Mi Ryung Roh

Comparison of Mohs Micrographic Surgery and Wide Excision for Extramammary Paget's Disease: Korean Experience

BACKGROUND Extramammary Pagets disease (EMPD) is an uncommon tumor that usually occurs on the genitalia. It almost always extends beyond clinically apparent margins and has a high rate of recurrence. OBJECTIVE To establish treatment guidelines for EMPD in Asian patients. METHODS A retrospective review was done on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 35 patients between 1996 and 2006. Review of literature for treatment modalities and recurrence rates of EMPD was also performed. RESULTS Thirty-four of the 35 patients (30 men and 5 women) had lesions in the genital area and one patient in the axilla. Mean follow-up duration was 62.7 months (8–156 months) and two of 11 (18.2%) recurred after Mohs micrographic surgery (MMS), compared with eight recurrences of 22 (36.4%) after standard wide excision. Two patients treated with nonsurgical modalities did not achieve complete remission. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 69.7% in all patients, with a rate of 81.8% for MMS and 63.6% for wide excision. CONCLUSIONS MMS is more effective, with lower recurrence rate than wide excision, and should be regarded as the first-line treatment for nonmetastatic EMPD.

Infraorbital Dark Circles: Definition, Causes, and Treatment Options

BACKGROUND Infraorbital dark circles refer to the conditions that present with darkness of the infraorbital eyelids. Although it is not a medical concern, it can be a cosmetic concern for a large number of individuals. Moreover, clear definition and possible causes have not been elucidated. OBJECTIVE To review the possible causes and treatment options for infraorbital dark circles. METHODS The article is based on a review of the medical literature and the authors clinical experience in treating infraorbital dark circles. CONCLUSION Possible causative factors of infraorbital dark circles include excessive pigmentation, thin and translucent lower eyelid skin overlying the orbicularis oculi muscle, and shadowing due to skin laxity and tear trough, but because multiple factors cause infraorbital dark circles in the majority of patients, it is essential to identify the cause and choose the appropriate treatment according to the cause. The authors have indicated no significant interest with commercial supporters.

Treatment and Outcomes of Melanoma in Acral Location in Korean Patients

Purpose A retrospective study was conducted to review the treatment and outcomes of mainly melanomas in acral location in a single institution in Korea, and to evaluate the prognostic significance of anatomic locations of the tumor. Materials and Methods A retrospective review was completed on 40 patients between 2001 and 2006 to obtain pertinent demographic data, tumor data, treatment characteristics, and follow-up data. Results Forty melanoma patients were identified and analyzed. Of these, 18 were male and 22 were female patients and the mean age at the time of diagnosis was 55.9 years. Of the tumors, 65% were located on the hands and feet with acral lentiginous melanoma being the most common histological subtype. Univariate analysis for the overall melanoma survival revealed that the thickness of the tumor and the clinical stage have prognostic significances. The most significant factor as analyzed by a multivariate analysis was shown to be the advanced clinical stage. Acral melanomas did not show statistically significant differences in the age at diagnosis, thickness of the tumor, stage, ulceration, and survival rates compared to non-acral melanomas. There was also no significant difference in the survival rate between the patients treated by amputation versus wide local excision in acral melanomas. Conclusion In Korean melanoma patients, thickness and advanced stages are significant factors for poorer prognosis. However, the location of melanoma did not have a significant prognostic value. In treating the melanomas in acral location, local wide excisions resulted in a similar prognosis compared to amputations.

Genetics of melanocytic nevi

Melanocytic nevi are a benign clonal proliferation of cells expressing the melanocytic phenotype, with heterogeneous clinical and molecular characteristics. In this review, we discuss the genetics of nevi by salient nevi subtypes: congenital melanocytic nevi, acquired melanocytic nevi, blue nevi, and Spitz nevi. While the molecular etiology of nevi has been less thoroughly studied than melanoma, it is clear that nevi and melanoma share common driver mutations. Acquired melanocytic nevi harbor oncogenic mutations in BRAF, which is the predominant oncogene associated with melanoma. Congenital melanocytic nevi and blue nevi frequently harbor NRAS mutations and GNAQ mutations, respectively, while Spitz and atypical Spitz tumors often exhibit HRAS and kinase rearrangements. These initial ‘driver’ mutations are thought to trigger the establishment of benign nevi. After this initial phase of the cell proliferation, a senescence program is executed, causing termination of nevi growth. Only upon the emergence of additional tumorigenic alterations, which may provide an escape from oncogene‐induced senescence, can malignant progression occur. Here, we review the current literature on the pathobiology and genetics of nevi in the hope that additional studies of nevi promise to inform our understanding of the transition from benign neoplasm to malignancy.

Impact of Postthyroidectomy Scar on the Quality of Life of Thyroid Cancer Patients

Background Surgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy. Objective To evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL. Methods Patients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score. Results Ninety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores. Conclusion Post-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar.

