Squamous cell carcinoma of the nail unit: a retrospective review of 17 cases and our proposal for surgical management

( Gwanghyun Jo ),( Tae Min Lee ),( Soo Ick Cho ),( Seong-jin Jo ),( Kwang-hyun Cho ),( Je-ho Mun ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: Reports regarding nail unit squamous cell carcinoma (NUSCC) are rare in Asia Objectives: To investigate clinical and histopathological characteristics of NUSCC in our institution and to propose a management algorithm. Methods: We performed a retrospective analysis of patients with NUSCC at Seoul National University Hospital over a period of 5 years (from April 2012 to April 2017) and literature review regarding NUSCC. Results: Seventeen cases were included. Eleven patients were male (64.7%). The fingers were more frequently affected (76.5%). Median duration of the disease at diagnosis was 3 years (Range: 0.3-22 years). The misdiagnosis rate was high (82.4%). The frequent clinical signs were subungual nodules, ulcer, nail dystrophy, and subungual hyperkeratosis. Most of the cases were invasive (76.5%). In terms of surgical methods, local excision, en-bloc excision of the nail unit, Mohs micrographic surgery, and digital amputation were performed on 23.5%, 11.8%, 35.3%, and 29.4% of the patients, respectively. Distant metastasis was not detected in all cases; however, recurrence was found in 2 cases (11.7%). Conclusion: Misdiagnosis of NUSCC was common, and most of the cases had prolonged delays until correct diagnosis was established. The majority of the lesions were invasive. Based on our surgical experience and literature review, we propose an algorithm for management of NUSCC depending on the proportion of nail involvement, the presence of dermal invasion, and bone involvement.

Tumor growth rate as a prognostic factor in acral melanoma

( Gwanghyun Jo ),( Soo Ick Cho ),( Youngjoo Cho ),( Jungyoon Ohn ),( Je-ho Mun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Rapid growth of malignant melanoma is associated with aggressive histopathologic features and poor prognosis in cutaneous melanoma. However, the impact of growth rate (GR) in acral melanoma (AM) has been largely unknown. Objectives: To identify the impact of GR on lymph node metastasis and survival in AM Methods: We analyzed cases of invasive AM diagnosed at our institution between 1998 and 2017. We investigated the impact of GR on the prognosis of AM. Results: In total, 126 cases of invasive AM were included. Log (GR) was significant for lymph node metastasis in univariate logistic regression (P=.005). Log-rank test revealed statistically significant difference in disease-free survival (DFS) and disease-specific survival (DSS) among four GR quartiles. In Cox regression analysis, log (GR) was an independent predictor for DFS (P=.041); However, for DSS, it was not retained in multivariate analysis. In subgroup analysis, log (GR) was an independent predictor for early-stage (≤2A) AM (DFS, P=.002; DSS, P=.004). Conclusion: Our results suggest that GR is an important prognostic factor for DFS and DSS in AM and an independent predictor for early-stage AM.

Functional surgery versus amputation for in situ or minimally invasive subungual melanoma: A systematic review and meta-analysis using individual patient data

( Gwanghyun Jo ),( Soo Ick Cho ),( Je-ho Mun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Evidence for which surgical treatment is appropriate for in situ or minimally invasive (Breslow thickness < 0.5mm) subungual melanoma between functional surgery and amputation is lacking. Objectives: To investigate the difference in local recurrence between the two interventions for in situ or minimally invasive subungual melanoma using available published literature Methods: We performed systematic search on Pubmed, EMBASE, Cochrane library, trial registers, and grey literature databases from inception to June 28, 2018. Due to lack of randomized controlled trial, we included observational studies with at least 5 in situ or minimally invasive subungual melanoma cases. Main outcome was local recurrence. Results: Odds ratio synthesized from 5 comparative studies including 110 patients (89 functional surgery and 21 amputation) was 1.57 (95% confidence interval: 0.31-8.00). Log-rank test using individual patient data of 75 patients (63 functional surgery and 12 amputation) from 3 comparative studies and 5 non-comparative studies, showed no statistical difference (P=0.225). Conclusion: Our results revealed there is no difference in terms of local recurrence between the two interventions for in situ or minimally invasive subungual melanoma. Considering functional deficit following amputation, functional surgery should be the treatment of choice for in situ or minimally invasive subungual melanoma.

