Yoo Sang Baek

Birt-Hogg-Dubé Syndrome, a Rare Case in Korea Confirmed by Genetic Analysis

Simple benign tumors can present as part of a syndrome with substantial mortality. Fibrofolliculomas are benign skin tumors most often associated with the Birt-Hogg-Dubé syndrome (BHDS). The most life-threatening complication of this syndrome is renal cancer and other major features include multiple lung cysts and spontaneous pneumothorax. We present the case of a 54 year-old man with multiple flesh-colored papules on his face confirmed histologically as fibrofolliculomas. He had a history of recurrent pneumothorax and chest computed tomography showed multiple lung cysts. To confirm the diagnosis of BHDS, we conducted gene analysis that revealed a single nucleotide duplication in the folliculin (FLCN) gene (Exon 11, C.1285dupC). BHDS confirmed by the FLCN gene mutation is rarely reported in Korea. Appropriate investigation is recommended whenever a patient with benign skin tumors is encountered.

Dual-color, break-apart fluorescence in situ hybridization probe for distinguishing clear cell sarcoma of soft tissue from malignant melanoma

Background Clear cell sarcoma (CCS) of soft tissue is a rare soft tissue sarcoma with melanocytic differentiation and shares morphologic, immunohistochemical, ultrastructural, and molecular features with malignant melanoma (MM). Because the prognosis of CCS is much different from MM, it is important to distinguish each other by selective method. CCS is well‐recognized as having the t(12;22)(q13;q12) translocation, on the other hand MM is not. Therefore, detecting Ewing sarcoma region 1 (ESWR1) gene rearrangement can serve as a crucial diagnostic determinant.

Eccrine poroma and eccrine porocarcinoma in linear epidermal nevus

INTRODUCTION Epidermal nevi arise from pluripotential germinative cells in the basal layer of the embryonic epidermis. These cells give rise to keratinocytes and skin appendages such as sebaceous glands, hair follicles, and apocrine glands. Therefore, epidermal nevi can be classified according to their predominant components, and terms such as nevus verrucosus, nevus sebaceus, nevus comedonicus, and nevus syringocystadenosus papilliferus are given to appropriate lesions. However, the division is not absolute, and overlap may be seen both clinically and histologically between classifications, forming a continuous spectrum. There are occasional reports of benign or malignant tumors developing in the preexisting verrucous, solitary, or linear epidermal nevi. However, these secondary neoplasms seem to be much rarer in epidermal nevi than in sebaceous or apocrine nevi. The majority of neoplasms that originate in epidermal nevi are epithelial tumors such as basal cell carcinoma, keratoacanthoma, Bowen disease, and squamous cell carcinoma. Skin appendageal secondary tumors are rare, and to the best of our knowledge, only 1 case report of eccrine poroma and eccrine porocarcinoma that developed within a linear epidermal nevus has been published.

Acquired dyskeratotic leukoplakia of the lip and conjunctiva

A 52-year-old woman presented with a 1-year history of asymptomatic white velvety plaques on the lip and linear spongy plaques on both of the conjunctiva (Fig. 1). The lesions were not removed by rubbing and no other affected lesions were found. A mucosal specimen was taken by a punch biopsy from the affected lip area for histological examination. It showed a thickening of the epithelium, and the suprabasal and superficial malpighian layers were enriched by hypereosinophilic cells showing premature keratinization (dyskeratosis); also, an irregularly acanthotic epithelium and hyperkeratosis with areas of both orthokeratosis and parakeratosis were also noted. However, the cell-withincell pattern, cells appearing to be engulfed by normal cells, was not observed (Fig. 2). Contact material history including smoking and occupational history were recorded to rule out any irritationcausing agents. The patient had no familial history with similar symptoms, and her general health status was good. We treated the affected lip lesion with a topical steroid and antifungal agents for six weeks, but no improvements were observed.

Application of dynamic thermal imaging in a photocarcinogenesis mouse model

Abstract Introduction: In clinical practice and experimental settings, cutaneous premalignant and malignant lesions are commonly diagnosed by histopathological biopsy. However, this technique is invasive and results in functional or cosmetic defects. Dynamic thermal imaging is a non-invasive technique that quantifies the infra-red (IR) radiation emitted by a subject after the introduction of external thermal stimuli (such as heat or cold). Methods: Forty hairless albino (Crl:SKH1-hr) mice were randomised to the control group or the experimental group. The experimental group was regularly irradiated with artificial ultraviolet. Clinical photographs, immunohistochemical staining and dynamic thermal imaging results of both groups were obtained. Results: As photocarcinogenesis proceeded, faster thermal recovery to basal temperature after heat stimuli was significant on dynamic thermal imaging. With histopathological correlations, it was possible to differentiate normal, premalignant and malignant cutaneous lesions according to thermal imaging results. CD 31 staining analysis showed that increased vasculature was the key change responsible for different thermal imaging results among photocarcinogenesis steps. Conclusions: Dynamic thermal imaging is useful to differentiate normal, premalignant and malignant cutaneous lesions. Increased vasculature is the key change responsible for different thermal imaging results.

