[P343] Regression of primary cutaneous malignant melanoma with multiple metastasis

( Seung Pil Ham ),( Hee Jae Park ),( Cheong Ha Woo ),( Mira Choi ),( Hai-jin Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

About 10% to 35% of malignant melanomas are reported to show partial or complete histologic regression . However, multiple metastasis with regression of primary cutaneous melanoma is rarely reported. Histologic characteristic of melanoma regression is similar to that of scar. Pigment-laden cell nests are admixed with lymphocytes in sclerotic dermis. Dermal collagen shows a horizontal appearance with increased vascularity like scar tissue. The impact of partial or complete regression on prognosis is controversial. Herein, we report a rare case of regressed melanoma with multiple metastasis. A 47-year-old woman referred to our clinic for the evaluation of melanoma after the surgery of brain tumor which turned out to be metastatic melanoma. PET-CT showed enhancing lesions on periumbilical area, left iliac and inguinal lymph nodes. Scar like whitish patch was found on the left thigh which was suspected as the primary melanoma. She had a history of pigmented lesion on the whitish patch which disappeared spontaneously after several months of development. Histologic examination showed lymphocytes and pigment-laden cell nest within horizontally lined dermal collagen. Melanin pigment in cell nest was positive on argentaffin stain and negative for HMB-45, S-100 stain. As BRAF mutation was detected from the brain, dabrafenib mesylate(BRAF inhibitor) and trametinib(MEK inhibitor) combination treatment was started after the streostatic radiosurgery.

Treatment of plantar and periungual warts with squaric acid dibutylester

( Seung Pil Ham ),( Hee Jae Park ),( Cheong Ha Woo ),( Mira Choi ),( Hai-jin Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Squaric acid dibutylester(SADBE) immunotherapy has been used to treat viral warts which is resistant to other modalities like cryotherapy and bleomycin injection. However, few studies evaluated its efficacy in the treatment of plantar and periungual warts. Objectives: This study is to evaluate the safety and efficacy of SADBE immunotherapy for plantar and periungual warts. Methods: We retrospectively reviewed the clinical data of 21 plantar and periungual wart patients treated with SADBE during 5 years in a secondary medical center. Results: Among 21 cases, 16 were plantar type and 5 were periungual type. 2 were excluded, because one was not sensitized and the other patient showed clearance during sensitization. 6 of 21(28.5%) experienced adverse reactions. Among 19 patients, 14 showed favorable response(12 with complete or almost clear, 2 with partial clear) and 5 failed to the treatment. Treatment duration were statistically shorter in response group(mean, 13.8 weeks) than failure group(mean, 24 weeks) (p=0.01). Number of treatment were also fewer in response group(mean, 7.6 times) than failure group(mean, 12.4 times) (p=0.019). There was no relationship between treatment response and age, gender, disease duration, location. Conclusion: Although further large study is needed, our study suggests SADBE can be an effective and safe treatment for plantar and periungual warts.

P103 Microbiological characteristics of pathogens associated with skin and soft tissue infections during 5 years

( Seung Pil Ham ),( Cheong Ha Woo ),( Ho Yeol Lee ),( Sik Haw ),( Hai-jin Park ),( Mira Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Skin and soft tissue infections (SSTIs) are frequently seen in dermatology department. Microbiologic characteristics of the pathogens may affect the treatment and outcome. Objectives: The objective of this study is to evaluate the recent microbiological characteristics of SSTI and to compare inpatient and outpatient in a single study center. Methods: We retrospectively reviewed the clinical data of 202 patients with SSTI from 2011 to 2015 in a secondary medical center. Results: Among 202 cases, 172 were outpatients and 30 were inpatients. Mean age was significantly older in inpatient (61.5 vs 44.1 years, p=0.001). Most common infection site was the face in outpatients (25.5%) and leg in inpatients (33.3%). In 65/202 cases (32.1%), no bacterial species was identified. Major isolated pathogen was Staphylococcus aureus (25.7%), followed by coagulase negative staphylococcus (CNS) (23.3%) and Pseudomonas aeruginosa (5.4%). CNS was the most frequently isolated from leg (26.0%), but S.aureus was the most common pathogen from the face (30.6%). The susceptibility rates of S. aureus to the methicillin was 35.2%, and hospitalization was a significant factor to the methicillin resistance (p=0.002). Conclusion: As various organisms can cause SSTI and 32.1% were no growth in this study, close monitoring of the microbiologic characteristics of pathogen is important and unnecessary administration of antibiotics should be avoided.

