BACKGROUND: Although intralesional methotrexate (MTX) is an effective, nonsurgical treatment of keratoacanthoma (KA), there have not been many reports of on the MTX treatment for KA in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of the intralesional MTX for the treatment of KA in Korean patients. METHODS: We retrospectively studied seven patients with KA who received intralesional injection of MTX in our department. The efficacy was evaluated based on the physician assessment. Our review also included the cases of KA treated with intralesional MTX in Korean patients from the previous reports. We then analyzed the therapeutic regimens in the Korean patients by comparing them with the Caucasian patients. RESULTS: We identified 11 cases of Korean KA patients treated with an intralesional MTX, including seven from our institution and four from the Korean literature. Ten of the 11 patients (91%) showed a complete resolution with an intralesional MTX. No adverse events were observed during the treatment and the follow-up periods. No recurrence was found during the follow-up. In therapeutic analysis, the Korean patients required 2 to 7 injections (mean 4.6 injections) to achieve a tumor resolution with the mean time to clearing at 7.6 weeks. CONCLUSION: Intralesional MTX can be an effective and safe non-operative treatment modality for most Koreans with KA.
Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Keratoacanthoma* ; Korea ; Methotrexate* ; Recurrence ; Retrospective Studies*

BACKGROUND: Keloids and hypertrophic scars represent excessive scarring. They require different therapeutic approaches, which can be hampered because of an apparent lack of morphologic difference between the two diseases. OBJECTIVE: This study investigated the clinical and dermoscopic features of keloids and hypertrophic scars in order to help dermatologists distinguish these lesions better. METHODS: A total of 41 keloids and hypertrophic scars in 41 patients were examined clinically and by performing dermoscopy with a digital imaging system. Lesions were evaluated for vascular structures. RESULTS: Dermoscopy revealed vascular structures in most keloid lesions (90%) but in only 27% of hypertrophic scar lesions. The most common dermoscopic vascular structures in keloids were arborizing (52%), followed by linear irregular (33%) and commashaped (15%); these features were present but less evident in hypertrophic scars (9% for all types). The distribution frequency of the vascular structures differed significantly between diseases (p<0.001). CONCLUSION: A strong association of vascular structures with keloids was observed on dermoscopic examination. The results suggest dermoscopic examination of vascular structures is a clinically useful diagnostic tool for differentiating between keloids and hypertrophic scars.
Blood Vessels ; Cicatrix ; Cicatrix, Hypertrophic* ; Dermoscopy* ; Humans ; Keloid*

Squamous cell carcinomas arising from the paranasal sinuses are often accompanied by eyeball pain, proptosis, decreased visual acuity and diplopia because of the proximity to the orbit. We report a case of squamous cell carcinoma of maxillary sinus mimicking chronic dacryocystitis and orbital cellulitis due to destruction of lacrimal apparatus.
Carcinoma, Squamous Cell* ; Dacryocystitis ; Diplopia ; Exophthalmos ; Lacrimal Apparatus* ; Maxillary Sinus ; Orbit ; Orbital Cellulitis ; Paranasal Sinuses ; Visual Acuity

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignant neoplasm. Cutaneous SCC shows a broad spectrum, ranging from easily managed superficial tumors to highly infiltrative, metastasizing ones that can cause death. We have experienced two patients with SCC with intracranial extension. One case was an 88-year-old man with a tumor on the forehead treated with Mohs micrographic surgery who presented with local recurrence at the perilesional region of the primary site after 3 years. Wide excision was performed, and histologic findings showed a SCC that extended to the dura mater. The other case was a 69-year-old woman who presented with an erythematous 2x4 cm-sized plaque on the right temple, and a biopsy examination revealed SCC. The patient refused surgery and 7 months later, presented with a 5x10 cm-sized oozing plaque with multiple ulcers. Radiologic evaluation demonstrated intracranial invasion and right retropharyngeal metastatic lymph nodes. She was treated with radiotherapy for 4 months.
Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Squamous Cell* ; Dura Mater ; Female ; Forehead ; Humans ; Lymph Nodes ; Mohs Surgery ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Skin ; Ulcer

Background: Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. Methods: Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. Results: We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, P=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. Conclusions US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

