BACKGROUND: Serial (staged) excision of congenital melanocytic nevi (CMN) is an important treatment option for medium-sized CMN. However, few studies have investigated the outcomes of serial excision in detail.OBJECTIVE: We report our experience regarding serial excision of CMN, including methods to effectively reduce the procedural stages and scar length.METHODS: We retrospectively reviewed medical records of patients with CMN treated between 2008 and 2015; 33 patients (7 men and 26 women) underwent serial excision.RESULTS: The CMN were located on the face (n=11), arms (n=6), legs (n=11), and other areas of the body (n=11), including the back (n=2), chest (n=1), deltoid region (n=1), and buttocks (n=1). The mean CMN area was 19.7 cm². The mean number of surgical stages was 2.2. The mean interval between surgeries was 10.6 months. A marginal S-shaped incision along both edges of the nevus was preferred over elliptical excision, to reduce scarring. Pulsed dye, erbium:yttrium–aluminum–garnet (YAG), neodymium-doped:YAG, and carbon dioxide fractional lasers were used to improve the final outcomes and minimize scarring.CONCLUSION: Serial excision is an effective treatment option associated with greater patient satisfaction, particularly for medium-sized and hairy CMN. Conventional elliptical serial excision is associated with the formation of elongated scars and sacrifices normal skin adjacent to the lesion. The marginal S-shaped incision reduces scarring by dispersing mechanical tension on the scar without skin wastage. Compared with the elliptical excision method, the marginal S-shaped incision reduces the number of surgical stages and results in a cosmetically superior scar. Performing a marginal S-shaped incision is technically challenging in certain anatomical locations, such as the eyes, nose, and mouth. Therefore, it is necessary to combine this procedure with erbium:YAG and neodymium-doped:YAG ablation.
Arm ; Buttocks ; Carbon Dioxide ; Cicatrix ; Dermatologic Surgical Procedures ; Humans ; Leg ; Male ; Medical Records ; Methods ; Mouth ; Nevus ; Nevus, Pigmented ; Nose ; Patient Satisfaction ; Retrospective Studies ; Skin ; Thorax

PURPOSE: This study was designed to investigate differences in ultrasonographic findings between malignant and benign mammary duct ectasia. METHODS: From January 2003 to June 2005, 54 surgically proven mammary duct ectasia lesions depicted on sonograms were included in this study. We evaluated the ultrasonographic (US) findings in terms of involved ductal location, size, margin, intraductal echogenicity, presence of an intraductal nodule, calcification, ductal wall thickening and echo changes of the surrounding breast parenchyma. The US findings were correlated with the pathological features. RESULTS: Of the 54 lesions, 46 lesions were benign and eight lesions were malignant. Benign lesions included an inflammatory change (n=7), ductal epithelial hyperplasia (n=7), fibrocystic change (n=18), intraductal papilloma (n=11), atypical ductal hyperplasia (n=2) and sclerosing adenosis (n=1). Malignant lesions included ductal carcinoma in situ (DCIS) (n=6), infiltrating ductal carcinoma (n=1) and mucinous carcinoma (n=1). On US images, the peripheral ductal location, an ill-defined margin, ductal wall thickening and a hypoechoic change of the surrounding parenchyma were features significantly associated with malignant duct ectasia. CONCLUSION: For ill-defined peripheral duct ectasia with ductal wall thickening and surrounding hypoechogenicity as depicted on US, the possibility of malignancy should be considered and radiologists should not hesitate to recommend a prompt biopsy.
Adenocarcinoma, Mucinous ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation, Pathologic ; Hyperplasia ; Papilloma, Intraductal ; Ultrasonography, Mammary