Validity of diagnostic codes for identification of psoriasis patients in Korea

( Seung Pil Ham ),( Jae Hong Oh ),( Hee Jae Park ),( Jong Uk Kim ),( Ho Young Kim ),( So Young Jung ),( Sun Young Choi ),( Jung Eun Seol ),( Hyojin Kim ),( Myoung Shin Kim ),( Un Ha Lee ),( Mira Choi 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Recently, nationwide medical research of psoriasis using National Health Insurance Service database is increasing. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and concordance with electronic medical records should be validated to identify psoriasis patient Objectives: To validate the diagnostic codes of psoriasis (ICD-10 L40) and to find algorithm for identification of psoriasis Methods: We collected medical records of patients who got their first diagnostic codes of psoriasis during 5 years (2012-2016) from five hospitals. 15 percent of patients were randomly selected at each hospital. Patients were classified as psoriasis, not psoriasis, and questionable for final diagnosis. We validated several algorithms to identify psoriasis Results: Total 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with primary diagnostic codes of psoriasis and prescription of vitamin D derivatives. Positive predictive value was 96.5% (95% CI, 93.9~98.1%) which were significantly higher than including patients with psoriasis diagnostic codes alone (p=0.002, 96.5% vs. 91.0%). Sensitivity was 90.8% (95% CI, 87.2~93.4%) and specificity was 92.4% (95% CI, 86.9~95.9%) Conclusion: Our study demonstrates validated algorithm to identify psoriasis which is useful for the nationwide population based study for psoriasis

Localized multiple basaloid follicular hamartoma in a 30-year-old woman

( Seung Pil Ham ),( Jae Hong Oh ),( Hee Jae Park ),( Cheong Ha Woo ),( Mira Choi ),( Hai-jin Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Basaloid follicular hamartoma (BFH) is a rare benign neoplasm of the skin appendage and has varying clinical presentations. It may be localized or generalized and presents as solitary papule, linear nevoid pattern or multiple lesions in generalized distribution. Also, it may be familial, congenital or acquired. Sometimes it is associated with several systemic diseases such as myasthenia gravis, systemic lupus erythematosus and alopecia. Histologically, BFH is characterized by anastomosing cords and strands of basaloid cells embedded in loose stroma. Basaloid cells rise from adnexal structure and usually connected with epidermis and limited to the upper dermis. Histologic differential diagnosis includes basal cell carcinoma, tumor of follicular infundibulum and trichoepithelioma. A 30-year-old woman presented with multiple grouped erythematous to brownish papules and patches on the right thigh for 10 years. The number of lesions were slowly increased. Histopathologic findings showed anastomosing basaloid cell strands extending from epidermis with abortive hair germ formation. Peritumoral cleft was not observed and Bcl-2 staining was negative. She was diagnosed as localized multiple BFH without systemic disease. She refused surgical excision and was lost to follow-up. In Korea, only 4 cases of localized multiple BFH has been reported. Therefore, we report a rare case of localized multiple BFH in a 30-year-old woman.