Analysis of judicial precedents cases regarding skin cancer from 1997 to 2017 in Republic of Korea

( Gwanghyun Jo ),( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Je-ho Mun ),( Soo Ick Cho ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Both medical disputes and the incidence of skin cancer are increasing in Korea. Objectives: To figure out the medical litigation related to skin cancer and propose a method to prevent the medical disputes Methods: Skin cancer-related judgments were searched by The Supreme Court of Korea’s Written Judgment Management System based on the keywords for skin cancer. The search system included sentenced cases at the Lower Courts, the Appellate Courts, and the Supreme Court from 1997 to 2017 Results: Seven cases were selected as the litigation cases related to skin cancer. Four cases (57.1%) presented malignant melanoma, while the rest presented squamous cell carcinoma, metastatic skin cancer, and peripheral T cell lymphoma (1 case in each). Four cases resulted in death from cancer metastasis, and 3 cases presented as sequelae. The legal issues related to the medical disputes could be categorized as follows: misdiagnosis, delayed diagnosis, performance error, and lack of informed consent. Delayed diagnosis and lack of informed consent were the most common issues (n=4) in the precedents. Five cases (71.4%) were sentenced the awarded amounts to the plaintiff, including 2 cases of settlement decision. The average awarded amount was 42,553,644±27,567,455 Korean Won. Conclusion: Physicians should pay attention to the cases of the skin cancer to prevent medical malpractice and disputes.

Secondary intention healing after conservative surgery of nail unit melanoma in situ: An analysis of healing time and outcomes

( Gwanghyun Jo ),( Soo Ick Cho ),( Je-ho Mun ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Secondary intention healing (SIH) after conservative surgery for nail unit melanoma in situ (NUMIS) can be a useful reconstructive method. However, the healing process and recovery time has not been sufficiently reported. Objectives: To investigate course after SIH with functional surgery for NUMIS Methods: We analyzed 10 patients with NUMIS treated by conservative surgery and SIH in our institution from January 2015 to June 2018. We evaluated healing time, functional outcome, cosmetic outcome, and patient’s subjective satisfaction and complication. Results: Median age was 51 (range: 28-69) years old. Seven patients were female. Seven patients had fingernail involvement. Granulation tissue coverage over phalangeal bone completed in 3.7±2.4 weeks (mean±SD). Re-epithelialization achieved in 10±2.7 weeks. Mean Quick-Disabilities of the Arm, Shoulder and Hand (DASH) score was 9.4±6.2. Foot Function Index (FFI) score was 1.3±2.3. Mean Vancouver Burn Scar Assessment Scale (VBSAS) score was 4.5±1.4. Patient’s subjective global satisfaction was median 8 (range: 7-10). Conclusion: Our data suggest that SIH is a good reconstructive method after conservative surgery of NUMIS.

Treatment of nail matrix nevus in children using 1,064-nm Q-switched Nd:YAG laser: two cases

( Gwanghyun Jo ),( Jaewon Lee ),( Hyun-sun Park ),( Hyun-sun Yoon ),( Soyun Cho ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

Melanonychia refers to the color change of the nail plate to brown or black. In children, the most common cause of melanonychia is nail matrix nevus (NMN), and melanoma is an extremely rare cause of melanonychia; however, clinical manifestation of NMN is so severe that parents want to remove melanonychia for cosmetic purposes. We present two cases of biopsy-proven NMN in children treated by 1,064-nm Q-switched Nd:YAG (QSNDY) laser. An 8-month-old male presented with a 5-mm wide black band on the left index fingernail. We made the diagnosis of NMN by histopathologic examination on nail matrix and treated the lesion with 1,064-nm QSNDY laser with a spot size of 4 mm and fluence of 3-6 J/㎠ with 2 passes at 4-week intervals. After 14 treatment sessions, the black band width decreased to 2 mm. After additional 11 treatment sessions with the fluence of 7 J/㎠, the black band disappeared completely without any complications. The second case was a 21-month-old female with a 6-mm wide black band on the right index fingernail. Her melanonychia was diagnosed as NMN by biopsy. She underwent the same treatment as the first case, with a fluence of 7 J/㎠. After 3 sessions of treatment, 60% of black band disappeared. Our results demonstrate that 1,064 nm QSNDY laser is a safe and effective treatment modality for treatment of NMN in children.