Mohs micrographic surgery for extramammary Paget disease: A pooled analysis of individual patient data

BACKGROUND Extramammary Paget disease (EMPD) is a rare intraepithelial neoplasm of the skin characterized by ill-defined margins and high recurrence rates after wide local excision. Although Mohs micrographic surgery (MMS) has been proposed to decrease the rate of local recurrence, the efficacy of MMS for this condition has not yet been established. OBJECTIVE We sought to assess the efficacy of MMS for the treatment of EMPD. METHODS A comprehensive systematic review and individual patient data meta-analysis was performed including all available clinical studies and case reports with 5 or more subjects describing the use of MMS for EMPD. RESULTS Eight studies were identified and included in the current review: 3 retrospective studies and 5 case series. In all, 81 patients with 90 cases of MMS were included from these 8 studies. The overall recurrence rate for EMPD after MMS was 12.2% correlating with an estimated 5-year tumor-free rate of 83.6% by using Kaplan-Meier curve analysis. The treatment of EMPD with MMS resulted in significantly lower recurrence rates than wide local excision in this meta-analysis of 3 observational studies with comparators (odds ratio 0.20; 95% confidence interval 0.05-0.81). LIMITATIONS Limitations include lack of controlled trials, small sample sizes in the included studies, and publication bias. CONCLUSION The current evidence supports the efficacy of MMS in the treatment of EMPD. Further controlled clinical trials are needed.

The 308‐nm excimer laser: a promising device for the treatment of childhood vitiligo

Background: Numerous modalities have been used to treat vitiligo in children. Up to now, phototherapy and topical corticosteroids are the most commonly used treatments for adult vitiligo but studies evaluating the efficacy of these treatments in the pediatric population remain insufficient.

Early Postoperative Treatment of Surgical Scars Using a Fractional Carbon Dioxide Laser: A Split‐Scar, Evaluator‐Blinded Study

Background Although focus has recently been directed toward the early treatment of surgical scars, the optimal time at which to initiate treatment with fractional laser and its effect on scar remodeling remains controversial. Objectives To assess the safety and efficacy of treating surgical scars using an ablative carbon dioxide (CO2) fractional laser during the early postoperative period. Materials and Methods We performed a prospective, split‐scar, evaluator‐blinded study on 16 postoperative scars of 15 patients. Patients began treatment 3 weeks after surgery and were treated in two sessions of CO2 fractional laser therapy on half of the scar at 2‐week intervals. All patients were followed for 3 months after the final treatment session. Results Three months after the last treatment, a greater decrease in Vancouver Scar Scale score was noted in the treated half of the scars, especially in terms of texture and thickness. Patients also expressed a significantly greater degree of satisfaction with the treated side as assessed using a subjective 4‐point scale. Only one patient experienced any adverse effect, which was the development of hypertrophy, on the treated and untreated side of the scar. Conclusion CO2 fractional laser is an effective treatment modality for surgical scars in the early postoperative period.

The effect of succinylated atelocollagen and ablative fractional resurfacing laser on striae distensae

Abstract Striae distensae are dermal atrophic scars with epidermal thinning and decreased collagen and elastic fiber. There is no ‘gold standard’ treatment modality in the treatment of striae distensae. Collagen is a major extracellular matrix component and is important in wound healing. The ablative CO2 fractional laser is effective in various cutaneous scars and this study was attempted to evaluate the effect of succinylated atelocollagen and ablative CO2 fractional laser in the treatment of striae distensae. Participants were divided into two groups and received three laser treatments at a 4-week interval. Clinical improvement was evaluated by participants and two blinded physicians by observing the comparative photographs. Skin biopsies were randomly taken from six participants. The ablative fractional resurfacing laser was effective in the clinical improvement of striae distensae. Statistically significant differences were partly observed between the collagen and placebo groups. Clinical improvement scored by doctors showed more improvement in the collagen group. However, scoring by participants did not show significant differences between the collagen and placebo groups. In conclusion, the ablative fractional resurfacing laser is effective in the treatment of striae distensae and succinylated atelocollagen may also be effective for striae distensae treatment. However, to prove the effect of succinylated atelocollagen, further research with a larger group of participants is needed.

Effects of Infrared Radiation on Skin Photo-Aging and Pigmentation

Infrared radiation is increasingly and uncritically used for cosmetic and wellness purposes, despite the poorly understood biologic effects of such treatments on humans. In the present study, we investigated the effects of infrared radiation on collagen and elastin production in dermal fibroblasts, as well as the clinical and histopathologic effects of infrared radiation on photo-aged facial skin lesions. In order to determine the effects of infrared radiation on collagen and elastin production, dermal fibroblasts were exposed to infrared radiation for varying lengths of time and collagen and elastin contents were subsequently determined. Additionally, 20 patients with mild to moderate facial wrinkles and hyperpigmented lesions received daily treatments of far infrared radiation (900 to 1000 µm) for six-months. During the treatment, patients and a medical observer conducted independent photographic and clinical evaluations every 4 weeks, and skin biopsies were obtained for histological analysis at baseline and one month post-treatment. We found that the content of collagen and elastin produced by the fibroblasts increased after infrared radiation, and that this increase was proportional to the duration of irradiation exposure. Following 6 months of treatment, all patients reported good (51-75%) improvements in skin texture and roughness. Additionally, patients noted fair (25-50%) improvement in color tone of the skin; however, improvements in hyperpigmented lesions were not observed. Objective medical evaluation of the patients indicated that roughness and laxity were fairly improved, but there was no significant improvement in hyperpigmented lesions. Histological examination failed to reveal any differences as well. These results suggest that infrared radiation may have beneficial effects on skin texture and wrinkles by increasing collagen and elastin contents from the stimulated fibroblasts. Therefore, skin treatment with infrared radiation may be an effective and safe non-ablative remodeling method, and may also be useful in the treatment of photo-aged skin.