Search

Background: Nail apparatus melanoma (NAM) is a subtype of cutaneous melanoma occurring at nail units and belongs to the acral lentiginous melanoma subgroup. Due to its unique anatomical structure to protect the acral site, mechanical trauma may have a clinicoprognostic impact on NAM. Therefore, we investigated the clinicoprognostic and histopathological characteristics of NAM according to the presence of trauma history prior to melanoma development. Methods: Clinicopathological and follow-up data of patients with NAM according to trauma history were obtained. Results: We included 87 patients with NAM, 21.8% of whom had a previous trauma history. Trauma-related NAMs were more likely to involve the toenail (p = 0.040), include a high proportion of amelanotic melanomas (p = 0.038) as well as nail bed tumor (p = 0.013), and have a longer time interval between the onset of nail change and confirmed diagnosis (p = 0.012). Moreover, survival analysis revealed that trauma-related NAMs more frequently showed progression in general (p = 0.034) and nodal metastasis (p = 0.047) and had worse prognosis in terms of progression-free survival (p = 0.004). Conclusion: In conclusion, NAMs with previous trauma have unique clinicoprognostic characteristics. The specific clinicopathological features of NAMs according to trauma indicate that trauma may play a role in melanoma development.

The clinicoprognostic implications of head and neck involvement of mycosis fungoides (MF) are poorly understood.To evaluate the association of head and neck involvement on the clinicoprognostic features of MF.The clinical features and survival outcomes of patients with MF in a Korean academic medical center database were retrospectively evaluated according to the presence of head and neck involvement at diagnosis.Cases of MF with (group A, n = 39) and without (group B, n = 85) head and neck involvement at diagnosis were identified. Advanced-stage disease (stages IIB-IVB) was more common in group A (43.6%) than in group B (5.9%) (P .001). MF progression, extracutaneous dissemination, and large-cell transformation more commonly occurred in group A than in group B. The 10-year overall survival rate was worse in group A (53.4%) compared with group B (81.6%) (P .001). Head and neck involvement at diagnosis was associated with poor prognosis in early-stage MF (stages IA-IIA) and was independently associated with worse progression-free survival (hazard ratio, 24.4; 95% confidence interval, 2.2-267.6; P = .009).A single center, retrospective design.Head and neck involvement of MF was associated with a poor prognosis.

The association between psoriasis and alopecia areata has not been thoroughly investigated. The objective of this study is to investigate the association of psoriasis with alopecia areata. An electronic search was conducted in August 2021. The analysis included studies that reported sufficient data on the prevalence, odds, or hazard of alopecia areata in patients with psoriasis or that of psoriasis in patients with alopecia areata. Meta-analysis using an inverse variance method was performed with a random-effects model, assuming inherent heterogeneity between the included studies. The subgroup analyses were performed according to the age group and study quality. A total of 27 studies were included. The pooled prevalence of alopecia areata among patients with psoriasis was 0.5% (95% confidence interval [CI], 0.3-0.7%). The pooled odds ratio of alopecia areata among patients with psoriasis was 2.71 (95% CI, 2.29-3.21), whereas the pooled prevalence of psoriasis among patients with alopecia areata was 2.5% (95% CI, 2.0-3.0%). Moreover, the pooled odds ratio of psoriasis among patients with alopecia areata was 3.52 (95% CI, 1.27-9.74). The association of psoriasis and alopecia areata remained in the subgroup analyses according to the age group and study quality. In conclusion, this study suggests a bidirectional association between psoriasis and alopecia areata. Clinical examinations may be necessary to determine the presence of comorbid alopecia areata in patients with psoriasis and vice versa.

Use of stem cells to treat various diseases in dermatology has been of interest. Conditioned media with the growth factors secreted from stem cells has been used as a topical agent. We report a case of foreign body granulomas that appeared days after dermal injection of the conditioned media mimicking scars at all injection sites.

Dermatofibrosarcoma protuberans (DFSP) is a rare fibrohistiocytic tumour of unknown pathogenesis with intermediate malignant potential. Although trauma has been hypothesized as a predisposing factor for DFSP development, clinicopathological characteristics of trauma-related DFSP have not been investigated.This study investigated the differences between trauma-associated DFSP and trauma-unrelated DFSP.Patients histopathologically diagnosed with DFSP from January 2000 to December 2019 at the Dermatology Department were included. Clinical, histopathological, prognostic features and trauma history were analysed.We recruited 141 patients with DFSP (mean age, 36.1 years; male: female, 1:1.01). Recurrence and systemic metastasis were observed in 15.6% and 2.8% of patients, respectively. Older patients were likely to develop DFSP at the trauma sites more frequently on the face and lower legs. The active-growing lesions were more frequently associated with trauma-related DFSP. Multivariable logistic regression revealed that age at diagnosis (OR: 1.031; 95% CI: 1.004-1.059; p = 0.024) and tumour growth (OR: 3.336; 95% CI: 1.162-9.578, p = 0.025) were significantly associated with trauma-related DFSPs.The age at diagnosis, lesion location and tumour growth were associated with DFSPs in this study. Analysis of DFSP with trauma history provides a deeper understanding of long-term trauma effects on sarcoma development.

