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Cutaneous metastases of malignant melanoma are usually confined to the dermis or subcutaneous fat. In someinstances, however, they may involve the epidermis. A 68-year-old woman with a malignant melanoma on thesubungual area of the right great toe presented with multiple blackish pinhead-sized macules surrounding anulcerative lesion on the right great toe. Histopathological study of the macules showed atypical melanocytes andmelanocytic nests in the papillary dermis and the dermoepidermal junction. A thinning of the epidermis, wideningof the dermal papillae by aggregated atypical melanocytes, epidermal collarette formation, and angiotropism werealso seen. A diagnosis of epidermotropic metastatic malignant melanoma (EMMM) was made. EMMM is a specificform of metastatic malignant melanoma that is associated with epidermotropism of melanoma cells and severalhistopathological features. The differential diagnosis between primary malignant melanoma and EMMM can bedifficult because of their similar clinical and histological features. Here, we report a case demonstrating EMMM. (Korean J Dermatol 2015;53(1):53∼57)
Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor that has been reported in systemic organs and in the skin as a biologically “borderline” neoplasm with intermediate malignant potentials. Skin involvement in EHE is rare, but when present, it occurs most commonly in the upper and lower extremities, presenting as a solitary, slightly painful, soft tissue mass. Skin involvement is often associated with underlying soft tissues or bone tumors. Histopathological study reveals cords and nests of epithelioid endothelial cells in a myxoid or hyalinized background and small intracytoplasmic vacuoles containing red blood cells. There have been no reported cases yet describing the dermoscopic features of EHE. Herein, we describe a young woman who developed cutaneous EHE that enlarged during pregnancy, we provided the dermoscopic findings and a review of the relevant literature. (Korean J Dermatol 2013;51(7):539∼543)
Background: As the immunocompromised population has increased in recent years, the number of cutaneous nontuberculous mycobacterial (NTM) infections has also risen. However, since this affliction has no pathognomonic clinical or histological features, the diagnosis and treatment of cutaneous NTM infections are often delayed. Objective: The aim of this study was to investigate the microbiological, clinical, and histological findings of cutaneous NTM infections. Methods: We reviewed medical records and histologic slides of 10 patients diagnosed with cutaneous NTM infections confirmed by culture or polymerase chain reaction. Results: All patients except one were immunocompetent, and 5 of 10 patients had preceding factors including trauma, liposuction, and intralesional triamcinolone injection. Microbiologically, of the 10 infections, 5 were caused by Mycobacterium marinum, 3 by Mycobacterium fortuitum, and 1 each by Mycobacterium chelonae and Mycobacterium ulcerans, respectively. Of the 5 patients with M. marinum, 2 had a fish-related job and 1 reared fish at a home aquarium. The most common clinical presentation was erythematous nodules (7/10). Histologically, irregular acanthosis (4/10), mixed cell infiltrate of lymphocytes, histiocytes, neutrophils (9/10), suppurative granuloma (7/10), microcysts lined by neutrophils (5/10), fibrosis (4/10), and panniculitis (7/10) were identified. Conclusion: We found microcysts lined by neutrophils in 50% of the samples and considered this finding to be a diagnostic marker of NTM infection. These clinicopathologic features will assist clinicians in diagnosing NTM infection more rapidly and accurately. (Korean J Dermatol 2014;52(1):26∼33)
PNP is a rare autoimmune mucocutaneous blistering disease associated with neoplasms, most frequently of the lymphoproliferative type. As PNP is clinically characterized by polymorphous mucosal lesions and cutaneous eruptions, it is important to differentiate it from erythema multiforme, Stevens-Johnson syndrome, lichen planus, and other bullous diseases. A diagnosis of PNP can be confirmed by immunologic studies such as direct and indirect immunofluorescence, immunoblotting, immunoprecipitation. Rare PNP cases related to nonhematological solid tumors have been reported. A 54-year-old male visited us with generalized pruritic scaly lichenoid lesions on the whole body from 5 weeks prior to his first visit. He also presented with extensive painful ulcers and erosions on the oral mucosa and lips for 2 months. Histopathologic findings showed lichenoid infiltration with vacuolar interface change, lichenoid interface dermatitis, keratinocyte apoptosis, and suprabasal acantholysis with cleft. Indirect immunofluorescence using normal human skin showed IgG deposition at the intercellular space. Immunoblotting using normal epidermal extracts in the serum of patient detected antibody to the 190 kDa (envoplakin), 210 kDa (periplakin) molecules polypeptides. He also had a hepatocellular carcinoma and chemoradiotherapy done before. The diagnosis of paraneoplastic pemphigus (PNP) was made. To our knowledge, there are only two reports of PNP associated with hepatocellular carcinoma worldwide, yet no report in Korean literature. Herein, we report the first case of PNP associated with hepatocellular carcinoma in Korea. (Korean J Dermatol 2014;52(1):34∼39)