Background: Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. Methods: Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. Results: We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, P=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6–8] vs. 8 [interquartile range, 7–9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. Conclusions US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

Several reports have described the usefulness of tumor markers detected in pancreatic juice for diagnosis of pancreatic cancer. We performed this study to evaluate the usefulness of tumor markers in pure pancreatic juice collected by duodenoscopic cannulation of pancreatic duct before and after injection of secretin. From April 1993 to July 1995, 8 cases of pancreatic cancer, 5 cases of benign pancreatic lesions, and 5 cases of benign biliary diseases without pancreatic lesion were involved. CEA and CA 19-9 immunoreactivity were measured by radioimmunoassay. Concentrations of CA 19-9 in pure pancreatic juice were significantly higher in patients with pancreatic cancer(median value; 3582, range 88.4-10410 IU/ml) than in control patients(median value 231, range 30.4-682 IU/ml)(p<0.05). Concentrations of CEA in pure pancreatic juice were not significantly different between patients with pancreatic cancer(median value: 6,5, range 1.0-152ng/ml) and control patients(median value: 4.0, range 1-17.2 ng/ml)(p>0.05). There was no significant correlation between levels of CA19-9, CEA in pancreatic juice and those levels in serum. The amounts of juice collected by duodenoscopic cannulation in patients with pancreatic cancer were 1.5+/- 0.9ml during 5 minutes before infusion of secretin, 11.3+/- 3.9ml, 10.8+/- 4.0ml, 10.6+/- 4.0ml in 5 minute interval after infusion of secretin. These results indicated that measurement of CA19-9 in pure pancreatic juice may be used as a marker for pancreatic cancer. Adequate amount of pancreatic juice was collected by duodenoscopic cannulation for evaluation of tumor marker, enzyme studies and cytology.
Catheterization ; Diagnosis ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Juice* ; Pancreatic Neoplasms ; Radioimmunoassay ; Secretin ; Biomarkers, Tumor

Subungual melanoma is a variant of acral lentiginous melanoma and is thought to carry a poor prognosis due to difficulties in early diagnosis. Classical management of subungual melanoma is based on the radical surgery of distal phalanx amputation. Instead, conservative treatment with non-amputative wide excision of the nail unit followed by reconstruction has been insufficiently reported, especially in Korea. A 71-year-old woman presented with dark brownish longitudinal bands on her right thumbnail. Punch biopsies from the nail matrix and nail bed showed proliferation of atypical melanocytes without dermal involvement. We describe a case of subungual melanoma in situ of the right thumb, and a non-amputative surgical management which aims to provide adequate clearance of the lesion with minimal morbidity and satisfactory preservation of function for the patient.
Amputation ; Biopsy ; Early Diagnosis ; Female ; Humans ; Korea ; Melanocytes ; Melanoma ; Nails ; Prognosis ; Thumb

BACKGROUND: The relationship between viral hepatitis and lichen planus (LP) remains as a matter of controversy. Geographical variations are suggested to be a major factor influencing such association. Reliable figures from Korean patients are still lacking. OBJECTIVE: The aim of this study is to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Korean patients with lichen planus (LP) and to compare it with patients without LP. METHODS: The retrospective study was performed on 45 LP patients and 45 controls with matching age and gender. We examined for serological evidences of hepatic disease, hepatitis B surface antigen (HBsAg), and anti-HCV seropositivity. Statistical analysis was calculated by using an unpaired t-test and Fisher's exact test. RESULTS: No significant differences between the serum levels of alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed between the two groups. The prevalence of HBsAg in LP patients (4.4%) was not significantly higher (p>0.05) than those of the control subjects (2.2%). None of the patients with LP nor the control subjects had Anti-HCV. CONCLUSION: Korean patients with LP did not have any significant associations with liver diseases or HBV, and HCV infections. Although a large-scale multicenter study is needed to support our results, it is not advisable for Korean patients with LP to be tested for liver functions or HBV, and HCV infections as part of a routine screening test.
Alanine Transaminase ; Aspartate Aminotransferases ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis* ; Humans ; Lichen Planus* ; Lichens* ; Liver Diseases ; Liver Function Tests* ; Liver* ; Mass Screening* ; Prevalence ; Retrospective Studies

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees