Delayed Reconstruction for the Non-Amputative Treatment of Subungual Melanoma

Background

In cases of early stage subungual melanoma (SUM), conservative treatment with non-amputative wide excision of the nail unit and subsequent skin graft is preferred over amputation to preserve the involved digit.

Objective

We report a series of patients with SUM treated with conservative surgery and suggest an effective supplementary treatment process.

Methods

We retrospectively reviewed 10 patients (2 males, 8 females) who were diagnosed with in situ or minimally invasive SUM on the first biopsy and underwent non-amputative wide excision of the nail unit. All patients underwent secondary intention healing during the histopathological re-evaluation of the entire excised lesion, and additional treatment was administered according to the final report.

Results

In two of 10 patients, amputation was performed because of the detection of deep invasion (Breslow thickness: 4.0, 2.3 mm) from the final pathologic results, which differed from the initial biopsy. In six patients who received delayed skin graft, the mean total time required for complete healing after secondary intention healing and the skin graft was 66.83±15.09 days. As a result of this delayed skin graft, the final scarring was similar to the original shape of the nail unit, scored between 5 and 10 on a visual analogue scale. Most patients were satisfied with this conservative surgery except one patient, who had volar portion involvement and received an interpolated flap instead of a skin graft.

Conclusion

Our treatment process can reduce the risk of incomplete resection and improve cosmetic outcomes in patients with SUM.     

Differentiation of Benign Pigmented Skin Lesions with the Aid of Computer Image Analysis: A Novel Approach

Background

The differential diagnosis of common pigmented skin lesions is important in cosmetic dermatology. The computer aided image analysis would be a potent ancillary diagnostic tool when patients are hesitant to undergo a skin biopsy.

Objective

We investigated the numerical parameters discriminating each pigmented skin lesion from another with statistical significance.

Methods

For each of the five magnified digital images containing clinically diagnosed nevus, lentigo and seborrheic keratosis, a total of 23 parameters describing the morphological, color, texture and topological features were calculated with the aid of a self-developed image analysis software. A novel concept of concentricity was proposed, which represents how closely the color segmentation resembles a concentric circle.

Results

Morphologically, seborrheic keratosis was bigger and spikier than nevus and lentigo. The color histogram revealed that nevus was the darkest and had the widest variation in tone. In the aspect of texture, the surface of the nevus showed the highest contrast and correlation. Finally, the color segmented pattern of the nevus and lentigo was far more concentric than that of seborrheic keratosis.

Conclusion

We found that the subtle distinctions between nevus, lentigo and seborrheic keratosis, which are likely to be unrecognized by ocular inspection, are well emphasized and detected with the aid of software.     

Three different clinical faces of the same histopathological entity: hair follicle nevus,trichofolliculoma and accessory tragus

BACKGROUND

Hair follicle nevus is a rare, congenital hamartoma with follicular differentiation characterized histologically by numerous, tiny, mature hair follicles. Trichofolliculoma, the histopathological features of which are quite similar to those of hair follicle nevus, is also a hamartoma that differs from hair follicle. Accessory tragus is a relatively common, benign congenital abnormality of the external ear with an incidence rate of 1 to 10 per 1,000 live births.

OBJECTIVE

This study seeks to assess the discriminatory value of currently available, histological criteria in the differential diagnosis of hair follicle nevus, accessory tragi and trichofolliculoma.

METHODS

Twenty-one patients comprising 9 cases of hair follicle nevus, 8 accessory tragi patients and 4 trichofolliculoma cases, were recruited to perform the study.

RESULTS

There were 10 males and 11 females in the study group. No significant difference was observed between the three study groups in terms of age, gender or histopathological parameters such as density of hair follicles, subcutaneous fat score and presence of connective tissue framework. Cartilaginous component was seen in 8 cases that were diagnosed as accessory tragi, while central cyst and radiating hair follicles were seen in 4 cases which were diagnosed as trichofolliculoma.

