Gwanghyun Jo

Assessment of a Predictive Scoring Model for Dermoscopy of Subungual Melanoma In Situ

Importance Subungual melanoma in situ (SMIS) is a malignant neoplasm that requires early diagnosis and complete surgical excision; however, little is known about the usefulness of the detailed dermoscopic features of longitudinal melanonychia (LM) to predict the diagnosis of SMIS. Objectives To investigate the characteristic dermoscopic findings of SMIS and to establish a predictive scoring model for the diagnosis of SMIS in patients with adult-onset LM affecting a single digit. Design, Setting, and Participants A cohort study of 19 patients with biopsy-proven SMIS and 26 patients with benign LM diagnosed in a tertiary referral hospital in Seoul, South Korea, from September 1, 2013, to July 31, 2017. Main Outcomes and Measures Patient demographics, frequency of specific dermoscopic findings, and a predictive scoring model. Results Of the total 45 patients with pigmented nails, the 19 patients with SMIS included 14 women and had a mean (SD) age of 52.0 (14.4) years, and the 26 patients with benign LM included 18 women and had a mean (SD) age of 48.1 (13.2) years. Asymmetry (odds ratio [OR], 34.00; 95% CI, 3.88-297.70), border fading (OR, 9.33; 95% CI, 2.37-36.70), multicolor (OR, 11.59; 95% CI, 2.21-60.89), width of the pigmentation of at least 3 mm (OR, 5.31; 95% CI, 1.01-28.07), and presence of the Hutchinson sign (OR, 18.18; 95% CI, 2.02-163.52) were features of LM that were significantly associated with SMIS. A predictive scoring model incorporating these dermoscopic features of SMIS was assessed. The model, ranging from 0 to 8 points, showed a reliable diagnostic value (the receiver operating characteristic curve had an area under the curve [C statistic] of 0.91) in differentiating SMIS from benign LM at a cutoff value of 3, with a sensitivity of 89% and a specificity of 62%. Conclusions and Relevance This study suggests characteristic dermoscopic features for SMIS. A predictive scoring model based on these morphologic features may help differentiate SMIS from benign LM.

Association between Breslow Thickness and Dermoscopic Findings in Acral Melanoma

Background Dermoscopy is a useful tool for the diagnosis of acral melanomas (AMs). However, little is known about the influence of tumor thickness on the dermoscopic findings of AM. Objective To investigate the affect Breslow thickness (BT) has on the dermoscopic patterns of AM. Methods Data on cases of AM on the glabrous skin were collected from 4 university hospitals. We investigated the frequency of each dermoscopic feature of AM according to the BT. Statistical analysis was performed to investigate the association between the specific dermoscopic patterns and BT. Results Multivariable analysis revealed that the colors red (odds ratio [OR] 16.482, 95% confidence interval [CI] 3.605‐99.016); blue (OR 7.092; 95% CI 1.707‐37.435); and white (OR 5.048, 95% CI 1.152‐22.897) were more common in AM with BT >2 mm than those with BT ≤2 mm. Regarding patterns, atypical vascular (OR 34.589, 95% CI 6.458‐305.852); blue‐white veils (OR 9.605, 95% CI 1.971‐72.062); and ulcers (OR 5.084, 95% CI 1.145‐24.152) were more frequently detected in cases with BT >2 mm than those with BT ≤2 mm. Limitations A retrospective study design and small sample size. Conclusion This study showed an association between dermoscopic patterns and tumor thickness among patients with AM. Dermoscopy can be a useful adjuvant tool for predicting BT in AM.

Onychoscopy of trachyonychia: an analysis of 30 patients and comparison with onychomycosis

The diagnosis of trachyonychia is often challenging, and misdiagnoses, particularly as onychomycosis, are common.1-3 The correct diagnosis of trachyonychia is crucial because treatment options for trachyonychia include observation/active non-intervention, topical and systemic steroids, or immunomodulating agents, while onychomycosis should be treated with antifungal agents1, 2 . Onychoscopy (nail dermoscopy) is a useful tool for various nail disorders.4-8 However, a detailed morphologic analysis of trachyonychia has not been performed. Here, we aim to describe the characteristic dermoscopic features of trachyonychia and to explore whether these features are significantly different from those in onychomycosis. This article is protected by copyright. All rights reserved.

Soft tissue chondroma on the lip: Clinical, histopathological and ultrasonographic findings

low-up visit, great improvement on the discoloration of the skin was noticed. Nevertheless, the nail pigmentary changes (Fig. 1d) only disappeared 7 months later, after the complete growth of a new nail plate. Diplopoda is a class of Arthropod also known as millipede or gongolo, found in dark, humid places. When threatened, they tend to curl into a coil and release toxic chemicals (Fig. 1a). Their body fluids contain toxins (cyanide and quinones) that are part of a defense mechanism and may cause skin and mucous membrane inflammation and hyperpigmentation. Humans are occasionally affected by these toxins, usually after accidentally compression of the arthropod. Reports of cutaneous lesions caused by millipedes are rare, as shown in Table 1. Clinically, these lesions have been characterized by the sudden appearance of a black or brownish spot, usually on the feet, along with local pain, burning sensation and paresthesias. The hyperchromic lesions may persist for months, as depicted in the present case, but inflammatory injuries spontaneously disappear within days. There is only one previous report of the dermoscopic pattern found on theses lesions, using a contact device, characterized by a parallel ridge pattern. In the present case, a diffuse pigmentation was found and acrosyringeal apertures were not visualized. The fact that the patient spent many hours in contact with the arthropod, the prominent scaling and the use of a dermoscope without contact may explain this diffuse pattern of pigmentation. Medical management varies from watchful waiting to the use of topical corticosteroids.

The influence of immune status, age, and sex on Majocchi granuloma: a review of 52 cases from a tertiary level hospital and published Korean cases in literature

Majocchi granuloma (MG) is a rare dermal and subcutaneous granulomatous inflammation caused by dermatophytes. The detailed characteristics of MG are not fully elucidated. This study investigated the influence of systemic immune status, age, and sex on the clinical, demographic, mycological, and therapeutic characteristics of MG in Korea.

Image Gallery: Congenital onychodysplasia of the toenails

DEAR EDITOR, We present two patients, an 11-month-old boy (bottom) and a 26-year-old man (top), with unilateral congenital nail deformities in the second toes. The patients were otherwise healthy, and the other nails had no abnormalities. A family history of nail deformity was not noted. X-ray imaging of the toes revealed a Y-shaped bifurcation and duplicated distal phalanx in the man and infant, respectively. Congenital onychodystrophy of the index fingers (COIF) identifies a clinical syndrome characterized by nail dysplasias of the index fingers associated with bone abnormalities. In our cases the terms congenital onychodysplasia or Iso and Kikuchi syndrome, rather than COIF, were preferred because the location could vary. Isolated congenital onychodystrophy of the toes with underlying bony abnormality has rarely been reported. M.-Y . YANG H.-C . KO B. -S . K IM M.-B . K IM G. JO J .-H. MUN Department of Dermatology, Pusan National University School of Medicine, Busan, Korea Department of Dermatology, Seoul National University College of Medicine, 101 Daehangno, Chongno-gu, 110-744, Seoul, Korea Institute of Human–Environment Interface Biology, Seoul National University, Seoul, Korea Correspondence: Je-Ho Mun. E-mail: jehomun@gmail.com