BACKGROUND: Numerous modalities of treatment for vitiligo have been introduced and have been proposed; however, treatment for vitiligo remains challenging with no adequate solution. OBJECTIVE: This study was designed to examine the capability of the use of a fractional laser to induce pigmentation for vitiligo and to investigate the therapeutic and clinical parameters that affect therapeutic outcome. METHODS: A total of 30 lesions in 12 patients with vitiligo were treated clinically with three fractional laser systems with a four-week interval. Simultaneously, all patients were treated with narrow-band UVB (NBUVB) light twice a week. The pigmentation rates were graded based on the use of a five-point scale by a dermatologist. We also investigated the patient satisfaction level and compared the pigmentation rates of the lesions treated with a fractional laser plus NBUVB with control areas treated only with NBUVB. In addition, we analyzed the mean grade of pigment induction for various therapeutic and clinical parameters. RESULTS: A total of 30 lesions were treated with a fractional laser. The pigmentation grade and satisfaction score were higher in the areas treated with a fractional laser, especially with an Nd:YAG fractional laser, as compared to the control areas. The degree of pigmentation was better achieved for small-sized lesions (<2 cm2). Other clinical parameters that affected the therapeutic outcome were the duration of vitiligo and the existence of poliosis. However, the anatomical location of lesions and the type of vitiligo did not affect the therapeutic outcome. No significant side effects were observed. CONCLUSION: A fractional laser system offers an increase of overall pigmentation with a minimal risk of discomfort and side effects, especially for a small-sized patch of vitiligo without poliosis and for patients with vitiligo of a short duration (less than one year).
Humans ; Light ; Patient Satisfaction ; Pigmentation ; Vitiligo

BACKGROUND: Hypertrophic scars and keloids are prevalent and emotionally debilitating dermatologic diseases. Various treatment modalities have been advocated to treat hypertrophic scars and keloids. OBJECTIVE: This study prospectively assessed the safety and efficacy of using intense pulsed light (IPL) on scars that originate from surgery. METHODS: A total 22 patients with surgically induced hypertrophic scars and keloids were treated with IPL. Treatment was administrated at 4-week intervals, with an average of 3.5 sessions (range=1~10). The scars were evaluated for pigmentation, pliability, height, vascularity, pain and pruritus by using the modified Vancouver Scar Scale (MVSS). The subjective assessment of satisfaction was scored by the patients on a 25% increment of satisfaction scale. Evaluations were performed monthly during the follow-up period. RESULTS: There was overall clinical improvement for the appearance of the scars. Although statistically significant improvement was not shown (p=0.47), the average MVSS showed a trend for favorable effects on the scars with the successive IPL treatments. The patients who had higher baseline MVSS (> or =10) demonstrated statistically significant improvements with the successive IPL treatments (p<0.05). The degree of the patient's satisfaction also improved with the treatment for all of the patients (p<0.05). The adverse effects were negligible. CONCLUSION: IPL is one of the effective, safe methods to improve the clinical appearance of surgically induced hypertrophic scars and keloids and this treatment had high patient satisfaction and relatively few side effects.
Cicatrix ; Cicatrix, Hypertrophic ; Follow-Up Studies ; Humans ; Keloid ; Light ; Patient Satisfaction ; Pigmentation ; Pliability ; Prospective Studies ; Pruritus

BACKGROUND: Malignant fibrous/fibrohistiocytic tumors are uncommon soft tissue tumors which gives dermatologists special attention on differential diagnosis. However, there has not yet been a multicenter study on these tumors in Korea. OBJECTIVE: The aim of this study was to investigate the epidemiology and clinical features of malignant fibrous/ fiborhistiocytic tumors. METHODS: A total of 62 patients from 11 training hospitals who had been confirmed with malignant fibrous/ fibrohistiocytic tumor were studied. A retrospective analysis of hospital records served as the data source for this study. RESULTS: Among patients with malignant fibrous/fibrohistiocytic tumors, the most common tumor type was dermatofibrosarcoma protuberance followed by malignant fibrohistiocytic. The male to female ratio among subjects was 1.38 to 1 and the mean age was 44 years old. Of the common complaints recorded, asymptomatic mass was the most frequent. The mean size of the subjects' tumors was 2.9 cm in the long axis and 2.3 cm in the short axis with a mean tumor thickness of 2.1 mm. The most common site for tumors was the back followed by the thigh. The recurrence rate after primary treatment was 14.5% and metastasis developed in 5 of 62 patients. CONCLUSION: This study is expected to be helpful for understanding the clinical and pathological characteristics of malignant fibrous/fibrohistiocytic tumors.
Axis, Cervical Vertebra ; Information Storage and Retrieval ; Dermatofibrosarcoma ; Diagnosis, Differential ; Female ; Hospital Records ; Humans ; Korea ; Male ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thigh