CONCLUSION

The results of our study showed that diagnostic discrimination of these diseases could be made only with the clinicopathologic correlation because of their clinical and histopathological similarities.     

Differences in the Known Cellular Composition of Benign Pigmented Skin Lesions Reflected in Computer-Aided Image Analysis

Background

Computer-aided image analysis (CAIA) has been suggested as an effective diagnostic tool for pigmented skin lesions (PSLs), especially melanoma. However, few studies on benign PSLs have been reported.

Objective

The purpose of this study was to evaluate benign PSLs with our CAIA software and analyze the differences between the parameters of those lesions.

Methods

By using homegrown CAIA software, we analyzed 3 kinds of PSLs-nevus, lentigo, and seborrheic keratosis. The group of seborrheic keratosis was divided into pigmented seborrheic keratosis, sebolentigine, and hyperkeratotic seborrheic keratosis. The CAIA was used to extract the color, as well as the morphological, textural, and topological features from each image.

Results

In line with clinical observations, the objective parameters indicated that nevus was dark and round, lentigo was small and bright, and seborrheic keratosis was large and spiky. The surface of nevus showed the highest contrast and correlation. In topological analysis, the concentricity clearly separated melanocytic lesions from seborrheic keratosis. The parameters of pigmented seborrheic keratosis were between those of typical nevus and seborrheic keratosis.

Conclusion

We confirmed that definite correlations exist between the subjective differentiation by experts'' examination and the objective evaluation by using CAIA. We also found that the morphological differences observed in CAIA were greatly influenced by the composition ratios of keratinocytes and melanocytes, which are already known histopathological characteristics of each PSL.     

Expression Patterns of Gli-1, Pleckstrin Homology-Like Domain,Family A,Member 1, Transforming Growth Factor-β1/β2, and p63 in Sebaceous and Follicular Tumors

Background

Certain epidermal appendage tumors, including hyperplasias (hamartomas), adenomas, benign epitheliomas, primordial epitheliomas, and malignant tumors, can exhibit any stage of differentiation. Several molecules associated with tumorigenesis, such as Gli-1, pleckstrin homology-like domain, family A, member 1 (PHLDA-1), transforming growth factor (TGF)-β1, TGF-β2, and p63, are associated with tumor grade and aggressive behavior in follicular and sebaceous tumors in ways that are not well understood.

Objective

The aim of this study was to elucidate the expression of Gli-1, PHLDA-1, TGF-β1/β2, and p63 in benign and malignant tumors of the hair and sebaceous glands and to determine their importance in the degree of tumor differentiation.

Methods

Immunohistochemistry was performed in follicular and sebaceous tumors using antibodies against Gli-1 (sebaceous tumor marker), PHLDA-1 (hair follicle outer root sheath [ORS] cell marker), p63, TGF-β1, and TGF-β2.

Results

Gli-1 was expressed in basaloid cells, sebocytes, and sebaceous carcinoma cells, and expression levels decreased as differentiation progressed. PHLDA-1 was expressed in ORS cells and some follicular tumor cells. Expression of p63 was observed in the nuclei of the outermost basaloid cells (seboblasts), poorly differentiated sebaceous carcinoma cells, and tumor cells toward the direction of the hair. Remarkably, TGF-β1 was expressed exclusively in the nuclei of benign and malignant follicular (hair) tumors, but not in sebaceous tumors, at levels that correlated with the degree of differentiation.

Conclusion

We propose that p63 and/or TGF-β1 are useful for predicting the degree of differentiation and malignant potential of sebaceous and follicular tumors and for distinguishing trichilemmal carcinoma from sebaceous carcinoma.     

Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side

Background

Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size.

Objective

The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin.

Methods

In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side.

Results

We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced.

Conclusion

We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.     

Extramammary Paget Disease: Minimal Surgical Therapy

Background

Extramammary Paget disease (EMPD) is an uncommon malignant neoplasm affecting apocrine gland-bearing skin which usually occurs in the anogenital area of patients older than 50 years. Although Mohs micrographic surgery (MMS) is recommended for the treatment of EMPD, wide local excision has also been performed by many other surgeons including dermatosurgeons. However, the extent of an adequate resection margin is still under debate.