보행자의 안전한 횡단을 위한 새로운 차세대 신호등 시스템

Cho, Seung-Pyo,Shin, Seong-Yoon,Jo, Gwanghyun 한국정보통신학회 2022 한국정보통신학회논문지 Vol.26 No.12

The meaning of crosswalks and traffic lights in modern society has changed a lot as the enforcement of traffic signal violations has been strengthened. In this paper, we present a new next-generation traffic light method using radar and Can-bus communication methods suitable for the new traffic signal enforcement system. This method is a system that prevents accidents by transmitting information on the entry of a person and a car to a traffic light in a place where a person and a car passing through a mutually invisible traffic light cannot be seen. Since this system has only been developed for a month, it may be somewhat lacking in experimentation. However, in just one month, there have been no incidents except for a few people where the system has been installed.

[P287] Altered mentality in a patient with herpes zoster

( Gwanghyun Jo ),( Hyun-sun Yoon ),( Soyun Cho ),( Hyunsun Park ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

A 70-year-old woman who was treated for herpes zoster presented with confusion. Physical examination, laboratory tests, cerebrospinal fluid (CSF) analysis, and computed tomography of the brain were performed. She was diagnosed as zoster encephalitis (ZE) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). After the correction of electrolyte imbalance and antiviral treatment for 2 weeks, she almost recovered to normal. When mental alteration occurs in herpes zoster patients, ZE or SIADH should be suspected. Immunocompromised states such as old age, diabetes mellitus, transplantation, malignancy and acquired immunodeficiency syndrome are risk factors for both ZE and SIADH. ZE manifest diverse conditions such as ischemic and hemorrhagic infarctions, demyelinating disease, seizures, and mental status changes. Such conditions in herpes zoster patients with the absence of other causes could be diagnosed with ZE. Detection of varicella-zoster virus by polymerase chain reaction of CSF is diagnostic. SIADH accompanied by herpes zoster is well documented. The mechanism is not clear. Hypo-osmolar euvolemic hyponatremia with elevated urine osmolality and Na+ concentration without cardiac, renal, hepatic, and endocrine dysfunction are consistent with the diagnosis of SIADH. Here we report this case for dermatologists to know the causes of mental alteration in immunocompromised herpes zoster patients and to cope well with them.

[P473] A case of pembrolizumab induced lichen planus like drug eruptions

( Gwanghyun Jo ),( Chong Won Choi ),( Seong-jin Jo ),( Kwang-hyun Cho ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

New advances in immunology have highlighted the role of the programmed cell death (PD)-1 protein in the suppression of the immune system. The use of recently-introduced anti-PD1 antibodies is rapidly increasing to combat cancer; they can activate the anti-cancer immune response by reversing the PD-1-induced inhibition of the immune system and thus control the progression of tumor cells. Pembrolizumab is a humanized anti-PD1 antibody approved for the treatment of unresectable or metastatic melanoma following disease progression after the treatment of ipilimumab. The adverse effects of pembrolizumab include pneumonitis, colitis, hepatitis and endocrinopathies, some of which may be related to the immunoregulatory mechanisms of the drug. In addition, several cutaneous adverse events have also been reported in association with the drug. Here we describe a case of lichen planus-like drug eruption following pembrolizumab treatment. A 72-year-old man underwent pembrolizumab treatment for small cell lung cancer. After ten courses of the treatment, he developed skin rashes, for which he was referred to our department for evaluation. The itchy, round erythematous plaques were found on his upper and lower extremities. Histopathologic examination revealed interface dermatitis with a few apoptotic keratinocytes in the basal layer. Thus, he was diagnosed with pembrolizumab-induced lichen planus-like drug eruption and treated with topical steroids.

학습환경에서 불쾌적온도에서 쾌적온도로의 변화시 생체신호 및 주관적 반응에 대한 실험적 연구

임광현(Gwanghyun Im),김진현(Jinhyun Kim),박차식(Chasik Park),조홍현(Honghyun Cho) 대한설비공학회 2015 설비공학 논문집 Vol.27 No.11

In this study, experiments using bioelectronic signals and questionnaire surveys were carried out in learning conditions when temperatures changed from low- and high-uncomfortable to comfortable. As a result, the stress factor Photoplethysmography (PPG) decreased, while the Root Mean Square of Standard Deviation (RMSSD) of PPG increased when the indoor temperature was changed from low- or high-uncomfortable to comfortable. Additionally, the absolute power of the α-wave in the brain increased. According to the analysis of the association between the questionnaire and bioelectronic signals, the standard deviation of the stress factor as measured by pulse was closely related to the result of the thermal sensation questionnaire. In addition, it was found that the concentration on studying improved under comfortable temperatures when compared to uncomfortable temperatures.