Clinical characteristics of extramammary paget’s disease among Korean population: Implication of hypopigmentation

( Sooyie Choi ),( Yeongjoo Oh ),( Byung Ho Oh ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Several studies reported the presence of the hypopigmentation in Extramammary Paget’s disease (EMPD), however, in-depth analysis regarding its clinical implication is lacking. Objectives: To evaluate the clinical characteristics of EMPD in Korean population and to find out the implication of hypopigmentation on the clinical outcome. Methods: We retrospectively reviewed 142 cases of EMPD diagnosed from a single tertiary hospital from 2005 to 2019. Baseline characteristics of the patients and the presence of hypopigmentation, multifocality, pattern, and anatomical location were analyzed. Also, the number of stages of the Moh’s micrographic surgery (MMS) and recurrence were evaluated in relation to the hypopigmentation. Results: 65.5% (n=93) of the patients showed hypopigmentation, while 31.0% (n=44) revealed no lesion of hypopigmentation. Recurrence was not statistically correlated with the presence of hypopigmentation. The average number of MMS stage was 2.92 stages for the hypopigmentation group, compared to 1.82 stages of the non-hypopigmentation group (95% CI = -1.770 ~ -0.425, p=0.002) The most commonly involved area of the hypopigmentation was the penile shaft, followed by the scrotum, pubis and labia major. Conclusion: Hypopigmented lesions may disguise the definite tumor margin, thus, the status of hypopigmentation must also be considered when deciding the surgical margin. Molecular mechanism of hypopigmentations occurring in EMPD patients’ needs further investigation.

Dermatofibrosarcoma protuberans: The use of secondary intention healing after mohs micrographic surgery

( Sooyie Choi ),( Sooyeon Choi ),( Yeongjoo Oh ),( Byung Ho Oh ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

Treatment outcome of adjuvant radiation therapy in T4 malignant melanoma patients

( Sooyie Choi ),( Yeongjoo Oh ),( Mi Ryung Roh ),( Byung Ho Oh ),( Kee Yang Chung ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.73 No.1

Poroma accompanied by lobular capillary hemangioma

( Sooyie Choi ),( Byung Ho Oh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Poroma is a cutaneous tumor derived from the ductal epithelium of eccrine gland. Since poroma and lobular capillary hemangioma (LCH) share similar clinical features, the differential diagnosis can be challenging. Here, we report a rare case of a poroma accompanied by LCH. A 55-year-old male visited our department with a 1 cm sized erythematous nodule with central erosion on the left heel. The biopsy specimen showed a proliferation of capillaries with some upper dermal cellular infiltration and erosion of epidermis. We diagnosed the patient with LCH and 1064nm long pulse Nd: YAG laser was practiced. There was no clinical response, thus surgical excision was performed. On excision specimen, dense cuboidal cells with monomorphous ovoid nuclei in the upper dermis and highly vascularized stroma were noted. Since lobular capillary proliferation was noted in the patient’s specimen, we diagnosed the patient with poroma accompanied by LCH. After surgical excision and primary repair, there was no recurrence. LCH is known to be developed as a response to angiogenic stimulus triggered by trauma and hormonal imbalance. Considering the location of the skin lesion, we assume that repeated mechanical irritation by shoes may have triggered upper dermal vascular proliferation of underlying poroma. We suggest complete surgical excision after biopsy not only to confirm the diagnosis but also to avoid the recurrence and malignant transformation.

Postoperative radiotherapy in the management of keloid: comparison of two cases

( Sooyie Choi ),( Byung Ho Oh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Treatment of keloid by surgical excision alone has not been satisfactory accounting to its high recurrence rate. Since the role of adjuvant treatment is increasing, here we compare the result of postoperative radiotherapy in two cases. A 31-year-old woman had 10x2 cm sized linear erythematous hypertrophied scar on pubic area with a history of two prior surgical revisions. Another patient, a 44 year-old-woman, had 5x7 cm sized hypertrophied scar with severe contracture on right neck. Cosmetic excision with modified pulley suture and z-plasty was performed for both patients. Postoperative radiotherapy at dose of 12 Gy in three fractions and 14 Gy in two fractions was performed for each patient. After the surgery, the first patient visited 4 months later after 3 short-term follow up sessions. The later patient visited regularly at 1 to 2 weeks interval in the initial and visited at 1 month interval for another 6 months. Careful postoperative management was performed using intra-lesional triamcinolone injection and 595nm pulse dye laser. Despite the similarity in surgical procedure and method of postoperative radiotherapy, the first patient newly developed linear hypertrophic scar along the incision at 6 months of follow up. Not only the postoperative radiotherapy but also the patients’ compliance and postoperative wound care of the practitioners are crucial factors for the cosmetic results in the management of keloids.

