Melanocytic Nevus: 수술 vs. 시술

노미령 ( Mi Ryung Roh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Objectives: For small to medium sized congenital melanocytic nevi (CMN), the treatment of choice is staged surgical excision. Ablative lasers or pigment-specific lasers have also been recommended for lesions difficult for surgical removal or to avoid surgery. In this study, we retrospectively analyzed the results of several treatment options for CMN to find out the optimal treatment method. Methods: Patients with small to medium sized CMN were retrospectively reviewed. Treatment options were categorized into four groups: (i) Excision only; (ii) Excision followed by scar laser; (iii) Excision followed by pigment specific laser; and (iv) Laser only. Treatment response was assessed by investigator’s global assessment (IGA) score on a seven-point scale. Results: A total of 119 cases were included. Lesions were most commonly located on the face (59/119, 49.6%), measured 210cm in size (72/119, 60.5%), and treated with excision only (50/119, 42.0%). Among treatment options, excision followed by scar laser showed the highest IGA score of 6.38. Options including surgical methods showed higher IGA scores compared to laser-only treatment (P<0.01). Staged excisions and single excisions showed no difference in IGA scores. Patient satisfaction scores increased after scar laser treatment of the staged excision scar. Conclusions: For the treatment of small to medium sized CMN, treatment strategies including surgical methods are cosmetically superior to laser-only treatment. Also, the combination of surgical excision with scar laser has the potential for better clinical outcomes and patient satisfaction.

Tips for giving a better presentation in English

노미령 ( Mi Ryung Roh ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

1. Talk to the audience. 2. Less is more. 3. Only talk when you have something to say. 4. Make the Take-Home Message persistent. 5. Be logical. Presentation should have a story. 6. Treat the floor as stage. 7. Practice and time your presentation. 8. Use visuals sparingly but effectively. 9. Review your presentation. 10. Provide appropriate acknowledgement.

Long-term management strategy for difficult patients: morphea

노미령 ( Mi Ryung Roh ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

Morphea, also known as “localized scleroderma”, is an inflammatory condition that primarily affects the dermis and sometimes extends to subcutaneous (SQ) fat and fascia producing thickening and hardening of the skin. According to the criteria of Laxer and Zulian, morphea subtypes can be classified as plaque (circumscribed), linear, deep, generalized, and mixed (>1 subtype). Although rarely life-threatening, morphea may be accompanied by substantial morbidity. Contracture, cosmetic or functional deformity, limb length discrepancy, and associated systemic disease (arthritis) can develop and lead to significant morbidity. Symptoms of active disease and functional impairment from damage are associated with decreased quality of life. The natural history of morphea is not completely understood, but an estimated 50 % of the cases undergo spontaneous remission or skin softening on average 2.7 years after onset. Even with spontaneous remission, residual damages occur due to previously active disease. Therefore, decisions regarding morphea treatment are a complex interplay of patient age, disease subtype, disease activity, and the presence of potential or existing damage. There is a relative lack of evidence for many therapies in morphea. Of existing studies, there is greatest support for the efficacy of phototherapy (ultraviolet A, ultraviolet A-1), methotrexate with/without systemic glucocorticoids, topical calcipotriene, and topical tacrolimus. Choice of therapy for morphea should be based on several factors: relative activity of disease, depth of involvement, and course. Subcutaneous involvement, rapid progression, and involvement of functionally/cosmetically sensitive areas or large body surface area are all indications for systemic treatment. Even with treatment, morphea lesions may lead to the deformation of the face which affects the patient’s quality of life. It is most pronounced in en coupe de sabre type, which is characterized by linear atrophy and hardening of skin, SQ tissue, muscles and bones, usually extending from the upper limit of the eyebrow to the scalp, often with concomitant alopecia and eyebrow loss. After treatment of progressive disease, the correction of facial defects can be restored using hyaluronic acid (HA), polymethylmethacrylate, poly-L-lactic acid and autologous fat. In some cases, ulceration of lesions may occur which requires great effort and time for restoration of the defect. In this talk, cases will be presented to discuss the treatment methods for morphea patients.

