The Relationship between the Size and the Invasion Depth of Tumors in Head and Neck Cutaneous Squamous Cell Carcinoma

이삼용,황원주,김경필,김홍민,황재하,김광석 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.6

Background Cutaneous squamous cell carcinoma (SCC), which occurs in keratinocytes of the epidermis and is the second most common skin cancer, has a more invasive growth pattern and higher potential to metastasize than basal cell carcinoma. Total excision of the primary tumor is the treatment of choice. For clear excision of the tumor, invasion depth is one of the most important factors. This study was conducted to clarify the relationship between the size and the invasion depth of cutaneous SCC. Methods Twenty-six cases were collected for this prospective study. Frozen biopsies were examined after complete resection of the tumor, followed by histological confirmation by pathological examination. The major and minor axis lengths of the tumor, the invasion depth, and the level of invasion were measured. Recurrence or metastasis was recorded through regular follow-up. Results The Pearson correlation coefficient was used for statistical analysis. Significant results were observed for the relationship between the major and minor axis lengths and the invasion depth of the tumor (0.747, 0.773). No cases of recurrence or metastasis were observed. Conclusions In head and neck cutaneous SCC, the invasion depth of the tumor is closely related to the major and minor axis lengths of the tumor. Therefore, the invasion depth of the tumor can be estimated by measuring the size of the tumor, and a standard vertical safety margin for head and neck cutaneous SCC can be established, which could be helpful in the development of a preoperative reconstruction plan.

A rare development of tumoral calcinosis of the ear auricle

이삼용,이한결,김광석,황재하 대한두개안면성형외과학회 2018 Archives of Craniofacial Surgery Vol.19 No.4

Tumoral calcinosis is a condition characterized by deposition of calcium salts in the skin and subcutaneous tissue, commonly found around the joints. However, tumoral calcinosis of the auricle is extremely rare. We present the case of a 13-year-old boy with tumoral calcinosis of the helix of the ear auricle. A 13-year-old boy presented with a 10-year history of an enlarging mass on the left auricle. The mass was hard, non-tender, and non-compressible. The patient had no history of trauma. Complete surgical excision and pathological examination of the specimen was performed. The final diagnosis of the excised mass was tumoral calcinosis. After 9 months of follow-up, there were no signs of recurrence of the tumor and the patient was satisfied with the surgical results. Tumoral calcinosis of the auricle is extremely rare and may be misdiagnosed as other tumors. Pathological examination is essential for definitive diagnosis and complete surgical excision should be considered as the treatment of choice.

안면부 대상포진에 의한 안검외반증의 치료

이삼용,황재하,김의식 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.4

Ectropion in upper eyelid is often considered as a consequence of thermal burn injury or trauma and skin disease, that causes excessive scarring or shrinkage in the skin or subcutaneous tissue. Herpes zoster, known as shingles is caused by varicella zoster virus. After primary inoculation, this virus lies dormant in neuronal ganglia until it is triggered by any of an assortment of factors. In case of involving the ganglion of the fifth cranial nerve(trigeminal nerve), it can descend down the affected nerve into the skin, then producing an eruption in the dermatome which is innervated including forehead, ocular and periorbital area in recurrent episode. We report one patient with cicatricial ectropion of the left upper eyelid secondary to herpes zoster. As a result of repeated healing process of herpes vesicles, he had a total exposed palpebral conjunctiva and scar contracture of the left upper eyelid. Surgical scar release of the lid traction, excision of scars, and full thickness skin graft were done with satisfactory outcome.

두꺼운 부분층 피부 이식술을 이용한 경부 구축 반흔의 교정

이삼용,황재하,김의식 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.6

Hypertrophic scar contracture is an unfavorable and critical phenomenon in deep second or more serious degree burn patients, particularly when these hypertrophic scar contractures involve face, neck, upper extremities, lower extremities and perineal area. In the neck, preservation of contour of cervicomental angle and good range of motion is important in deeply burned patients. Traditionally cutaneous free flap or full thickness skin graft were used to restore this skin defects after release of scar contracture. Using one large piece of thick skin graft for covering the defect of neck is important key point. We applied thick split thickness skin graft instead of full thickness skin graft or free flap treating these patients who had hypertrophic scar contracture of neck. We experienced 12 patients of hypertrophic scar contracture of neck treated with thick split thickness skin graft of 30/1,000 inch in thickness. All patient were followed up for one year and evaluated for ROM(Range of motion) by means of A.M.A.(American Medical Association) method.All patients restored the ROM near to normal after one year. In conclusion, thick split thickness skin graft can be easily harvested from thick thigh and allows patients to restore good range of motion of neck and contour.