Comprehensive studies of primary cutaneous extranodal natural killer/T-cell lymphoma (PCENKTL) are scarce. The objectives of this study are to describe PCENKTL in terms of its clinical features, histopathology, immunophenotypes, and prognosis, and to analyze factors affecting patient survival outcomes. We searched four databases and include studies with extractable data. We also searched the Asan Medical Center database for cases of PCENKTL. We include a total of 289 patients. The mean age at diagnosis was 52.8 years and the female to male ratio was 1:1.2. The most common clinical morphology was a subcutaneous nodule, followed by ulceration. About half of the patients presented with disseminated skin lesions. The median overall survival was 12.0 months and the 5-year survival rate was 22.0%. There was no correlation between the clinical morphology or the histopathological features of the skin lesions with the patient outcomes. Advanced TNM stage, a disseminated skin lesion, tumor location on the leg or trunk, the presence of B symptoms, and a high International Prognostic Index score were associated with a worse prognosis, and chemoradiotherapy was associated with a better survival outcome as compared with chemotherapy alone in univariable analyses. In multivariable analyses, only advanced TNM stage and tumor location on the leg were associated with a worse prognosis. In conclusion, PCENKTL is an aggressive cutaneous lymphoma and its prognosis is associated with TNM stage and tumor location.

The diagnostic role of preferentially expressed antigen in melanoma (PRAME) immunohistochemistry has not been thoroughly evaluated for acral melanocytic tumors. The objective of this study was to evaluate the utility of this modality for the diagnosis of acral melanocytic tumors compared with other potential markers. Melanocytic tumors were classified as either acral nevi, challenging melanocytic tumors (superficial atypical melanocytic proliferation of uncertain significance (SAMPUS)-favor benign (SAMPUS-FB), SAMPUS-favor malignant (SAMPUS-FM)) or acral melanomas. A total of 106 acral melanocytic tumors including acral nevi (n = 32), SAMPUS-FB (n = 17), SAMPUS-FM (n = 20), and acral melanomas (n = 37) were included. Diagnostic power, assessed using an area under the receiver operating characteristic curve (AUC) for distinguishing acral melanomas and acral nevi, was highest for PRAME (AUC = 0.997), followed by c-Myc (AUC = 0.755), cyclin D1 (AUC = 0.652), and c-Kit (AUC = 0.573). At a PRAME expression level ≥30% as a positive test for acral melanoma, the sensitivity and specificity of this marker for discriminating acral melanoma from acral nevus were 100% and 96.9%, respectively. PRAME immunohistochemistry also discriminated SAMPUS-FM from SAMPUS-FB with a sensitivity and specificity of 90.0% and 76.5%, respectively. In conclusion, PRAME immunohistochemistry can be used effectively to distinguish between various spectra of acral melanocytic neoplasms.

Background Kaposi sarcoma (KS) is a mesenchymal tumor with distinct histopathological features according to tumor progression. Programmed death-1 (PD-1) and its ligand PD-L1 play major roles in the immune escape strategy of tumors. Objectives This study evaluated expression of PD-1 and PD-L1 in various stages of KS and investigated associations between their expression and clinical characteristics. Methods Fifty cases with histopathologically diagnosed KS were classified as early or late stage. These specimens were stained with anti-PD-1 and anti-PD-L1 antibodies. The extent of expression in the intratumoral and peri-tumoral areas was judged by two dermatopathologists. Results PD-1 and PD-L1 were expressed in 72.2% (13/18) and 11.1% (2/18) of early-stage cases, respectively, compared with 43.8% (14/32) and 28.1% (9/32) of late-stage cases, respectively. At the late stage, PD-1 expression was significantly higher in the peri-tumoral area than in the intratumoral area (P = 0.001). PD-1 expression in the intratumoral area was significantly higher at the early stage than at the late stage (P = 0.013). PD-L1 expression in the peri-tumoral area was significantly higher at the late stage than at the early stage (P = 0.038). Conclusions The pattern of PD-1 and PD-L1 expression differs according to the stage of KS, but is unaffected by clinical variables.

Background Although cutaneous melanoma has been widely evaluated, data elucidating the clinical features and prognostic factors of cutaneous metastatic melanoma are limited. Objective To determine and compare the clinicoprognostic features of cutaneous metastasis in acral and nonacral melanoma. Methods The Asan Medical Center database was reviewed for cases of cutaneous metastatic melanoma that had been confirmed by skin biopsy between January 1996 and December 2017. Results Cutaneous metastasis occurred in 12.4% (61 of 492 cases) of our cohort. The frequency of cutaneous metastasis was higher in nonacral melanoma than that in acral melanoma. The mean duration between the initial diagnosis of a primary tumor and cutaneous dissemination was 19.8 months. Cutaneous metastasis developed earlier during the disease course in acral melanoma than that in nonacral melanoma. Cutaneous metastasis was more disseminated, involving multiple anatomy sites in nonacral melanoma than that in acral melanoma. In-transit metastasis was significantly more common in acral melanoma than that in nonacral melanoma. The disease stage at the time of cutaneous metastasis was not significantly different between acral and nonaral melanoma. In-transit metastasis was commonly associated with visceral involvement in acral melanoma but not in nonacral melanoma. The extent and multiplicity of cutaneous metastasis were dependent on the status of other viscera during the cutaneous metastasis. No significant difference in survival during the cutaneous metastasis was observed between acral and nonacral melanoma. Conclusion Clinicoprognostic features of cutaneous metastasis were different between acral and nonacral melanoma.