Treatment of Pincer Nail with Topical Hydrating Nail Solution

( Sooyie Choi ),( Yeongjoo Oh ),( Byung Ho Oh ) 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.1

Primary cutaneous marginal zone lymphoma successfully treated with radiotherapy: a case report

( Sooyie Choi ),( Young Joo Oh ),( Nu Ree Cha ),( Ju Hee Lee ),( Soo Chan Kim ),( Jihee Kim ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

MALT lymphomas are considered extranodal marginal zone B-cell lymphomas under the current world health organization classification system. Herein, we present the case of a 14-year-old female with no past medical history who presented with a child-palm sized plaque on the trunk. The skin biopsy specimen showed an extremely dense band-like lymphocytic infiltration in the upper dermis and lymphocytic exocytosis with epidermal atrophy. Immunohistochemistry was positive for BCL2, CD20 and negative for BCL6, which was suggestive of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). The patient received definitive radiation to 2000 cGy in 10 fractions to the trunk. The patient tolerated the treatment well, developing only mild erythema of the skin. At a follow-up visit, 3 months after completing treatment, the patient’s skin lesion was flattened and subsequently demonstrated a resolution of the lesion. The presentation of laryngeal MALT lymphomas is exceedingly rare, with few reported cases in the literature. These lymphomas are highly radiosensitive. Radiation therapy represents a definitive treatment option for MALT lymphoma in patients with localized disease. Definitive radiation to a low dose represents an excellent treatment option with limited morbidity, excellent functional outcome, and durable disease control for early-stage disease.

Questionnaire investigation on the treatment history and characteristic of patients with recalcitrant warts: a pilot study

( Sooyie Choi ),( Kee Yang Chung ),( Byung Ho Oh ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Despite various treatment modalities, there are refractory warts that show resistance to the treatments. To understand the patient’s difficulty and discomfort in detail, a questionnaire that can describe their own symptom and history can be an effective method. Objectives: The purpose of this study is to investigate the clinical characteristics, treatment methods, and discomfort of the patients diagnosed with recalcitrant warts with the aid of a questionnaire. Methods: A survey was conducted on patients with warts who first visited the dermatology department of Severance hospital from March 1, 2018 to March 31, 2020. The questionnaire included age, sex, family history, disease onset, location, and the number of lesions, previous treatment history, and its effectiveness. Results: Among 116 patients with recalcitrant warts, the average number of lesions indicated by the subjects was 6.73, mostly located on the hand and the foot. The most commonly performed previous treatment was cryotherapy (89/116, 76.72%), followed by topical application (69/116, 59.48%) and laser therapy (47/116, 40.5%). Of the total respondents, 60.34% (70/116) of patients answered that the treatment was not effective, and 83.62% (97/116) of patients complained of one or more discomfort due to the illness. Conclusion: In the treatment of recalcitrant warts, it's important to select a proper treatment option in consideration of the previous treatment history, and the patient’s discomfort and quality of life.

A case of a cryopyrin-associated periodic syndrome with NLRP3 gene mutation

( Sooyie Choi ),( Tae-gyun Kim ),( Min-geol Lee ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Cryopyrin-Associated Periodic Syndrome (CAPS) is a rare autoinflammatory disorder featuring urticarial rash with generalized symptoms like fever, chill, conjunctival injection and arthralgia upon exposure to low temperature. This condition is associated with defect in interleukin-1β (IL-1β) regulation. A 27-year-old male visited our department for multiple erythematous maculopapules on trunk and extremities when exposed to low temperature since childhood. Fever, chill, myalgia with joint swelling and arthralgia was accompanied. Patient’s father also reported similar episodic skin eruption and arthralgia when exposed to cold. Previously, the patient was treated with oral prednisolone, antihistamine and intermittent non-steroidal anti-inflammatory drug without a definite diagnosis. Serologic examination and autoimmune screening showed no abnormal findings except slightly elevated inflammatory markers. Upon genetic testing, pathogenic heterozygote mutation of p. Gly303Asp in the NLRP3 gene was found, which is known to be the cause for CAPS. Until targeted agents were available, systemic steroid and analgesics were the main streams of the treatment in CAPS patients. Since IL-1 blockade can be a promising treatment option, genetic confirmation for selected patients should be considered if the patient has unusual episodic skin rash and systemic symptoms with family history.

Treatment of papular eruptive basal cell carcinomas with intralesional chemotherapy: two cases

( Sooyie Choi ),( Yeong Joo Oh ),( Kee Yang Chung ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Treatment of numerous basal cell carcinomas (BCCs) on cosmetically important locations can be challenging. Since intralesional chemotherapy for cutaneous malignancies is not frequently used due to its limited data, we share our experience of two papular eruptive (PE) BCC patients treated with intralesional chemotherapy: one with bleomycin and the other with 5-fluorouracil (5-FU). A 78-year old woman with 0.5 to 1 cm sized papules on forehead, cheek and temporal area was diagnosed with BCC in 2015. She also had less than 5mm sized flesh-colored papules on centro-facial area. Large tumors were cleared by mohs micrographic surgery but smaller tumors were too many in number to be surgically removed. 12 cycles of bleomycin intralesional injections at two-month interval were performed. Remarkable tumor size regression was noted, with clinical response over 80%. A 70-year-old woman with multiple 1mm sized erythematous papules on bilateral upper, lower eyelids and periocular area was diagnosed with BCCs in 2013. This patient was treated with intralesional injections of 0.5ml 5-FU, and after six injections, complete response was noted without any remnant tumors detected after the last treatment in June 2016. We suggest intralesional chemotherapy a promising treatment option for the selected patients with the inoperable condition, guaranteeing high and long-term cure rate with excellent cosmetic outcome.