Nowadays, patients have high expectations when it comes to minimization of postoperative scarring after dermatologic surgical procedures. When an annular lesion is being excised, normal skin should be excised, as well, to prevent a dog ears resulting in a long scar. We introduce a new flap reducing the scar length in annular defects. In order to avoid a long scar, we designed a quadruple fan flap (O-X flap) that is a variation of the rotation flap. It consists of four rotation flaps arranged like fans, with open and closed configuration. We suggest that the quadruple fan flap (O-X flap) is a viable option for treating annular skin defects, because it shortens the scar line, preserves normal tissue, and provides a cosmetically favorable outcome.
Animals ; Cicatrix ; Dermatologic Surgical Procedures ; Dogs ; Ear ; Humans ; Skin

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.
Cicatrix ; Cosmetics ; Cryosurgery ; Curettage ; Dermabrasion ; Erythema ; Humans ; Laser Therapy ; Lasers, Solid-State ; Melanoma ; Nevus ; Nevus, Pigmented ; Sutures

BACKGROUND: There are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery. The proper choice of treatment depends on the size, location, thickness and clinical appearance of the nevi, the risk for developing melanoma, the psychological effect and the cosmetic component. OBJECTIVE: The purpose of this study is to evaluate the outcome of a combination of surgical excision with Er: YAG laser ablation for treating CMNs. METHODS: A total of 13 patients were included in this study. The nevus was excised as much as possible and only dermal suturing was performed, without epidermal suturing, for the primary closure. We then ablated the whole lesion, including the suture lines, by using a dual-mode 2,940 nm Er:YAG laser with three to five passes. All the lesions were followed up for 6 months and they were evaluated with respect to the healing status, infection, erythema, scarring, textural change and pigmentary change. Subject satisfaction was scored at the 16th week by the patients. RESULTS: Eleven (83%) of the 13 patients were clinically rated as having a good to excellent result by the physicians' Global Assessment Scale (GAS) scores for the lesions' reduction of size, the degree of scarring and the pigmentary change with only a one stage procedure. 10 (77%) of the total 13 patients reported a good to excellent result at four months after treatment. CONCLUSION: A combination of surgical excision with Er:YAG laser ablation as a one stage procedure is a safe, effective modality and it should be considered as one of the options for treating medium-sized CMNs.
Cicatrix ; Cosmetics ; Cryosurgery ; Curettage ; Dermabrasion ; Erythema ; Humans ; Laser Therapy ; Lasers, Solid-State ; Melanoma ; Nevus ; Nevus, Pigmented ; Sutures

BACKGROUND: Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. OBJECTIVE: The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. METHODS: In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. RESULTS: We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. CONCLUSION: We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.
Animals ; Cicatrix ; Dogs ; Ear ; Humans ; Nevus ; Nevus, Pigmented ; Skin ; Sutures

Acantholytic squamous cell carcinoma is a well-defined variant of squamous cell cancer in which significant portions of the neoplastic proliferation show a pseudoglandular or tubular microscopic pattern. It usually presents as a nodule with various colors, and it is accompanied by scaling, crusting, and ulceration on the sun-exposed areas of older aged individuals. Histologically, the tumor consists of a nodular, epidermal-derived proliferation that forms island-like structures. At least focally or sometimes extensively, the tumor cells shows a loss of cohesion within the central gland-like or tubular spaces. This tumor resembles the structure of eccrine neoplasms, but it is negative for dPAS, CEA and mucicarmine and it is only positive for EMA and cytokeratins. Herein we report a case of acantholytic squamous cell carcinoma that occurred on the face of an 82-year-old woman.
Adenoids ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; Carmine ; Humans ; Keratins ; Neoplasms, Squamous Cell ; Skin ; Ulcer