Background Primary cutaneous angiosarcoma (CA) is a rare but aggressive tumor with a high rate of local recurrence. This study was designed to analyze the clinicopathological features of primary CA and identify factors of cutaneous manifestations associated with the prognosis of angiosarcoma. Methods Medical records of 55 patients with primary CA were retrospectively analyzed to investigate clinical features, survivals, and prognostic factors. Anatomical location of tumor was classified to the scalp, face, and neck, and sites outside the head and neck. Results Primary CA presented cutaneous nodules (31/55, 47.2%), patches (13/55, 23.6%), and indurated plaques (11/55, 20.0%). Nodular lesion was significantly more common in CA on the scalp compared to CA on sites outside the scalp. Histologically, tumors presenting as nodular lesions on the scalp was predominantly composed of solid sheets of large pleomorphic cells, whereas non-nodular lesions composed of tumor cells between collagen bundles forming irregular vascular spaces. Cutaneous angiosarcoma on the scalp showed a worse prognosis compared to CA on sites outside the scalp. Patients presenting clinical morphology with nodules and multiple skin lesions showed significantly reduced overall survival (OS). Conclusion In primary CA, location on the scalp, morphology with nodules, and multiplicity of skin lesions significantly affected survival outcomes.

In this study, the clinicopathologic features and survival outcomes of patients with hyperpigmented MF from a single tertiary referral center database were retrospectively evaluated. Hyperpigmented MF accounted for 10.9% (14/128) of all MF cases. The mean age at diagnosis was 46.9 years, and the female-to-male ratio was 1:1.3. Concurrent hypopigmented, ichthyosiform, and poikilodermatous lesions were detected in 21.4%, 14.3%, and 14.3% of the patients, respectively. Histopathologically, most patients (85.7%) showed interface change with pigment incontinence. Double negative (CD4- and CD8-) immunophenotypes were more frequent in patients with hyperpigmented MF (25%) than in those with other MF subtypes (9.8%). Most patients (85.7%) had early-stage disease at diagnosis. The survival outcomes did not differ significantly between hyperpigmented and other MF subtypes. In conclusion, hyperpigmented MF often accompanies other atypical MF variants and is frequently associated with atypical immunophenotypes. The outcomes of hyperpigmented MF are comparable to those of other MF subtypes.

The clinical and pathological features of lymphomatoid papulosis (LYP) are diverse. The objective of this study is to evaluate the clinical and pathological features associated with the prognosis and clinical course of LYP.The clinical and pathological features of LYP in a medical center database were retrospectively retrieved.Overall, 58 LYP patients were included in the study. The mean age at diagnosis was 39.1 years and the female-to-male ratio was 1:1.2. More than two-thirds (40/58, 69.0%) of the patients showed a chronic and recurrent disease course. A longer pre-diagnosis duration (odds ratio (OR), 1.01; 95% confidence interval (CI), 1.00-1.03) was significantly associated with secondary lymphoma development. Lower extremity involvement (OR, 10.40; 95% CI, 1.17-92.28) and the absence of eosinophils in the lesions (OR, 11.28; 95% CI, 1.01-126.24) were found to be significantly associated with the chronic and recurrent course of LYP.A longer pre-diagnosis duration is associated with secondary lymphoma, while a lower extremity involvement and the absence of lesional eosinophil infiltration are associated with the chronicity of LYP.

Background Distinguishing benign lesion from early malignancy in melanocytic lesions of the nail unit still remains a diagnostic challenge, both clinically and histopathologically. While several immunohistochemistry (IHC) stainings have been suggested to help discriminate benign subungual melanocytic proliferation (SMP) and subungual melanoma in situ (MIS), the diagnostic utility of IHC staining for cyclin D1 and PRAME has not been thoroughly investigated in melanocytic lesions of nail unit. Methods This retrospective study included cases of benign SMP and subungual MIS confirmed by biopsy at Asan Medical Center from January 2016 to December 2020. Cases of melanocytic activation without proliferation and melanoma where dermal invasion was identified were excluded. Cyclin D1 and PRAME expression was assessed by counting proportion of melanocytes with nuclear positivity under 200x magnification. Results A total of 14 patients with benign SMP and 13 patients with subungual MIS were included in this study. 11 patients with benign SMP (71.4%) and 5 patients with subungual MIS (38.5%) showed > 60% nuclear immunostaining for cyclin D1, respectively. While 13 patients with benign SMP (92.9%) showed totally negative staining for PRAME, 10 patients with subungual MIS (76.9%) exhibited > 50% nuclear immunostaining for PRAME. Using the cutoff of 10%, PRAME exhibited good overall discrimination between benign SMP and subungual MIS (AUC = 0.849, 95% CI = 0.659–0.957). Conclusions This study suggests that PRAME IHC staining as a reliable discriminator in distinguishing subungual MIS from benign SMP.