Knowledge, attitudes and practices regarding methicillin-resistant Staphylococcus aureus (MRSA) infection control and nasal MRSA carriage rate among dental health-care professionals

BACKGROUND Dental health-care professionals (DHCPs) with nasal colonisation of methicillin-resistant Staphylococcus aureus (MRSA) can serve as a reservoir for MRSA transmission to others and be exposed to self-contamination with MRSA. Evaluating the knowledge, attitudes and actual practice of DHCPs is imperative for appropriate infection control. METHODS Dentists, dental hygienists and dental technologists from Seoul National University Dental Hospital were recruited to participate in a cross-sectional survey and undergo nasal sampling of MRSA. The survey included demographic questions, six questions about knowledge, eight questions about attitudes/perceptions and six questions about practices/behaviours regarding MRSA infection control. Nasal samples from the participants were analysed for MRSA presence, antimicrobial susceptibility and staphylococcal cassette chromosome mec (SCCmec) typing. MRSA carriers underwent decolonisation with topical mupirocin. RESULTS Among 139 DHCPs, four (2.9%) were nasal MRSA carriers. Decolonisation was successful in three participants. One participant was decolonised with topical fusidic acid after failure to decolonise with mupirocin. Dentists had a higher knowledge score compared with the other professionals (P < 0.05). Dental hygienists scored higher on practice questions compared with the other professionals (P < 0.05). There was a significant, positive correlation between attitude and practice scores (P < 0.01). CONCLUSIONS The nasal MRSA carriage rate among DHCPs is 2.9%, which is higher than that in the general population but lower than that in other health-care professionals. Further education of DHCPs on MRSA, especially regarding its seriousness, is needed to improve MRSA infection control in a dental hospital setting.

Antimicrobial resistance of Staphylococcus aureus isolated from skin infections and its implications in various clinical conditions in Korea.

Periodic investigations into patterns of antimicrobial resistance can help to optimize the efficacy of treatment and limit the development of resistance.

An unusual case of nevus of Ota combined with nevus spilus.

References 1 Leonard AL, Meehan SA, Ramsey D, et al. Cutaneous and systemic plasmacytosis. J Am Acad Dermatol 2007; 56: S38–S40. 2 Arico M, Bongiorno MR. Primary cutaneous plasmacytosis in a child. Is this a new entity? J Eur Acad Dermatol Venereol 2002; 16: 164–167. 3 Gilliam AC, Mullen RH, Oviedo G, et al. Isolated benign primary cutaneous plasmacytosis in children: two illustrative cases. Arch Dermatol 2009; 145: 299–302. 4 Ahn JJ, Yang YS, Shin MK, et al. Case of isolated benign primary cutaneous plasmacytosis in a child. J Dermatol 2011; 38: 364–367.

Dynamic thermal imaging on actinic keratosis patients: A preliminary study

Diagnosis of actinic keratosis (AK) based only on clinical findings can be misleading, and histopathological diagnosis results in scars. Dynamic thermal imaging is a potential non‐invasive tool for the diagnosis of AK. This imaging technique quantifies the infrared (IR) radiation emitted by a subject after exposure to external thermal stimuli, such as heat or cold.

Laboratory tests and compliance of dermatologic outpatients

Laboratory tests, including blood tests and urine analysis, are frequently performed in the dermatology outpatient clinic, but doctors often do not consider the cognitive or psychological effect of the examinations. Based on terror management theory, we hypothesized that performing laboratory tests increases the patient’s fear of mortality, and therefore has a positive effect on the patient’s attitude toward the doctor’s recommendations and willingness to accept them. The study employed a single factor between-subjects design, using a questionnaire completed by the patients. One group consisted of patients who had undergone laboratory tests 1 week before the survey, and the other group consisted of patients who had not undergone a laboratory test. Although the differences between two groups were not statistically significant, the patients who had laboratory tests had tendency to show even lower positive attitude toward the doctor’s recommendations and less intention to follow the recommendations. In contrast to our hypothesis, performing laboratory tests does not subliminally increase patients’ fears or anxieties about their disease or their compliance with doctors’ recommendations.