Objective

The efficacy of minimal surgical therapy consisting of a wide excision combined with preoperative multiple scouting biopsies and postoperative topical imiquimod was investigated for the treatment of EMPD in Korean patients.

Methods

Between 2006 and 2012, 10 patients with primary EMPD were treated with wide surgical excision, with a surgical margin of less than 2.5 cm. Multiple preoperative scouting biopsies and postoperative topical imiquimod were also performed to delineate the lesional boundaries and to reduce the recurrence rate.

Results

During the 6-year follow-up period, complications and recurrences were not observed.

Conclusion

Minimal surgical therapy may be an effective alternative when MMS is unavailable.     

Comparison of Marketed Cosmetic Products Constituents with the Antigens Included in Cosmetic-related Patch Test

Background

Currently, cosmetic series (Chemotechnique Diagnostics, Sweden) is the most widely used cosmetic-related patch test in Korea. However, no studies have been conducted on how accurately it reflects the constituents of the cosmetics in Korea.

Objective

We surveyed the constituents of various cosmetics and compare with the cosmetic series, to investigate whether it is accurate in determining allergic contact dermatitis caused by cosmetics sold in Korea.

Methods

Cosmetics were classified into 11 categories and the survey was conducted on the constituents of 55 cosmetics, with 5 cosmetics in each category. The surveyed constituents were classified by chemical function and compared with the antigens of cosmetic series.

Results

155 constituents were found in 55 cosmetics, and 74 (47.7%) of constituents were included as antigen. Among them, only 20 constituents (27.0%) were included in cosmetic series. A significant number of constituents, such as fragrance, vehicle and surfactant were not included. Only 41.7% of antigens in cosmetic series were found to be in the cosmetics sampled.

Conclusion

The constituents not included in the patch test but possess antigenicity are widely used in cosmetics. Therefore, the patch test should be modified to reflect ingredients in the marketed products that may stimulate allergies.     

Human Papillomavirus Deoxyribonucleic Acid may not be Detected in Non-genital Benign Papillomatous Skin Lesions by Polymerase Chain Reaction

Background:

Papillomatosis is a known histopathologic pattern usually seen in human papillomavirus (HPV) infection and verruca vulgaris is the typical example. This pattern is also detected in some other benign cutaneous lesions such as nevus sebaceous (NS), seborrheic keratosis (SK), trichilemmoma (TL) and inverted follicular keratosis (IFK). The association between papillomatous lesions and HPV infection is questionable.

Objective:

The objective of this study was to investigate the presence of HPV deoxyribonucleic acid (DNA) in non-genital benign papillomatous skin lesions (NS, SK, TL and IFK) by polymerase chain reaction (PCR).

Materials and Methods:

A total of 100 specimens of non-genital NS, SK, TL and IFK were retrieved from archives of Dermatopathology Department of Razi Hospital, between 2003 and 2010. The conventional PCR using consensus GP5+/GP6+ primer and hydroxymethylbilane synthase gene as inner control was performed.

Results:

PCR for HPV DNA revealed no positive results in any of 28 seborrheic keratosis (SK), 28 nevus sebaceous (NS), 28 inverted follicular keratosis (IFK) and 13 trichilemmoma (TL) studied specimens.

Conclusion:

Papillomatosis is usually a characteristic pattern of HPV infection. However, we found no association between HPV infection and non-genital benign papillomatous lesions.     

Merkel Cell Polyomavirus Is Frequently Detected in Korean Patients with Merkel Cell Carcinoma

Background

Merkel cell carcinoma (MCC) is an increasingly common neuroendocrine cancer of the skin. Merkel cell polyomavirus (MCPyV) is one of the causative agents of MCC. The prevalence of MCPyV in primary MCC and sun-exposed non-MCC tumors has been known to have different results depending on where it was investigated.

Objective

This study assesses the prevalence of MCPyV from primary MCC and sun-exposed non-MCC tumors in Korea.