This was a single-center, unmasked, paralleled, randomized controlled trial.A randomized trial was conducted in a tertiary care institute in South Korea to validate whether artificial intelligence (AI) could augment the accuracy of nonexpert physicians in the real-world settings, which included diverse out-of-distribution conditions. Consecutive patients aged19 years, having one or more skin lesions suspicious for skin cancer detected by either the patient or physician, were randomly allocated to four nondermatology trainees and four dermatology residents. The attending dermatologists examined the randomly allocated patients with (AI-assisted group) or without (unaided group) the real-time assistance of AI algorithm (https://b2020.modelderm.com#world; convolutional neural networks; unmasked design) after simple randomization of the patients.Using 576 consecutive cases (Fitzpatrick skin phototypes III or IV) with suspicious lesions out of the initial 603 recruitments, the accuracy of the AI-assisted group (n = 295, 53.9%) was found to be significantly higher than those of the unaided group (n = 281, 43.8%; P = 0.019). Whereas the augmentation was more significant from 54.7% (n = 150) to 30.7% (n = 138; P0.0001) in the nondermatology trainees who had the least experience in dermatology, it was not significant in the dermatology residents. The algorithm could help trainees in the AI-assisted group include more differential diagnoses than the unaided group (2.09 vs. 1.95 diagnoses; P = 0.0005). However, a 12.2% drop in Top-1 accuracy of the trainees was observed in cases in which all Top-3 predictions given by the algorithm were incorrect.The multiclass AI algorithm augmented the diagnostic accuracy of nonexpert physicians in dermatology.

Several studies have determined the correlation between programmed cell death protein-1 (PD-1) and chronic plaque psoriasis (CPP). However, limited studies have assessed the association between PD-1 expression and the clinicoprognostic and distinct clinicopathological characteristics of CPP and guttate psoriasis (GP). Twenty-nine patients with skin biopsy-confirmed CPP were recruited at the Asan Medical Center between January 2018 and June 2020, and 33 patients with biopsy-confirmed GP were enrolled between January 2002 and June 2020. The clinicoprognostic and histopathological characteristics were analyzed according to immunohistochemical PD-1 expression in the epidermal or dermal inflammatory infiltrates. The CPP and GP lesions were divided into PD-1-low and PD-1-high groups. The CPP epidermal PD-1-high group had typical histopathological changes and significantly higher psoriasis area and severity index scores (p = 0.014) and disease duration (p = 0.009) than the epidermal PD-1-low group. In patients with GP, compared with the dermal PD-1-high group, the dermal PD-1-low group exhibited significantly higher disease duration (p = 0.002) and relapse rate of plaque psoriasis (p = 0.005) and significantly lower relapse-free survival (p = 0.016). Upregulated epidermal PD-1 expression was correlated with the chronicity and severity of CPP, while downregulated dermal PD-1 expression was correlated with poor prognosis of GP.

With the increasing incidence of skin cancer, many noninvasive technologies to detect its presence have been developed. This review focuses on reflectance confocal microscopy (RCM), optical coherence tomography (OCT), high-frequency ultrasound (HFUS), electrical impedance spectroscopy (EIS), pigmented lesion assay (PLA), and Raman spectroscopy (RS) and discusses the basic principle, clinical applications, advantages, and disadvantages of each technology. RCM provides high cellular resolution and has high sensitivity and specificity for the diagnosis of skin cancer. OCT provides lower resolution than RCM, although its evaluable depth is deeper than that of RCM. RCM and OCT may be useful in reducing the number of unnecessary biopsies, evaluating the tumor margin, and monitoring treatment response. HFUS can be mainly used to delineate tumor depths or margins and monitor the treatment response. EIS provides high sensitivity but low specificity for the diagnosis of skin malignancies. PLA, which is based on the genetic information of lesions, is applicable for the detection of melanoma with high sensitivity and moderate-to-high specificity. RS showed high accuracy for the diagnosis of skin cancer, although more clinical studies are required. Advances in these technologies for the diagnosis of skin cancer can lead to the realization of optimized and individualized treatments.

