Adenoid cystic carcinoma (ACC) is a malignant neoplasm of glands commonly occurs in salivary glands. Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of ACC that primarily presents on the skin. Herein, we represent a rare case of PCACC occurred in the umbilicus in a 66-year-old Korean male patient. The patient visited our center with erythematous indurated patch on the umbilicus diagnosed as ACC by incisional biopsy at another center. The diagnosis of PCACC was confirmed by additional histopathologic examination and imaging study. We proceeded Mohs micrographic surgery and reconstructed umbilicus with tacked purse string suture. Local recurrence and distant metastasis were not observed during 30-month follow-up. We report this rare case of PCACC on the umbilicus so that dermatologist can aware of the rare disease. Furthermore, we recommend MMS and tacked purse string suture as effective methods for treatment of PCACC and immediate umbilical reconstruction.
Adenoids ; Aged ; Biopsy ; Carcinoma, Adenoid Cystic ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Mohs Surgery ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Salivary Glands ; Skin ; Sutures ; Umbilicus

Birt-Hogg-Dubé syndrome (BHDS) is a rare disease with autosomal dominant inheritance that manifests through skin tumors, pulmonary cystic lesions, and renal tumors. A mutation of FLCN located on chromosome 17p11.2, which encodes a tumor-suppressor protein (folliculin), is responsible for the development of BHDS. We report the case of a patient presenting with spontaneous pneumothorax, in whom a familial genetic study revealed a novel nonsense mutation: p.(Arg379*) in FLCN.
Birt-Hogg-Dube Syndrome* ; Codon, Nonsense ; Estrone* ; Humans ; Pneumothorax* ; Rare Diseases ; Skin ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Wills

Birt-Hogg-Dubé syndrome (BHDS) is a rare disease with autosomal dominant inheritance that manifests through skin tumors, pulmonary cystic lesions, and renal tumors. A mutation of FLCN located on chromosome 17p11.2, which encodes a tumor-suppressor protein (folliculin), is responsible for the development of BHDS. We report the case of a patient presenting with spontaneous pneumothorax, in whom a familial genetic study revealed a novel nonsense mutation: p.(Arg379*) in FLCN.
Birt-Hogg-Dube Syndrome* ; Codon, Nonsense ; Estrone* ; Humans ; Pneumothorax* ; Rare Diseases ; Skin ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Wills

Xanthogranulomas are the most common form of non-Langerhans cell histiocytosis. Both adult and childhood forms have been described. Adult cutaneous forms can present as solitary or multiple yellowish, orange-red or tan-hued papules. Herein, we present the case of a 28-year-old Chinese man with a skin-coloured nodule on his left nasal ala that persisted for several months. While initial impression was that of a fibrous papule of the nose, the results of an excision biopsy showed histological features corresponding to xanthogranuloma. This case demonstrates the condition’s myriad of dermatological presentations, and adds to the differential diagnoses of a cutaneous lesion found in the head and neck region.
Adult ; Biopsy ; Diagnosis, Differential ; Granuloma ; diagnosis ; surgery ; Histiocytosis ; diagnosis ; Humans ; Male ; Skin ; pathology ; Skin Diseases ; diagnosis ; surgery ; Treatment Outcome