Methods

A molecular pathology study was performed on 7 tissue specimens of MCC, 1 tissue specimen of metastatic small cell carcinoma of the lung, and 32 tissue specimens of non-MCC tumors occurring from sun-exposed areas [8 basal cell carcinomas (BCCs), 8 squamous cell carcinomas (SCCs), 8 actinic keratoses (AKs), and 8 seborrheic keratoses (SKs)]. All specimens were analyzed to determine the presence of MCPyV-DNA using both polymerase chain reaction (PCR) and real-time quantitative PCR. Immunohistochemistry with monoclonal antibody of MCPyV large T antigen (CM2B4) was also conducted.

Results

Using both PCR, MCPyV sequences were detected in six of seven MCC tissue specimens (85.7%). Five (71%) of seven MCC tumors were immunoreactive for CM2B4. All five immunoreactive cases were positive for MCPyV. However, there was no association of MCPyV with BCC, SCC, AK, and SK.

Conclusion

Our results implicate that MCPyV may contribute to the pathogenesis of primary MCC, not of non-MCC skin tumors in Korea, and the persons with MCPyV infection are unusual in Korea compared to other areas.     

Photodynamic Therapy with Ablative Carbon Dioxide Fractional Laser for Treating Bowen Disease

Background

Topical photodynamic therapy (PDT) has been increasingly used to treat malignant skin tumors including the Bowen disease. However, patients could be displeased with the long incubation time required for conventional PDT.

Objective

We evaluated the efficacy and safety of PDT with a short incubation time of ablative CO₂ fractional laser pretreatment for treating Bowen disease.

Methods

Ten patients were included. Just before applying the topical photosensitizer, all lesions were treated with ablative CO₂ fractional laser, following the application of methyl aminolevulinate and irradiation with red light (Aktilite CL 128). Histological confirmation, rebiopsy, and clinical assessments were performed. Adverse events were also recorded.

Results

Five of the ten (50%) lesions showed a complete response (CR) within three PDT sessions. After four treatment sessions, all lesions except one penile shaft lesion (90%) achieved clinical and histological CR or clinical CR only. The average number of treatments to CR was 3.70±1.70. The treatments showed favorable cosmetic outcomes and no serious adverse events.

Conclusion

The results suggest that pretreatment with an ablative fractional CO₂ laser before PDT has similar treatment efficacy and requires a shorter photosensitizer incubation time compared with the conventional PDT method.     

Cutaneous metastasis from internal carcinomas: a review of 45 years

BACKGROUND

cutaneous metastases are not so frequent and in the medical literature there are several communications of isolated cases, thereby we decided to continue our study initiated in 1981 (45 years).

OBJECTIVE

our objective is to present the research and review of cutaneous metastases of 45 years through our archives at Hospital do Servidor Publico Estadual de Sao Paulo.

METHODS

the data were collected from clinical cases registered in our archives at anatomopathology department.

RESULTS

since 1963 we have registered 209 patients with cutaneous metastases being the anterior thorax region the most affected area and in second place the abdominal region. Breast cancer was responsible for most of the cases in women and the lung in men.

CONCLUSION

this study represents a signioficant number of cases in medical practice because skin metastases of internal carcinomas rarely are observed and the great predominance, mainly due of his origin were represented by adenocarcinomas.     

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics,frequency of local recurrence and metastasis

BACKGROUND

squamous cell carcinoma is the second most common type of skin malignancy and may evolve to regional lymph node and distant metastases.

OBJECTIVE

The objective of this study was to evaluate patients with head and neck cutaneous squamous cell carcinoma to identify its clinical and histopathological characteristics, as well as the frequency of local recurrence and metastasis.

METHODS

A retrospective cohort of patients with head and neck cutaneous squamous cell carcinoma. Inclusion criteria: histopathological confirmation, follow-up for longer than one year after diagnosis. Exclusion criteria: immunosuppression; lip and oral cavity squamous cell carcinoma; and non-surgical resection of the lesion. We evaluated demographic, clinical and anatomopathologic findings and explored their associations.