Background Epstein-Barr virus (EBV) positivity frequently presents in patients with nodal angioimmunoblastic T-cell lymphoma (AITL). However, the presence of EBV in skin lesions and its clinicopathologic significance have not been evaluated. Objective To analyze the clinical and histopathologic features of cutaneous AITL and evaluate EBV positivity in skin tissue and its effects on clinicopathologic features of AITL. Methods Clinicopathologic variables in patients with cutaneous AITL were analyzed and compared depending on EBV in situ hybridization status in skin lesions by using patients' medical records. Results Of the 86 patients with AITL, 42 had a cutaneous presentation. In situ hybridizations positive for EBV were noted in 19 of 42 patients with cutaneous AITL. EBV positivity was more common in papular and nodular skin lesions than other cutaneous morphologies, such as nonspecific rash or purpuric patches. An EBV-positive in situ hybridization was associated with a pattern of dense, superficial and deep infiltrates of pleomorphic, large-sized, atypical lymphocytes. EBV positivity in skin lesions was an independent negative prognostic factor in patients with AITL. Limitations Retrospective study at a single institution. Conclusion EBV-positive cutaneous AITL is associated with distinctive clinicopathologic features.

Background: Multiple types of fillers have been developed for soft tissue augmentation.Objective: We investigated the efficacy and safety of the novel filler BM-PHA.Methods: In this multicenter, randomized, split-face study, 91 participants received injections of BM-PHA and Restylane Perlane (PER) into the nasolabial folds. Efficacy was determined by the improvements in the Wrinkle Severity Rating Score (WSRS) and Global Esthetic Improvement Scale (GAIS), and safety by adverse events, laboratory tests, and a check of vital signs.Results: WSRS scores assessed by independent evaluators at Week 24, the primary efficacy measure, showed no significant difference between the two treatments. The treatments also showed no significant differences in WSRS scores assessed by the evaluators at Week 8 and WSRS and GAIS scores assessed by the treating investigators and participants at Weeks 8 and 24. The proportion of nasolabial folds whose WSRS scores improved by at least one grade at Week 24 was similar between the treatments. Only minor local side effects were reported without sequelae.Conclusion: BM-PHA was not inferior to PER in the treatment of moderate to severe nasolabial folds and may be an appropriate alternative product for their improvement. Further studies are needed to confirm the long-term safety of BM-PHA.

Gordonia species were recently found to cause human infection. Most Gordonia bronchialis infections are associated with sternal wounds and foreign bodies. Here, we present a case of a firm cutaneous nodule caused by G. bronchialis on an immunocompetent patient's lower extremity after receiving acupuncture. Our present case indicates that spontaneous cutaneous infection of G. bronchialis can develop even in a healthy patient. With the popularity of complementary and alternative medicine, physicians should be aware that G. bronchialis infection can be associated with Oriental medicine similar to mycobacterial infection. Recognizing the diverse clinical features of newly emerging Gordonia species will facilitate appropriate diagnosis and management of future patients.

We aimed to evaluate the efficacy and safety of a fractional microneedle radiofrequency device (FMRD) for the treatment of primary axillary hyperhidrosis (PAH). The FMRD adopted insulated microneedles, which could be located at a depth of up to 4.5 mm and deliver a radiofrequency current in a fractional manner. Also, the device could automatically regulate the amount of the delivered energy. Sixteen Korean patients with PAH received two FMRD treatment sessions at a 3-week interval and were followed-up until week 15. The primary outcome was Patient Satisfaction Scale (PSS) score at each visit. Hyperhidrosis Disease Severity Scale (HDSS) and Global Aesthetic Improvement Scale (GAIS) were also assessed. The area and amount of sweat produced were evaluated by specific tests. Mean PSS score significantly improved from 1.6 at week 3 to 2.5 at week 15 by 56%. More than a 50% improvement in sweating assessed by the PSS score was seen in 63% and 50% of patients at weeks 11 and 15, respectively. Mean HDSS score significantly decreased by week 3 and further decreased by week 7. Mean GAIS scores improved from the first follow-up visit at week 3 and improved again at week 7. The mean hyperhidrosis area assessed by starch–iodine test significantly decreased by 36% at week 15 compared with baseline. Mean transepidermal water loss level significantly decreased by 42% at week 15 compared with baseline. No patients experienced any serious adverse events. FMRD can be an effective and safe treatment modality for PAH.

Background Partial unilateral lentiginosis (PUL) is a rare acquired circumscribed hyperpigmentation characterized by multiple simple lentigines involving half of the body. Since the previous studies of PUL were mostly based on case reports and the current literature lacks well-designed retrospective studies that involve a large number of cases, PUL is not a well-defined entity, and differential diagnosis with nevus spilus is still difficult. This study aims to evaluate clinical and histopathological characteristics and treatment outcomes of PUL on head and neck area of Koreans. Methods Thirty-two patients with PUL on head and neck area were diagnosed clinicohistopathologically at the Asan Medical Center from 2004 to 2017. Their medical records, photographs, and biopsy specimens were reviewed, and immunohistochemical staining for protein kinase C (PKC)-βΙΙ was evaluated for melanogenic activity. Results Four patients (12.5%) of PUL had congenital lesions, and 24 (75.0%) had age of onset younger than 10 years. Confluency of lentiginous lesions (100%) and mild to moderate background interlesional hyperpigmentation (90.6%) were observed. The lentiginous lesions showed increased melanocytes, melanophages, basal melanins, lentiginous hyperplasia, and perivascular inflammatory cells compared with background interlesional hyperpigmentation, and PKC-βΙΙ was focally positive in 7 of 12 stained PUL lesions. Among the 16 patients who received laser treatments, 10 (62.5%) showed more than 50% of improvement. Conclusions The findings of this study will allow for improved diagnosis of PUL and understanding of its features, which may facilitate proper management in the future.