Dermatofibrosarcoma protuberans: What we know and what to do

노미령 ( Mi Ryung Roh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Skin biopsy and suture techniques

노미령 ( Mi Ryung Roh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Congenital melanocytic nevus: When and how to treat

노미령 ( Mi Ryung Roh ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Eccrine gland, apocrine gland and sebaceous gland

노미령 ( Mi Ryung Roh ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Humans have 2-24 million sweat glands. They are generally found as two types, eccrine and apocrine. Eccrine gland sweat allows the body to control its internal temperature in response to thermal stress. Apocrine gland function is more obscure but likely includes pheromone production. Up to 10L/day of sweat is produced by acclimatized individuals, and hypothalamic temperature is the strongest stimulus for sweating. Human eccrine sweat is composed of inorganic ions, lactate, urea, ammonia, amino acids and proteins including protease. Apocrine glands have roles as odoriferous sexual attractants, territorial markers and warning signals. Apocine sweat contains three types of precursors which are fatty acids, sulfanyl alkanols and odiferous steroids. They are converted by bacteria on axillary skin, particularly corynebacterium striatum, into odiferous substances. Apocrine glands are controlled mainly by adrenergic agonists although some cholinergic control also has been reported. In contrast, eccrine glands are under cholinergic control. Sebaceous glands are unilobular or multilobular structures that consist of acini connected to a common excretory duct and are usually associated with a hair follicle. The sebaceous glands exude lipids by disintegration of entire cells, a process known as holocrine secretion. Human sebum contains squalene, cholesterol, cholesterol esters, wax esters, and triglycerides. Sebaceous glands are regulated by various factors such as androgens, retinoids, melanocortins, peroxisome proliferator-activated receptors (PPARs), and fibroblast growth factor receptors (FGFRs). In this session we will thoroughly review the basic anatomy, function and disorders associated with these glands.

Skin biopsy and suture techniques

노미령 ( Mi Ryung Roh ) 대한피부과학회 2021 대한피부과학회 학술발표대회집 Vol.72 No.2

Skin biopsy and suture techniques

노미령 ( Mi Ryung Roh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Treatment of dermatofibrosarcoma protuberans

노미령 ( Mi Ryung Roh ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

1. Learning Objectives 1) Diagnosis of DFSP-pathologic and molecular diagnosis 2) Patient-oriented selection of treatment modality 2. Clinical Presentation A 57-year old woman presented with 4-year history of mass on her left proximal index finger and web space. The lesion was initially excised in 2007, but recurred in 2009, so the lesion was re-excised again. However the mass recurred in 2011. Clinically, a 1.5 x 2.0 cm red to violaceous mass was seen on the ulnar side of the proximal left proximal index finger abutting the finger web. 3. Pathologic Presentation Skin biopsy was performed and histologic findings showed infiltration of bland to moderately pleomorphic spindle cells in hypocellular, myxoid and collagenous stroma extending into subcutaneous tissue. Immunohistochemical stain for CD34 was positive. Mutation analysis of COL1A1-PDGFβ showed that the end of exon 43 in the COL1A1 gene was fused with the start of exon 2 in the PDGFβ gene. 4. Discussion Although a third wide excision was considered this treatment option, was not done due to the location and possibility of postoperative loss of digital function. Therefore, Gleevec® 400mg twice a day for 3 months followed by reduced dose, 400mg once a day for 2 months was prescribed. During treatment, the patient complained of facial edema, nausea, epigastric pain, and intermittent palpitation. After 5 months, the lesion clinically showed marked reduction in size and a follow up MRI scan confirmed marked reduction of tumor. Four months later, the lesion maintained its reduced size and showed no evidence of recurrence. To confirm the absence of the tumor cells, skin biopsy was performed again and histopathology finding showed reduced cellular density and hyaline changes. However, CD34 immunohistochemical stain was positive although the number of positive cells was less in number than the number prior to imatinib mesylate treatment. For complete removal of the remaining tumor, Mohs microsurgery was done on the suspected residual site and wound defect was closed with a full thickness skin graft. Frozen sections of the Mohs margin showed no evidence of tumor cells on the epidermis, dermis and subcutaneous layer. From the removed tumor tissue, mutation analysis was done again and we still found the fusion mutation of COL1A1 gene with PDGFβ gene in tumor cells. 5. References 1) Roh MR, Bae B, Chung KY. Moh`s micrographic surgery for dermatofibrosarcoma protuberans, Clin Exp Dermatol 2010;35(8):849-52 2) Jeon IK, Kim JH, Kim SE, Kim SC, Roh MR. Successful treatment of unresectable dermatofibrosarcoma protuberans on finger with imatinib mesylate and Mohs microsurgery. J Dermatol 2013;40(4):288-6-9.