안검에 발생한 기저 세포암의 치험례

조백현,임기영,곽승호,김병삼,이삼용 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.2

Basal cell carcinoma is the most common skin cancer. Although it rarely metastasizes to a distant site and rarely invades the deeper structure it occurs often in the face especially, the eyelids and the nasolabial fold. If left uncontrolled for a long time, reconstruction is be difficult, and severe complications such as visual and definitive treatment is essential. Currently accepted treatment modalities are curettage and electrodesiccation, radiation therapy, surgery, cryotherapy and application of 5-FU, etc. Among them, we preferred to use the surgical treatment. We underwent 11 basal cell carcinomas developed on eyelids between May of 1988 and April of 1990 and gained satisfactory results by wide excision of the tumors and reconstruction of eyelids using various techniques: As for the lower eyelid, we used cheek rotation skin flap or bilobed skin flap with chondromucosa graft, or bipedicled and nasolabial flaps with chondromucosal and fascial graft. When the upper eyelid was involved, we used Fricke flap with oral mucosal graft. In case of both upper and lower eyelids, we used median forehead, Fricke and cheek rotation flaps with oral and chondromucosal graft.

피부종양의 Epidermal Growth Factor 표현에 관한 연구

박희만,최석현,이삼용 大韓成形外科學會 1990 Archives of Plastic Surgery Vol.17 No.4

Epidermal growth factor(EGF) is extracted first from the submandibular gland of a mouse by Cohen, and the expression of EGF in normal squamous epithelium, fibroblasts and marrow cells has been reported. Since EGF is expressed and increased in neoplastic tissue, study on possibility of EGF as a tumor marker has been attempted. The author performed immunoperoxidase staining for EGF on the common skin tumors such as squamous cell carcinoma, Bowen's disease, basal cell epithelioma, proliferatin trichilemmal tumor, keratoacanthoma, and neveus sebaceus to confirm the patterns of EGF expression and the relationships between EGF expression and cellular differentiation of malignant potentiality of tumors, and the results obtained were as follows. 1. Positive expression of EGF was characteristic in the cells with intracytoplasmic keratinization in squamous cell carcinoma, keratoacanthoma, Bowen's disease, and proliferating trichilemmal tumor. And the intensity was more strong to the degree of keratinization, but negative in keratin pearls. 2. In basal cell epitelioma, EGF was not expressed or weakly expresse. 3. EGF was expressed in the sebaceous cells in nevus sebaceus, and also expressed in neighboring normal eccrine glands. From the above results, the expression of EGF in skin tumors was related to cellular differentiation, especially toward squamous cells, but there was no any relationship to malignant behavior.

화상 환자 531예에 대한 임상적 고찰

조백현,김병삼,임기영,류봉수,이삼용 大韓成形外科學會 1992 Archives of Plastic Surgery Vol.19 No.2

During the 10 years from January, 1981 to December, 1990, 531 cases of burn patients were admitted into the Department of Plastic & Reconstructiove Surgery, Chonnam Medical School Hospital. The following results were obtained after the analysis of these burn patients. 1) Male were affected more frequently than female, the incidence being 197 cases(60%) and 212 cases (40%). The male to female ratio was 1.5:1 2) The hightest incidence was noted in winter, 180, cases(33.9%) and the least in summer, 108 cases (20.4%) The highest incidence was noted in March, 68 cases(12.8%) and the least in May, 22 cases (4.1%) 3) The most common cause of the burns was scalding : 226cases(42.5%) 4) In 81.6% of all cases, the burned surfaces covered less than 30% of the total body and in 34.1% of them, the burned surfaces covered less than 10% of total body surface area. 5) 357 cases(67.2%) required fluid rescucitation, and 239 cases(66.9%) were rescucitated by the parkland formula. 6) The topical antibacterial agents were as follows: Sliver sulfadiazine cream 192 cases(36.2%), Sofra-tulle 150 cases, Gentamycin ointment 75 cases(14.1%), Cambison ointment? 47 cases(8.9%) in order of frequency. 7) The cultures of wound surface revealed Pseudomonas aeruginosa(41.0%), Staphylococcus aureus(16.0%), E-coli(14.0%), Staphylcoccus albus (77.5%) etc. in order of frequency. 8) The surgery was perfomed in 291 cases and the most frequent method of surgery was split thickness skin graft. 9) The graft loss rates of topical antimicrobial agents after grafting were as follows: Saline gauze(23%), Cambison ointment (15%), Gentamicin ointment(11%), Sofra tulle(8%) 10) The Complications were as follows 58 cases(14.8%), gastrointestinal tract complications 55 cases(14.0%), conjunctivitis 21 cases (5.4%), genitourinary tract infections 18 cases(4.6%) etc. in order of frequency. 11) The mortality rate and cause of death were as follows: (1) The total mortality rate was 3.2%(17cases). (2) The most common cause of death was sepsis in 8 cases(47.0%) (3) The mortality rate of the early children and old age group was high. (4) The most common period of intervals between the time of the accident and death was within 3days.