Background Mycosis fungoides (MF) shows racial and regional differences in terms of clinical features. The availability of therapeutic options as well as drugs differs from one country to another. There are only limited data on the clinical characteristics and treatment experience of MF from South Korea. Methods Medical records of 97 patients with MF were retrospectively analyzed to investigate clinical features, survivals, and prognostic factors. Assessment of prognostic variables was done using univariate Cox proportional hazard models. Results Median age at time of diagnosis was 45 years. The median time from onset of skin lesion to diagnosis of MF was 36 months with a median follow-up period of 96 months. A number of clinical variants of MF were observed. Treatment mainly consisted of narrow-band UVB, systemic retinoids, methotrexate, chemotherapy, and regional radiotherapy. Complete remission was observed in 78% of patients with records on their clinical course. About 12% experienced disease progression. No clinical prognostic factor apart from TNM staging was identified. Conclusion Despite delay in diagnosis, most cases of MF in Korea were diagnosed in early stages. Prognosis of our patients was more favorable than those of other geographic regions as reported in previous studies. Good response to treatment, consisting mainly of phototherapy and radiation therapy, and relatively indolent clinical behavior of disease were observed in this homogeneous cohort of Korean patients with MF.

Inflammatory skin diseases, such as rosacea and acne, are major causes of facial erythema and accompanying skin barrier dysfunction. Several methods to restore the impaired skin barrier and improve facial erythema, such as medication, radiofrequency, laser, and ultrasound therapy were attempted. This study evaluated the efficacy and safety of dual-frequency ultrasound with impulse mode, for improving skin hydration and erythema in Asian subjects with rosacea and acne. Twenty-six subjects with facial erythema received an ultrasound treatment once per week, for 4 weeks, over both cheeks. The erythema index and transepidermal water loss (TEWL) were measured at each visit. Clinicians assessed the erythema improvement and patients evaluated their satisfaction level. The average decrease in TEWL and erythema index at 6 weeks was 5.37 ± 13.22 g·h−1·m−2 (p = 0.020) and 39.73 ± 44.21 (p = 0.010), respectively. The clinician’s erythema assessment and the subject satisfaction questionnaire score significantly improved at final follow-up (p &lt, 0.001, p = 0.003, respectively). No serious adverse effects were observed during the treatment and follow-up periods. The dual-frequency ultrasound with impulse mode appears to be effective and safe for improving skin hydration and erythema in patients with rosacea and acne.

BACKGROUND Although deep neural networks have shown promising results in diagnosing skin cancer, a prospective evaluation in a real-world setting could confirm these results. OBJECTIVE The aim of this study was to evaluate whether an algorithm (http://b2019.modelderm.com) could improve the accuracy of nondermatologists in diagnosing skin neoplasms. METHODS A total of 285 cases (random series) with skin neoplasms suspected by either physicians or patients were recruited in two tertiary care centers located in South Korea. An artificial intelligence (AI) group (144 cases, mean [SD] age, 57.0 [17.7] years; 62 [43.1%] men) was diagnosed via routine examination with capturing photographs and assisted by the algorithm, whereas the control group (141 cases, mean [SD] age, 61.0 [15.3] years; 52 [36.9%] men) was diagnosed only via routine examination with a photographic review. The accuracy of the nondermatologists before and after the interventions was compared. RESULTS Among the AI group, the accuracy of the first impression (Top-1 accuracy; 58.3%) after the assistance was higher than that before the assistance (46.5%, P = 0.0081). The number of differential diagnoses of the participants increased from 1.9 ± 0.5 to 2.2 ± 0.6 after the assistance (P < 0.0001). In the control group, the difference in the Top-1 accuracy between before and after reviewing photographs was not significant (before, 46.1%; after, 51.8%; P = 0.1867) and the number of differential diagnoses was not also significantly increased (before, 2.0 ± 0.4; after, 2.1 ± 0.5; P = 0.5653). CONCLUSIONS In real-world settings, artificial intelligence augmented the diagnostic accuracy of trainee doctors. The limitation of this study is that the algorithm was tested only for Asians recruited from a single region. Additional international randomized controlled trials involving various ethnicities are required.