Validity of Diagnostic Codes for Identification of Psoriasis Patients in Korea

( Seung Pil Ham ),( Jae Hong Oh ),( Hee Jae Park ),( Jong Uk Kim ),( Ho Young Kim ),( So Young Jung ),( Sun Young Choi ),( Jung Eun Seol ),( Hyojin Kim ),( Myoung Shin Kim ),( Un Ha Lee ),( Mira Choi 대한피부과학회 2020 Annals of Dermatology Vol.32 No.2

Background: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly. Objective: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis. Methods: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm. Results: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~ 93.4%) and specificity was 92.5% (95% CI, 86.9%~ 95.9%). Conclusion: Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea. (Ann Dermatol 32(2) 115∼121, 2020)

Case Study of Extensive Nevus Comedonicus in a Middle-aged Woman

( Seung Pil Ham ),( Hai-jin Park ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.4

[P196] A case of extensive nevus comedonicus in a middle aged woman

( Seung Pil Ham ),( Hee Jae Park ),( Cheong Ha Woo ),( Mira Choi ),( Hai-jin Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Nevus comedonicus is a rare hamartoma derived from pilosebaceous unit. Clinically nevus comedonicus is characterized by grouped or zosteriform arranged papules with central follicular openings containing keratinous plugs. It was named as nevus comedonicus because the lesions resemble comedones. Since it usually appears at early ages, delayed development of nevus comedonicus has been rarely reported. In addition, nevus comedonicus with extensive range also has been rarely reported. We describe a case of 51-year-old female with late onset nevus comedonicus. She had extensive black comedone like lesions located unilaterally on right upper arm, back and chest. It started from right upper arm 15 years ago. Histopathologic findings showed deep epidermal invagination filled with keratin plugs that consistent with nevus comedonicus. She did not have any systemic abnormality in spite of the extensive involvement of one half of trunk. We administrated topical ammonium lactate and oral isotretinoin. After 2 months of treatment, comedones on her arm slightly improved but the lesions on back and chest showed no significant improvement. Herein, we report a rare case of extensive nevus comedonicus occurred in adulthood.

The case of isolated nail psoriasis with onychomycosis progressed to psoriatic arthritis

( Seung Pil Ham ),( Jae Hong Oh ),( Hee Jae Park ),( Cheong Ha Woo ),( Mira Choi ),( Hai-jin Park ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Nail involvement is a common feature in psoriasis as 10-78% of psoriasis patients are affected and the percentage increases up to 85% in psoriatic patients. However, isolated nail psoriasis without cutaneous lesion constitutes only 5-10% of the patients. It is difficult to differentiate isolated nail psoriasis with other nail disease, such as, onychomycosis. They can even coexist and make it difficult to treat. As nail psoriasis can be a first manifestation of psoriatic arthritis or prognostic factor of psoriatic arthritis, early recognition and treatment of nail psoriasis in important. Herein, we report the difficult case of 67-year-old woman who were first treated as twenty nail dystrophy by onychomycosis but turned out to be nail psoriasis with onychomycosis after the diagnosis of psoriatic arthritis after 2 years later.

A case of myxofibrosarcoma on the thigh

( Seung Pil Ham ),( Byeong Chang Ko ),( Jae Hong Oh ),( Hee Jae Park ),( Mira Choi ),( Hai-jin Park ),( Sik Haw ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Myxofibrosarcoma is a malignant myxoid tumor of fibroblastic origin. It locates commonly on the extremities and limb girdles of elderly. Clinically, it appears as painless nodule in the proximal extremities, especially the thigh. Approximately two thirds develop within the dermis or subcutis. The other cases appear in deep tissues like skeletal muscles. Histologically, it appears as a multinodular tumor characterized by a proliferation of fusiform or stellate fibroblasts and delicate, curvilinear blood vessels within hyaluronic acid-rich myxoid stroma. It should be distinguished with other soft tissue tumor because of its malignant potential. It has a high rate of recurrence and metastasis which is related to the anatomic depth of the primary tumor and histologic grade. A 47-year-old female presented with 2-year history of painless subcutaneous mass on the left posterior thigh. When standing still, it was unrecognizable, but when it was bent, the lesion protruded. Excisional biopsy showed proliferation of round, spindle, and stellate shaped fibroblasts with curvilinear blood vessels within a prominent myxoid stroma. Tumor cells were positive to vimentin in focal area. Based on these findings, myxofibrosarcoma was diagnosed. The patient was referred to orthopedic surgery department for complete excision. She had radiotherapy after the surgery and is now under observation without recurrence.