기저 편평 세포암

정기양(Kee Yang Chung),전수일(Soo Il Chun) 대한피부과학회 1986 대한피부과학회지 Vol.24 No.4

An 89- Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.

Update in surgical treatments for skin cancers: understand new surgical methods

정기양 ( Kee Yang Chung ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

Background: Dermatologic surgery is widely becoming an important subspecialty of dermatology and new developments are being reported on surgical management of skin cancers. Objectives: To summarize recent new developments in the surgical aspects of cutaneous oncology. Methods: Literatures were searched and pertinent articles on surgical treatment of skin cancers during the last 2 years were summarized. Results: Mohs micrographic surgery is usually used for the most common nonmelanoma skin cancers, i.e., squamous cell carcinomas and basal cell carcinomas. However, it can be applied to to treat rarer and more aggressive types of cancer, such as Merkel cell carcinoma and also can be utilized for skin cancers in areas where preservation of function and cosmesis is very important. Squamous cell carcinomas occurring on penis can be cleared with Mohs to conserve penis of its function and benign condition such as erosive adenomatosis of the nipple can be safely removed to maintain the cosmesis of the nipple. Among the many methods of wound reconstruction, secondary intention wound healing is very effective but has a drawback of taking longer time to heal than direct closures. However, using porcine xenograft over the second intention wounds can protect the wound and promote healing. Conclusion: Surgical innovations in dermatologic surgery is ongoing and they can surely benefit patients who have to undergo surgery of the skin for various causes.

Focus 2-6 (FS 2-6) : Mohs surgery: Is it truly worthwhile considering outcome, cost and effort?

정기양 ( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Measures to minimize scars in dermatosurgery

정기양 ( Kee Yang Chung ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Unless a tumor recurs after a surgery, scar is what patients use to evaluate the overall experience of the skin tumor treatment. In order to maximize patient satisfaction, measures to minimize scars or to prevent unsightly scars should be employed during various phases of the surgery. Designing an incision line and reconstruction method is the first step in this process. Scars are usually more prominent on the trunk than on the face, due to the gradual widening caused by greater tension exerted on this body part. Therefore, careful placement of incision lines for tumor removal and flap closure should follow the relaxed skin tension lines whenever possible but this may not always be feasible in complicated repairs. When closing a defect, meticulous hemostasis and closure of any dead space should be carried out as the second step. Delayed bleeders or dead spaces that result in hematomas are very likely to generate secondary infection and delayed healing which will always produce unattractive scars. As the third step, to close any dead spaces and also to counteract the tension as much as possible, sutures should be placed in multiple layers and in special knots if necessary. Subcuticular sutures should enclose maximum amount of dermis in their bites since it is the strongest component in the skin. Not only placing the sutures right is important but also choosing the appropriate suture material is equally significant because when an absorbable suture is used that dissolves in a short period of time before the skin regains enough tensile strength, the scar is guaranteed to spread. The cutaneous sutures should be removed around 1 week in order to minimize the unsightly suture marks and cautious taping of the scar to substitute for the loss of upper-most sutures is the fourth step in minimizing the scar. In addition to these initial measures, there are further steps with which to modify and improve later stages of scar healing and remodeling but only the first 4 steps will be discussed in this lecture.

항보체 간접 면역형광법을 이용한 조직내의 Treponema pallidum 검출에 관한 연구

정기양(Kee Yang Chung),이민걸(Min Geol Lee),이정복(Jung Bock Lee) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.4

Using the FTA-ABS complernent test, 32 skin speciruens from 27 patients with primary and secondary syphilis and a stomach specimen from a patient with suspected gastric syphilis which were confirmed by clinical history, physical examination, VDRL, FTA-ABS, and 19S(IgM)-FTA test, were tested. The following results were obtained. 1. In the darkfield examination, 7 of the 9 specimens(78%) were positive and in the FTA-ABS complernent test, 20 of the 33 specimens(61%) were positive. 2. The ratio of agreement between the darkfield examination and the FTA- ABS complement test was 89%. 3. In the chancres, macular syphilids, and condyloma lata, T. pallida were diffusely scattered in the epidermis, dermoepidermal junction, connective tiasue, and vascular walls, whereas in the papular syphilid T. pallida were mainly aggregated in the the epidermis, dermoepidermal junction, papillary dermis as well as the blood vessel walls in the papillary dermis. From these results, the FTA-ABS complement test can be considered to be a useful method for both the diagnosis and research of syphilis. It is especially helpful in cases where serological or histopathological study can not confirrn the diagnosis as when internal organs are involved.