The association between tumor-associated macrophages (TAMs) and the expression of immune checkpoint molecules has not been well described in cutaneous melanoma. We evaluated the correlations between the expression of markers of TAMs, cluster of differentiation 163 (CD163), and immune checkpoint molecules, programmed cell death protein-1 (PD-1), and lymphocyte activating gene-3 (LAG-3). We also determined their relationships with the clinicopathological features and disease outcomes in melanoma. Diagnostic tissues collected from melanoma patients were evaluated using immunohistochemistry for CD163, PD-1, and LAG-3 expression. CD163 expression positively correlated with PD-1 and LAG-3 expression. High expression of both CD163 and PD-1 expressions was significantly associated with negative prognostic factors and worse prognosis than high expression of the single markers. High co-expression of CD163 and LAG-3 was associated with poor clinicopathological indexes of melanoma and worse survival compared to the high expression of the single markers. The expression of immune checkpoint molecules PD-1 and LAG-3 positively correlated with the M2-TAM density in melanoma tissue. Simultaneous high M2-TAM density and immune checkpoint molecules expression acted as independent poor prognostic factors in cutaneous melanoma.

Background: Pyoderma gangrenosum is a rare autoinflammatory neutrophilic dermatosis that rapidly evolves. However, little is known about the clinicopathological features and prognosis of pyoderma gangrenosum. Aims: We aimed to document clinicopathologic and prognostic data of the patients with pyoderma gangrenosum. Methods: In this retrospective observational study, we reviewed case records of patients diagnosed with pyoderma gangrenosum between 1999–2019. Results: Fifty-three patients were identified by reviewing medical records for skin biopsy; of these, 37 were men and 16 were women. Mean age at onset was 43.3 ± 18.5 years. The most frequently affected area was the lower extremities (60.4%), followed by the head and neck (17.0%). The most common subtype was ulcerative (47.2%), followed by bullous (22.6%). 30 cases had underlying diseases and the most common were malignancy (24.5%), followed by inflammatory bowel diseases (18.9%). The proportion of cases with history of trauma were significantly higher in post-operative type (100%) as compared to the bullous type (8.3%). Histologic features of granulation tissue were frequently found in post-operative type (66.7%) and bullous type (58.3%). Granulomas were predominantly found in bullous type (58.3%). Age Limitations: This study was a single-centre study with a retrospective design. Conclusion: Pyoderma gangrenosum appears to have ethnic differences. Underlying haematologic disorders and bullous subtype have a worse prognosis. However, the type of histopathology did not correlate with the clinical outcome of pyoderma gangrenosum.

Importance Large population-based studies investigating the risks of overall and specific cancers among patients with hidradenitis suppurativa (HS) are limited. Objective To assess the overall and specific cancer risks in patients with HS compared with the risks in patients without HS in the Republic of Korea. Design, Setting, and Participants A nationwide population-based cohort study, using the Korean Health Insurance Review and Assessment Service database was conducted over a 2-year period from January 1, 2007, to December 31, 2008. Individuals in the control group who were never diagnosed with HS or cancer during the washout period were randomly extracted and matched by age, sex, index year, and insurance type at a case-control ratio of 1:8, and patients with newly diagnosed HS between January 1, 2009, and December 31, 2017, were included. Follow-up data on incident cancer from January 1, 2009, to December 31, 2018, were included. Main Outcomes and Measures The overall and specific cancer incidence rates were calculated per 100 000 person-years in patients with HS and in the matched control cohort. The risk for cancers was assessed by multivariable Cox regression models in patients with HS compared with the matched control cohort. Results In total, 22 468 patients with HS and 179 734 matched controls were included in the study. The mean (SD) age was 33.63 (17.61) years and 63.7% of the participants in both groups were male. The adjusted hazard ratio (aHR) of overall cancer in patients with HS was 1.28 (95% CI, 1.15-1.42). Patients with HS had significantly higher risk for Hodgkin lymphoma (aHR, 5.08; 95% CI, 1.21-21.36), oral cavity and pharyngeal cancer (aHR, 3.10; 95% CI, 1.60-6.02), central nervous system cancer (aHR, 2.40; 95% CI, 1.22-4.70), nonmelanoma skin cancer (HR, 2.06; 95% CI, 1.12-3.79), prostate cancer (aHR, 2.05; 95% CI, 1.30-3.24), and colorectal cancer (aHR, 1.45; 95% CI, 1.09-1.93). Conclusions and Relevance In this study, HS appeared to be associated with a significantly increased risk of overall cancer as well as several specific cancers.

Relatively little is known about the clinicopathological characteristics of solar lentigo (SL), rendering the choice of laser treatment a clinical challenge. This study compared the clinicohistopathological characteristics of patients with SL on the face with and without conspicuous inflammation. The medical records were evaluated to determine the clinical and histopathological characteristics. Based on the degree of histopathologically observed inflammation, the patients were divided into two groups, those with inflammatory and noninflammatory SL. The demographic characteristics of patients in the inflammatory (n = 62, 62.6%) and noninflammatory groups (n = 37, 37.4%) did not differ significantly. Lesion duration was shorter, and the proportion of patients whose lesions changed within 6 months was higher in the inflammatory than in the noninflammatory group. The mean longest lesion diameter was greater in the inflammatory than in the noninflammatory group. Histopathologically, epidermis was thicker in the inflammatory than in the noninflammatory group. The grade of basal hyperpigmentation was higher in the noninflammatory group, whereas telangiectasia was more frequent in the inflammatory group. The treatment response rate was lower in the inflammatory (7/21, 33.3%) than in the noninflammatory group (8/10, 80.0%). Optimal laser treatment strategies may differ in these two groups.