BACKGROUND/AIMS: Non-tuberculous Mycobacterium (NTM) infections usually result in chronic disease, and making a diagnosis is often difficult. Skin and soft tissue infections due to NTM are not common and are usually diagnosed relatively late. We investigated the clinical characteristics of nine cases of skin and soft tissue infections with NTM. METHODS: Nine patients with an NTM infection who were confirmed consecutively by skin and soft tissue and/or adjacent bone cultures at a teaching hospital between August 2006 and July 2013 were enrolled in this study. The demographics, clinical characteristics, underlying diseases, treatment, and prognosis between different NTM species were reviewed retrospectively. RESULTS: The most common NTM species causing a soft tissue infection was Mycobacterium abscessus (five patients, 55.6%). Common sites of infection were the knee and lumbar spine. Five patients (55.6%) had underlying diseases. Six patients (77.8%) were treated with combined surgical treatment (incision and drainage) plus antibiotics. The duration from symptom onset to diagnosis was long (77.7 +/- 44.6 days) due to inadequate microbiological evaluation and disregard for the clinical significance of the NTM culture. All patients were cured with treatment; however, the treatment duration was long (181.7 +/- 140.0 days). Procedure and cosmetic surgery were the most important risk factors for infection. CONCLUSIONS: The diagnosis of NTM skin and soft tissue infections tends to be delayed in a clinical setting. Therefore, a high index of suspicion for NTM infection in chronic localized soft tissue infections is essential for diagnosis. Mycobacterium abscessus appears to be the most common NTM species causing soft tissue infections.
Anti-Bacterial Agents ; Chronic Disease ; Demography ; Diagnosis ; Hospitals, Teaching ; Humans ; Knee ; Mycobacterium Infections ; Mycobacterium* ; Prognosis ; Retrospective Studies ; Risk Factors ; Skin ; Skin Diseases ; Soft Tissue Infections* ; Spine ; Surgery, Plastic

OBJECTIVETo investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar.

METHODSThe proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects. The deep fascia was cut off at the both sides of flaps. The plantar fascia should be included into the flaps. Then the flaps were rotated to cover the defects, containing two or three perforators. If necessary, the original supplying vessels could be cut off to facilitate the advancement of flaps.

RESULTSFrom Jan. 2010 to Oct. 2012, 7 cases with plantar defects were treated with the horn shaped perforator flaps. The defects size ranged from 1.5 cm x 2.0 cm to 4.0 cm x5. 0 cm with the size of the flaps ranging from 7 cm x 3 cm to 13 cm x 7 cm. All the flaps survived completely with primary healing both on donor and recipient sites. The flap color, texture, function and appearance were satisfactory during the follow-up period of 3-24 months.

CONCLUSIONSThe plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue, which facilitates the functional reconstruction. No skin graft is necessary for the defect at donor site.

Adult ; Female ; Foot Diseases ; surgery ; Humans ; Male ; Middle Aged ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Soft Tissue Injuries ; surgery

OBJECTIVETo investigate the treatment of upper lip atrophy resulted by previous therapy.

METHODSFrom Mar. 2008 to Mar. 2012, 4 cases with upper lip atrophy resulted by radiotherapy and sclerosing agent injection were treated with lower orbicularis oris muscle flap wrapped by acellular dermis. The thickness and height of upper lip were increased to improve the lip atrophy.

RESULTSPrimary wound healing was achieved in all the 4 cases. All the patients were followed up for 3 years with obvious improvement and inconspicuous scar.

CONCLUSIONThe volume of lower lip in children is not sufficient as donor site. The lower orbicularis oris muscle flap wrapped by acellular dermis can effectively improve the lip thickness and vermilion portion of upper lip.

Acellular Dermis ; Atrophy ; surgery ; Child ; Female ; Humans ; Lip Diseases ; surgery ; Male ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps

OBJECTIVE: To study the clinical and pathological features of pilomatricoma. METHOD: The authors retrospectively investigated the clinical and pathological materials of 399 patients with pilomatricoma. RESULT: Single lesion occurred in most patients (99%) and 56.39% of them were younger than 30 years. The male-female ratio was 1:1.33. The lesions which sizes average 1.22 cm were commonly emerged in the head, neck, and upper extremity. CONCLUSION Pilomatricoma is a slowly developed benign cutaneous tumour, but it can aggravate sometimes. It's manifestation is diversed and easily misdiagnosed. Early complete excision is recommended for hard or tenacious nodules on head, neck and upper extremity.
Adult ; Extremities ; Female ; Hair Diseases ; pathology ; surgery ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Pilomatrixoma ; pathology ; surgery ; Retrospective Studies ; Skin Neoplasms ; pathology ; surgery ; Tumor Burden