칼슘 차단제 전신처리가 백서의 임의형 피부판 생존에 미치는 영향

백영홍,최석현,조백현,박희만,이삼용 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.3

Skin flap necrosis can be a catastrophe in reconstructive surgery. Many attempts have been made clinically and experimentally to improve the survival in random pattern flaps. As the delay phenomenon theory, that is, vascular smooth muscle relaxation augments the blood flow to the capillary bed of the skin flap, experimental study using the Sprague-Dawley rats performed with the calcium antagonists which cause the dilatation of vascular smooth muscle by blocking the calcium-influx into the cells. Total 100 rats were grouped into control group(10) and 3 experimental groups. Each experimental group was subdivided into pre-operation, post-operation and pre-operation & post-operation group in accordance with the injection period of calcium antatonists, nifedipine and diltiazem. All the experimental groups increased the surviving skin flap area than the control group. This suggests that sustained vasodilatation by the calcium antagonists ia a major factor of flap survival increment. The mean survival area in all experimental groups was significantly greater than that in the control group.

백서의 임의형 피부판 생존에 대한 Nicardipine, Nitroprusside 및 Enalapril의 효과

이삼용,김병삼,조백현,김한용,임기영 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.6

The prevention of necrosis of skin flaps is very important in clinical plastic and reconstructive surgery. Numerous techniques and drugs have been used in attempt to increase the survival of the flap. The vascular physiology and mechanism of "delay" in a flap-how to prevent necrosis-are not still understood, but many experiments on random patern skin flaps ave suggested various hypotheses. Ischemia has been implicated as a critical factor in some studies. Others studies suggest that sympathectomy during a surgical delay in random pattern flaps is the crucial factor, and that denervation supersensitivity of arteriovenous shunts accounts for the delay phenomenon. We suggest that vascular smooth muscle relaxation is the vascular mechanism that accounts for the delay phenomenon. Effect of nicardipine (calcium antagonist), nitroprusside (direct vasodilator) and enelapril (angiotension converting enzyme inhibitor) on survival of skin flap were investigated in Sprague-Dawley rats. The mean surviving areas of the skin flap in all experimental groups were significantly greater than in the control group. The mean survival area of skin flap in enalapril+nicarkipine group was significantly greater than in single drug treated group. We conclude that sustained vasodilation by drugs increases the survival area of the skin flap.

융기성 피부섬유육종의 치험2례

이삼용,안호범,조백현,윤강모 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.3

Dermatofibrosarcoma protuberans is an uncommon soft tissue neoplasm that usually presents as a painless, often long standing mass arising in the dermis of the skin. In most patients, the nodule enlarges slowly and painlessly for a period of 3 months to 2 years as it infiltrates the adjacent tissue and becomes multinodular. At the later stage, however, its growth rate accelerates, and it can ulcerate, bleed, or become painful. Histologically, on light microscopy, this tumor shows the characteristic cartwheel patterns, with the fibroblasts arranged radially about a small central hub of fibrous tissue, and on electron microscopy, fairly monotonous population of spindle-shaped cells with a few stellate cells. Many of the spindle cells contained intracytoplasmic aggregates of microfilaments with dense bodies and were partially surrounded by basal lamina, interpreted as being typical of myofibroblasts. Other cells showed typical features of fibroblasts Dermatofibrosarcoma protuberans typically arises on the trunk and proximal extremities. head and neck and scalp lesions have also been described. It is more frequent in men with a peak incidence during the third decade of life. We have encountered 2 cases, develpoed on the both ear lobules of a 25-year-old woman and the right lower of a 7-year-old child ; but there were no evidence of metastasis. A scapular fasciocutaneous free flap and a skin graft covered large defects resulting from wide tumor excision. Follow-up at 1 year showed the patient doing well with no evidence of local or regioal recurrence.