RESULTS

Sixty-one patients with 79 tumors and followed by 4.8±3.0 years were selected. The average age was 67.1 years, and 63% of tumors had up to two centimeters. Seven tumors (8.9%) recurred and two of them had positive margins. Recurrence was associated with higher Broders'' grade (p<0.01). Two patients (3.3%) had regional lymph node metastases. There were no distant metastases. Seventy tumors were considered to be usual tumors (89.7%), and 68 (87.2%) were classified as Broders'' grade 1 and 2. Additionally, 64.1% of tumors had a depth of invasion below four millimeters. Thirteen tumors (16.7%) had positive histological margins.

CONCLUSIONS

Most patients had good prognosis in the first year of follow-up, confirming that head and neck cutaneous squamous cell carcinoma has a better prognosis than squamous cell carcinoma of other regions such as mucosa, oral cavity, and internal organs.     

Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up

Background

Few studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin.

Objective

We retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans.

Methods

A total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm² for ALA-PDT and a diode lamp at 37 J/cm² for MAL-PDT.

Results

The complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities.

Conclusion

MAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study.     

Eccrine Angiomatous Hamartoma: A Review of Ten Cases

Background

Eccrine angiomatous hamartoma (EAH) is a rare benign nodular lesion characterized by the proliferation of eccrine and vascular structures, generally capillaries, in the middle and deep dermis. It may be congenital or appear later in childhood, but rarely arises in adulthood.

Objective

To investigate the clinicopathologic features of EAH in Korean patients.

Methods

Ten cases of EAH diagnosed at Ajou University Hospital and Gangnam Severance Hospital in Korea from 2007 to 2010 were retrospectively reviewed.

Results

The age range of patients was between 5 and 66 years with an equal number of male and female patients. Apart from two congenital cases, the onset was late, ranging from 6 months to 65 years of age. All lesions were solitary and located on the distal extremities. Nine cases appeared as a yellow-brown nodule or plaque resembling a callus. Neither hyperhidrosis nor hypertrichosis was documented. Apart from the typical histological findings of EAH, prominent mucin deposition, fat component and nerve infiltration were observed.

Conclusion

This is one of the largest single case series of EAH in the literature. Clinically, resemblance to callosities and the frequent occurrence in the adulthood were the unique features in our series.     

Chemokine Receptor CCR3 Expression in Malignant Cutaneous Tumors

Background

Chemokines and their receptors are important players in tumorigenesis by facilitating tumor proliferation and metastasis. Little is known about the possible function of chemokine receptors in relation to the development and progression of malignant cutaneous tumors.

Objective

The aim of this study was to determine the chemokine receptor CCR3 expression pattern and the protein expression level in selected malignant cutaneous tumors.

Methods

Four types of cell lines (G361, A431, SK-MEL-2, SK-MEL-24) were analyzed, using Western blotting, for the expression of CCR3 protein. Immunohistochemical staining for CCR3 was done on 36 skin cancer tissue samples that included 16 squamous cell carcinomas (SCCs), 16 basal cell carcinomas (BCCs), 16 malignant melanomas (MMs) and 6 normal tissue samples.

Results

Western blot analysis showed that CCR3 protein was more expressed in the MM cell lines (G361, SK-MEL-2,SK-MEL-24) than that in the SCC cell line (A431), and the immunohistochemical analysis showed that CCR3 protein was overexpressed in MM and SCC, it was mildly expressed in BCC and it was hardly expressed in normal tissue.

Conclusion

This study demonstrated via immunochemistry that CCR3 was more expressed in MM, followed by SCC and BCC. The existence of CCR3 protein may enhance the tumorigenic potential of malignant cutaneous tumors.     

Systemic lupus erythematosus and Raynaud's phenomenon

BACKGROUND

Patients with systemic lupus erythematosus seem to belong to different serological and clinical subgroups of the disease. Genetic background can cause the appearance of these subgroups.