PURPOSE: Eczema herpeticum, caused by herpes simplex virus, is an infectious disease involving skin and internal organs. Varieties of physiologic, psychosocial, or environmental stress reactivate reservoir virus which exists in the trigeminal nerve ganglia. Authors report rare cases of nasal eczema herpeticum following corrective rhinoplasty. METHODS: First case, 22-year-old female underwent corrective rhioplasty through an external approach in a local clinic. She developed progressive and painful erythema, nodules and vesicles on nose on the 9th day postoperatively. This unfamiliar lesion lead to a misdiagnosis as a bacterial infection, and had accelerated its progress to the trigeminal innervation of the nasal unit. Second case, a 23-year-old female underwent corrective rhinoplasty by external lateral osteotomy. Ten days after the surgery, disruption occurred on the external osteotomy site, and the ulceration gradually worsened. The surgeon misdiagnosed it as secondary bacterial infection and only an antibacterial agent was applied. RESULTS: Both cases were healed effectively without any complication with proper wound dressing and antiviral therapy, and show no sequelae during an 8-month follow-up period. CONCLUSION: Eczema herpeticum is rare in the field of plastic surgery, but it should be kept in mind that secondary bacterial infections may lead to serious complications such as full-thickness skin loss. Thus, acknowledgement of the patient's past history regarding perioral or intraoral lesion may provide the surgeon with the possible expectancy of eczema herpeticum. Thus, if anyone develops eczema herpeticum, following facial plastic surgery, early diagnosis and immediate proper antiviral therapy will allow fast recovery without serious complications.
Bacterial Infections ; Bandages ; Communicable Diseases ; Diagnostic Errors ; Early Diagnosis ; Erythema ; Female ; Follow-Up Studies ; Ganglia ; Herpes Simplex ; Humans ; Kaposi Varicelliform Eruption ; Methylmethacrylates ; Nose ; Osteotomy ; Polystyrenes ; Rhinoplasty ; Simplexvirus ; Skin ; Surgery, Plastic ; Trigeminal Nerve ; Ulcer ; Viruses ; Young Adult

PURPOSE: Eczema herpeticum, caused by herpes simplex virus, is an infectious disease involving skin and internal organs. Varieties of physiologic, psychosocial, or environmental stress reactivate reservoir virus which exists in the trigeminal nerve ganglia. Authors report rare cases of nasal eczema herpeticum following corrective rhinoplasty. METHODS: First case, 22-year-old female underwent corrective rhioplasty through an external approach in a local clinic. She developed progressive and painful erythema, nodules and vesicles on nose on the 9th day postoperatively. This unfamiliar lesion lead to a misdiagnosis as a bacterial infection, and had accelerated its progress to the trigeminal innervation of the nasal unit. Second case, a 23-year-old female underwent corrective rhinoplasty by external lateral osteotomy. Ten days after the surgery, disruption occurred on the external osteotomy site, and the ulceration gradually worsened. The surgeon misdiagnosed it as secondary bacterial infection and only an antibacterial agent was applied. RESULTS: Both cases were healed effectively without any complication with proper wound dressing and antiviral therapy, and show no sequelae during an 8-month follow-up period. CONCLUSION: Eczema herpeticum is rare in the field of plastic surgery, but it should be kept in mind that secondary bacterial infections may lead to serious complications such as full-thickness skin loss. Thus, acknowledgement of the patient's past history regarding perioral or intraoral lesion may provide the surgeon with the possible expectancy of eczema herpeticum. Thus, if anyone develops eczema herpeticum, following facial plastic surgery, early diagnosis and immediate proper antiviral therapy will allow fast recovery without serious complications.
Bacterial Infections ; Bandages ; Communicable Diseases ; Diagnostic Errors ; Early Diagnosis ; Erythema ; Female ; Follow-Up Studies ; Ganglia ; Herpes Simplex ; Humans ; Kaposi Varicelliform Eruption ; Methylmethacrylates ; Nose ; Osteotomy ; Polystyrenes ; Rhinoplasty ; Simplexvirus ; Skin ; Surgery, Plastic ; Trigeminal Nerve ; Ulcer ; Viruses ; Young Adult