Melanoma surgery and NPWT as a reconstruction option

정기양 ( Kee Yang Chung ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot and wide excision usually results in a substantial defect. Various repair methods including distant flap, full-thickness skin graft and secondary intention healing (SIH) are used to repair these defects. Recently, use of negative pressure wound treatment (NPWT) has been shown to accelerate wound healing in different types of wounds. We have retrospectively compared the functional and cosmetic results of NPWT and SIH in 22 patients who underwent wide excision of melanomas on the foot. The defects of 13 patients were healed by secondary intention (SIH group) and 9 using negative pressure wound treatment (NPWT group). There was no significant difference in time to complete wound healing between the two groups. However, evaluation using Vancouver Burn Scar Assessment Scale of Scars at time of complete healing showed that the mean value of NPWT group was significantly lower than that of the SIH group. The NPWT group also had significantly better results than the SIH group for total score, vascularity, and height of the scars. As for complications, no wound infection was encountered in NPWT group, whereas 8 of 13 patients in SIH group were found to be affected by wound infection in the course of treatment despite frequent and meticulous aseptic dressing changes. These results show that, despite the drawback of rather prolonged healing time, NPWT is an excellent therapeutic option for post-wide excision wounds on feet with acceptable functional and cosmetic outcomes.

Dialogues and Debates in Dermatology (DDD 1) : Which is the best option? To treat ASAP vs wait & see

정기양 ( Kee Yang Chung ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Actinic keratosis (AK) is a precancerous lesion caused by chronic exposure to ultraviolet light. It is known to occur mainly in Caucasians but the incidence in Korea is known to increase as well. Not all AKs progress into squamous cell carcinoma (SCC) but approximately 90% of SCCs have contiguous AKs which is consistent with the perception that SCCs are preceded by AKs. A study found that up to 60% of SCCs arise directly from an AK and another study showed that 136 of 165 SCCs have close relationship to AKs. Of these SCCs, 26.7% were seen to have occurred directly from an existing AKlesion and 55.7% were closely situated to an AK lesion. How much of the AKs actually progress into invasive SCCs is not yet known with certainty but the range is known to be anywhere from 0.075% to 16% or even more. This means that the majority of AKs remain stable or they may even regress. A review found that annual rates of regression for a single AK to be 15% to 63% with recurrence rates of 15% to 53%. These clinical data are not conclusive and it is still impossible to predict which AK will progress into an invasive SCC and which will regress. This uncertainty has ignited much discussion regarding the best treatment approach for AKs, with some encouraging careful follow up and others claiming aggressive approach.

Focus 2-2 (FS 2-2) : Is Mohs micrographic surgery really necessary?

정기양 ( Kee Yang Chung ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Mohs micrographic surgery (MMS), first developed by Dr. Frederic E. Mohs in 1936, is a microscopically controlled surgery used to treat skin cancers such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma in situ. Currently, indications for MMS have been expanded encompassing dermatofibrosarcoma protuberans (DFSP), sebaceous carcinoma, microcystic adnexal carcinoma, extramammary paget’s disease (EMPD), angiosarcoma and atypical fibroxanthoma and many other benign and malignant lesions. The goal of MMS is to remove the skin cancer completely with free margins to maximize cure rates and also to achieve minimal surgical defects. This procedure therefore allows to achieve a high cure rate and excellent cosmetic result. MMS is usually performed as follows; 1. Outline the visible tumor and remove the main mass with very small safety margin. 2. Mark and map the resected tissue by color encoding. 3. Make frozen sections of the margin and stain. 4. Microscopic examination of the frozen sections and map any residual tumor for 2nd stage removal. Repeat the procedure until completely tumor free margin is acquired. 5. Reconstruction of the surgical defect The cure rate of MMS is superior to other treatment modalities and MMS is expanded to treat dermatofibrosarcoma protuberans, sebaceous carcinoma, microcystic adnexal carcinoma, extramammary Paget’s disease, angiosarcoma, atypical fibroxanthoma and various other skin tumors. This lecture will outline why MMS is necessary in surgically managing skin cancers as compared toconventional wide excision and introduce challenging cases that were successfully treated by MMS.

Surgery of acral melanoma

정기양 ( Kee-yang Chung ) 대한피부과학회 2023 대한피부과학회 학술발표대회집 Vol.74 No.2

혀에 발생한 구공성 결핵

정기양(Kee Yang Chung),박성현(Seong Hyun Park),이승헌(Seung Hun Lee) 대한피부과학회 1987 대한피부과학회지 Vol.25 No.6

A tender, non-healing ulcer of 3 months' duration developed on the tongue tip of a 51-year-old male with active pulmonary tuberculosis. Acid-fast bacilli were grown in the tissue and sputum cultures. The patient was anergic to PPD skin test before the treatment and IL-2 productivity was significantly decreased. Sections from the tongue tip showed ulceration, infiltration of neutrophils and tuberculoid granulornas accompanying caseation necroses in the dermis. The ulcer healed after administration of anti-tuberculosis medication for 2 months.