Background: Since primary skin cancers in organ transplant recipients (OTRs) are rare, little is known about the characteristics and risk factors of skin cancer in OTRs. Objectives: To improve understanding of primary skin cancers in OTRs. Methods: The database of the Asan Medical Center was searched for OTRs diagnosed with primary post-transplant skin cancers from January 1990 to December 2018.The standardized incidence ratios (SIR), defined as the ratio of the observed number of cancers divided by the expected number of cancers were determined for each cancers. Results: Of 13,469 OTRs, 113 (0.8%) were diagnosed with skin cancers over the 28 years. The most common skin cancer was squamous cell carcinoma, followed by basal cell carcinoma and Kaposi’s sarcoma. The cumulative incidence of skin cancers at 28 years was 5.3%. Over the 10 year period from January 2009 to December 2018, the SIR for premalignant in situ skin lesions increased, whereas the SIR for skin cancers decreased, and the types of post-transplant skin cancers became more diverse. Age at transplantation and treatment with more than two immunosuppressive agents were risk factors for the development of new skin cancers in OTRs. Conclusion: Over the most recent 10 year period, post-transplant skin cancers have been found earlier and to be more diverse than in previous periods. Older age and treatment with more than two immunosuppressive agents increase the risk of post-transplant skin cancers.

V-domain Ig suppressor of T-cell activation (VISTA), which mediates immune evasion in cancer, is mainly expressed on hematopoietic cells and myeloid cells in the tumor. We evaluated correlations among the expression of VISTA, the myeloid-derived suppressor cell marker CD33, and programmed death-1 (PD-1), and determined their relationships with clinicopathological characteristics and disease outcomes in melanoma. Diagnostic tissue from 136 cases of melanoma was evaluated by immunohistochemistry for CD33, VISTA, and PD-1 expression. Dual immunofluorescence using CD33 and VISTA antibodies was performed. VISTA expression positively correlated with CD33 expression in melanoma tissue. Dual immunofluorescence staining revealed that VISTA was expressed by CD33-positive myeloid cells. PD-1 expression correlated with CD33 and VISTA expression. CD33 and VISTA expression were significantly associated with negative prognostic factors, including a deeper Breslow thickness and an advanced stage of disease. High expression of either CD33 or VISTA was associated with worse survival. Positivity for both VISTA and PD-1 predicted worse survival. Multivariate analysis showed that both CD33 and VISTA expression were independent prognostic factors in cutaneous melanoma. VISTA and CD33 expression are independent unfavourable prognostic factors in melanoma, which suggests their potential as therapeutic targets.

Background: Filler injection has become an extremely popular method for facial skin rejuvenation, including the periorbital area. In the recent years, new polynucleotide (PN)-containing filler products have been used for esthetic purposes.Aim: We aimed to investigate the efficacy and safety of PN filler injection in the periorbital area.Patients/methods: A total of 27 subjects were enrolled in this randomized, pair-matched, and active-controlled study. Each subject received filler injections thrice with two-week intervals, with a PN filler injection on one side and a non-crosslinked hyaluronic acid (HA) filler injection on the contralateral side of the periorbital area.Results: Improvements in the visual analog scale and global esthetic improvement scale scores were not significantly different between the PN and HA groups. The improvement rates of skin elasticity and hydration decreased over time in both groups, with the PN group showing a higher improvement rate. The improvement rates of roughness and pore volume were higher in the PN group than in the HA group. The improvement rate of dermal density was not significantly different between the groups. No serious adverse events were reported.Conclusion: The PN filler injection is effective and safe for periorbital rejuvenation.

There have been limited studies comparing the clinical significance of lymphatic invasion in melanoma according to tumour site. The objective of this study was to evaluate the impact of lymphatic invasion on the clinicoprognostic features of acral and non-acral melanoma. Clinical and histopathological features and survival outcomes of 532 patients with acral melanoma or non-acral melanoma in the database of the Asan Medical Center, Korea, were retrospectively evaluated according to the presence of lymphatic invasion. Lymphatic invasion was significantly more common in acral melanoma than non-acral melanoma. In acral melanoma, lymphatic invasion was significantly associated with a higher frequency of lymph node involvement and advanced stages, but not associated with Breslow thickness or visceral dissemination. By contrast, lymphatic invasion in non-acral melanoma was significantly associated with a higher rate of visceral involvement, deeper Breslow thickness, as well as a higher rate of lymph node involvement and advanced stages. When acral melanoma and non-acral melanoma both with lymphatic invasion were compared, Breslow thickness was significantly shallower and vertical growth phase was significantly less common in acral melanoma. Meanwhile, visceral involvement was significantly more frequent in non-acral melanoma than acral melanoma. In conclusion, lymphatic invasion was more common in acral melanoma than non-acral melanoma and occurred in acral melanoma cases with relatively thin Breslow thickness, suggesting acral melanoma is lymphotropic.