck CT revealed that there were no metastatic lesions in both two patients. But PET-CT and needle aspiration biopsy were done after finding palpable neck mass and lymph node metastasis were confirmed in both patients. This early lymph node metastasis of SCC after MMS suggests the importance of periodic follow-up and patient education in SCC after MMS, especially in SCC that was on the high risk anatomic location such as temple area, although MMS showed significantly low recurrence rate.

Alopecia areata developed in a thymoma patient without myasthenia gravis: a case report

( Yeo-rye Cho ),( Ho-jin Kim ),( Jeong-wan Seo ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Alopecia areata is a chronic, organ-specific autoimmune disease characterized by hair loss in localized or diffuse pattern on hair-bearing areas including scalp. The course of alopecia areata is unpredictable but most patients have recurred in more than one episodes of hair loss. We herein report a case of alopecia areata developed after the diagnosis of thymoma, which are known to be associated with paraneoplastic autoimmune diseases at a high frequency. In this case, the patient’s hair loss recovered rapidly after thymectomy with applying topical and systemic treatment for six months. And this was faster than the recovery rate of other alopecia areata. We therefore considered this case to be alopecia areata associated with thymoma and focused on the possibility that this hair loss has improved after thymomectomy. So we presented the very rare case of alopecia areata in a patient associated with myasthenia gravis-free thymoma.

Mohs surgery for recurrent facial mucinous carcinoma of the skin

( Yeo-rye Cho ),( Jung-hwan Kim ),( Ho-jin Kim ),( Hee-chul Eun ),( Ki-hoon Song ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Mucinous carcinoma of the skin (PMCS) is a rare neoplasm arising from adnexal eccrine sweat gland and commonly occurs in head and neck, especially in periorbital region. Although the rate of metastasis in mucinous carcinoma is not high (less than 6 %), local recurrence rate is known to be about 19.6%. Mucinous carcinoma treated with Mohs micrographic surgery (MMS) showed lower local recurrence and metastasis than wide local excision. We report three cases of recurrent mucinous carcinoma after excision and treated with MMS. Firstly, a 72-year-old male patient who had a hardly movable hyperpigmented nodule on right nasolabial fold that recurred and had slowly grown 3 years after the excision. Secondly, a 48-year-old male patient who had diagnosed with mucinous carcinoma for an erythematous nodule at right lateral canthus by surgical excision and recurred. Finally, a 51-years-old male patient with a subcutaneous mass on left temple that occurred 3 years ago and recurred 16 months after excision. All three patients had no distant metastasis on radiologic findings and underwent MMS with local flap or primary closure after the confirming the diagnosis. No local recurrence or metastasis has occurred after a long term follow-up. Not only the MMS for mucinous carcinoma would help to reduce local recurrence and metastasis and improve cosmetic outcome after the tumor is diagnosed initially, it also helps to treat local recurrence.

A case report of the extranodal NK/T-cell lymphoma, nasal type

( Yeo-rye Cho ),( Ho-jin Kim ),( Jeong-wan Seo ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Extranodal NK/T cell lymphoma is a lymphoma belonging to the mature T and NK neoplasm in the 2016 WHO classification. Skin is the second most common site of this disease, and when it appears on the skin, it shows various clinical features such as nodule and necrosis from erythema, so it is difficult to distinguish it from other skin diseases. We report a case of multiple necrotic lesions of the skin that had not improved with antibiotics and repeated incision and drainage and debridement, which diagnosed after skin biopsy with extranodal NK/T cell lymphoma, nasal type. Histologic examination revealed lymphoma in H & E stain, and immunohistochemistry staining showed positive for CD56 and EBV in situ hybridization. EBV was also detected quantitatively by EBV PCR. It is important to perform skin biopsy early in case of a skin ulcer that does not have a common cause of chronic ulcers, has a random site of occurrence, and does not improve on the general treatment of chronic ulcers. And we present this case to emphasize that early skin biopsy and diagnosis is important for the rapid start of treatment of extranodal NK/T cell lymphoma.

Topical methyl aminolevulinate photodynamic therapy in porokeratosis of mibelli: an alternative treatment for a refractory disease

( Yeo-rye Cho ),( Ho-jin Kim ),( Jeong-wan Seo ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Porokeratosis (PK) is a chronic progressive disorder of keratinization, characterized clinically by hyperkeratotic papules or plaques surrounded by a thread-like elevated border that expands centrifugally. Intervention is necessary if the lesions are cosmetically unacceptable or potentially malignant. Although many treatments such as topical steroids, topical 5-fluorouracil and imiquimod creams, and cryotherapy have been attempted, complete treatment of PK is difficult. Recently, there have been attempts to treat PK using photodynamic therapy (PDT). A 65-year-old man presented with solitary erythematous scaly plaque with a raised border on his left buttock for 20 years, which histologically proved to be porokeratosis of Mibelli. We treated the lesion with methyl aminolevulinate PDT (MAL-PDT) and observed partial response. We report this case with the expectation that MAL-PDT could be a good alternative treatment for PK.