Spitz nevus is a benign melanocytic nevus, common in children or young adults, and it has histological features that are confused with those of malignant melanoma. Polypoid Spitz nevus is the benign counterpart of polypoid malignant melanoma. A 22-year-old woman presented with a solitary 1.5×1.5 cm-sized firm polypoid erythematous nodule on the left thigh. On dermoscopy, pink to yellowish lagoons intermingled by white fibrous septa were found but milky red globules or irregular linear vessels were not found. Therefore, melanoma almost could be ruled out cautiously. Histopathology showed symmetrical, well-circumscribed, polypoid architecture with predominant dermal nests of spindle cells. Immunohistochemically, the nevus cells were strongly positive for S-100 protein and negative for HMB-45. Thus, the diagnosis of polypoid Spitz nevus was made. Herein, we report a case of polypoid Spitz nevus that was differentiated from polypoid melanoma by histopathologic and dermoscopic findings. (Korean J Dermatol 2016;54(4):293∼296)
Vinorelbine, a vinca alkaloid anticancer drug, is widely used to treat various cancers. Several dermatological side effects of vinorelbine, such as acral erythema, phlebitis, and severe extravasation reactions, have been reported. Vinorelbine is categorized as non-DNA binding vesicant that undergoes high metabolism and clearance, which limits the degree of tissue injury if extravasation occurs. A 73-year-old male presented with erythematous linear patches on his left wrist and a 51-year-old male presented with erythematous eroded patches and bullae on his right forearm. Histopathologic study showed interface changes with basal vacuolar degeneration and epidermal dysmaturation. Separation of the dermis from the epidermis was observed, as well as interstitial and perivascular inflammatory infiltrates in the dermis. Both patients were being treated with vinorelbine for lung cancer. Before the onset of the skin lesions, accidental intravenous extravasation of vinorelbine had occurred. Herein, we report two cases of chemotherapy induced drug reaction due to extravasation of vinorelbine. (Korean J Dermatol 2016;54(5):372∼376)
The effects of hormones in acne are most notable in women. Although hormones influence acne, most acne patients do not have an endocrine disorder. Hyperandrogenism should be considered in female patients whose acne is severe, sudden in its onset, or is associated with hirsutism, or irregular menstrual periods. Additional clinical signs of hyperandrogenism include Cushinoid features, increased libido, clitoromegaly, deepening of the voice, acanthosis nigricans, or androgenetic alopecia. Patients with hyperandrogenism may also have insulin resistance. Causes of Hyperandrogenism ·Polycystic ovary syndrome ·Idiopathic hirsutism ·Hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome ·Congenital adrenal hyperplasia (classic and non-classic) ·Cushing``s syndrome ·Androgen-secreting tumors (ovarian, adrenal) ·Hyperprolactinemia ·Hypothyroidism ·Androgenic medications (eg, danazol) Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, affecting 5% to 10% of women in this age-group. PCOS include hirsutism, obesity, insulin resistance, acanthosis nigricans, and menstrual irregularities. Diagnostic criteria for PCOS were established by the 2003 Rotterdam Consensus Workshop. PCOS can be diagnosed when 2 of the following 3 features are present: (1) Oligoovulation (fewer than eight menses per 12-month period) or anovulation (2) Clinical and/or biochemical signs of hyperandrogenism (ie, hirsutism, acne, male pattern balding, elevated serum androgens) (3) Polycystic ovaries. PCOS can be practically divided into the following four subtypes: (1) irregular menstruation (IM)/polycystic ovary morphology (PCOM)/hyper-androgenism (HA) (2) IM/PCOM (3) IM/HA (4) HA/PCOM It is important to exclude other disorders with a similar clinical presentation before a diagnosis of PCOS is made. Hormonal therapy is suggested as first-line therapy for androgenic acne in women with hyperandrogenism. Once the decision has been made to initiate hormonal therapy, the various options to choose from include: (1) Agents that block the androgen receptor Spironolactone, Cyproterone Acetate, Flutamide (2) Inhibitors of adrenal androgen production Glucocorticoids (3) Inhibition of ovarian androgen production Gonadotropin-Releasing agonists, Oral contraceptives, Progestins