OBJECTIVE

To determine whether Brazilian patients who have systemic lupus erythematosus and Raynaud''s phenomenon differ from those who do not.

METHODS

Retrospective analysis of 373 medical records of systemic lupus erythematosus patients studied for demographic, clinical and serological data. A comparative analysis was performed of individuals with and without RP.

RESULTS

There was a positive association between Raynaud''s phenomenon and age at diagnosis (p=0.02), presence of anti-Sm (p=0.01) antibodies and anti-RNP (p<0.0001). Furthermore, a negative association was found between Raynaud''s phenomenon and hemolysis (p=0.01), serositis (p=0.01), glomerulonephritis (p=0.0004) and IgM aCL (p=0.004) antibodies.

CONCLUSION

Raynaud''s phenomenon patients appear to belong to a systemic lupus erythematosus subset with a spectrum of clinical manifestations located in a more benign pole of the disease.     

Time needed to schedule dermatological consultations in Brazil

BACKGROUND

It is not clear what the population''s demand for dermatologists is, nor how many professionals are needed in order to provide adequate care in this area of expertise. Knowledge of the flow of patients at dermatological clinics throughout the country allows for the formation of expansion and distribution policies regarding professionals, and provides backing for the decision to increase medical residency places.

OBJECTIVES

To evaluate the time it takes to schedule a private dermatological consultation in Brazil, and other factors concerning consultations.

METHODS

Survey with a random sample of 14% of Brazilian dermatologists, simulating the scheduling of emergency clinical and cosmetic consultations, and botulinum toxin procedures. Also, details relating to cost and professionals, were studied. Data were adjusted for each region of the country.

RESULTS

A total of 873 dermatologists were evaluated. Full SBD members represented 85%, and 66% were women. The median time to schedule a consultation ranged from 6 (out-of-pocket payment) to 7 (medical insurance) consecutive working days. Times varied depending on the region. A multivariate analysis showed that out-of-pocket consultations and procedures were scheduled sooner than with medical insurance, regardless of whether they were clinical or cosmetic.

CONCLUSION

The characteristics of dermatologists are varied throughout regions of the country. Private consultations and procedures are scheduled sooner than with insurance companies.     

Clinicopathological profile and management of 161 cases of actinic cheilitis

BACKGROUND

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun.

OBJECTIVES

To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading.

METHODS

Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system.

RESULTS

There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803).

CONCLUSION

This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.     

Postoperative Electron Beam Radiotherapy for Keloids: Treatment Outcome and Factors Associated with Occurrence and Recurrence

Background

In the treatment of keloids, the recurrence after surgical excision is relatively high. Various types of adjuvant therapy such as radiotherapy and corticosteroid injection have been used to reduce the recurrence.

Objective

The aim of this study was to determine the appropriate time for initiating postoperative radiotherapy and to analyze factors associated with the occurrence and recurrence of keloids.

Methods

Of these 37 lesions, 22 were located in the ear lobe, 6 in the helix of the auricle, 4 on the shoulder, 3 on the chest wall, and 2 on the abdomen. Causative factors were piercings (n=24), trauma (n=5), previous surgical lesions or bacillus Calmette-Guerin vaccination lesions (n=3) and acne (n=2). Radiation therapy was initiated within 24 h in 24 lesions, between 24 and 72 h in 6 lesions, and after more than 72 h in 7 lesions.

Results

Seven lesions recurred, including 5 recurrences in high stretch-tension regions (p=0.010). Initial treatments were administered within 24 h in 1 lesion and more than 72 h after surgical excision in 6 lesions (p<0.0001). In the 19 patients with family histories, maternal and paternal genetic predispositions were present in 14 and 5 patients, respectively (p=0.033).

Conclusion

Radiotherapy should be initiated within 72 h of surgical excision. Location in a high stretch-tension region was significantly associated with recurrence. Patients with a family history showed a significant tendency toward maternal genetic predisposition. Therefore, combination therapy should be considered to reduce the occurrence and recurrence of keloids, and careful observation is required.