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Background Kaposi sarcoma (KS) is a mesenchymal tumor with distinct histopathological features according to tumor progression. Programmed death-1 (PD-1) and its ligand PD-L1 play major roles in the immune escape strategy of tumors. Objectives This study evaluated expression of PD-1 and PD-L1 in various stages of KS and investigated associations between their expression and clinical characteristics. Methods Fifty cases with histopathologically diagnosed KS were classified as early or late stage. These specimens were stained with anti-PD-1 and anti-PD-L1 antibodies. The extent of expression in the intratumoral and peri-tumoral areas was judged by two dermatopathologists. Results PD-1 and PD-L1 were expressed in 72.2% (13/18) and 11.1% (2/18) of early-stage cases, respectively, compared with 43.8% (14/32) and 28.1% (9/32) of late-stage cases, respectively. At the late stage, PD-1 expression was significantly higher in the peri-tumoral area than in the intratumoral area (P = 0.001). PD-1 expression in the intratumoral area was significantly higher at the early stage than at the late stage (P = 0.013). PD-L1 expression in the peri-tumoral area was significantly higher at the late stage than at the early stage (P = 0.038). Conclusions The pattern of PD-1 and PD-L1 expression differs according to the stage of KS, but is unaffected by clinical variables.

Several studies have determined the correlation between programmed cell death protein-1 (PD-1) and chronic plaque psoriasis (CPP). However, limited studies have assessed the association between PD-1 expression and the clinicoprognostic and distinct clinicopathological characteristics of CPP and guttate psoriasis (GP). Twenty-nine patients with skin biopsy-confirmed CPP were recruited at the Asan Medical Center between January 2018 and June 2020, and 33 patients with biopsy-confirmed GP were enrolled between January 2002 and June 2020. The clinicoprognostic and histopathological characteristics were analyzed according to immunohistochemical PD-1 expression in the epidermal or dermal inflammatory infiltrates. The CPP and GP lesions were divided into PD-1-low and PD-1-high groups. The CPP epidermal PD-1-high group had typical histopathological changes and significantly higher psoriasis area and severity index scores (p = 0.014) and disease duration (p = 0.009) than the epidermal PD-1-low group. In patients with GP, compared with the dermal PD-1-high group, the dermal PD-1-low group exhibited significantly higher disease duration (p = 0.002) and relapse rate of plaque psoriasis (p = 0.005) and significantly lower relapse-free survival (p = 0.016). Upregulated epidermal PD-1 expression was correlated with the chronicity and severity of CPP, while downregulated dermal PD-1 expression was correlated with poor prognosis of GP.

Gordonia species were recently found to cause human infection. Most Gordonia bronchialis infections are associated with sternal wounds and foreign bodies. Here, we present a case of a firm cutaneous nodule caused by G. bronchialis on an immunocompetent patient's lower extremity after receiving acupuncture. Our present case indicates that spontaneous cutaneous infection of G. bronchialis can develop even in a healthy patient. With the popularity of complementary and alternative medicine, physicians should be aware that G. bronchialis infection can be associated with Oriental medicine similar to mycobacterial infection. Recognizing the diverse clinical features of newly emerging Gordonia species will facilitate appropriate diagnosis and management of future patients.

Background: Since primary skin cancers in organ transplant recipients (OTRs) are rare, little is known about the characteristics and risk factors of skin cancer in OTRs. Objectives: To improve understanding of primary skin cancers in OTRs. Methods: The database of the Asan Medical Center was searched for OTRs diagnosed with primary post-transplant skin cancers from January 1990 to December 2018.The standardized incidence ratios (SIR), defined as the ratio of the observed number of cancers divided by the expected number of cancers were determined for each cancers. Results: Of 13,469 OTRs, 113 (0.8%) were diagnosed with skin cancers over the 28 years. The most common skin cancer was squamous cell carcinoma, followed by basal cell carcinoma and Kaposi’s sarcoma. The cumulative incidence of skin cancers at 28 years was 5.3%. Over the 10 year period from January 2009 to December 2018, the SIR for premalignant in situ skin lesions increased, whereas the SIR for skin cancers decreased, and the types of post-transplant skin cancers became more diverse. Age at transplantation and treatment with more than two immunosuppressive agents were risk factors for the development of new skin cancers in OTRs. Conclusion: Over the most recent 10 year period, post-transplant skin cancers have been found earlier and to be more diverse than in previous periods. Older age and treatment with more than two immunosuppressive agents increase the risk of post-transplant skin cancers.

Traditional attempts at alleviating photoaging-associated facial pigmentation conditions such as melasma, mottled hyperpigmentation, and post-inflammatory hyperpigmentation have yielded disfiguring cosmetic results. Laser toning using a low-fluence Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been more commonly applied to date. However, the treatment efficacy and safety of this approach have not been widely reported. This study therefore evaluated the efficacy and safety of picosecond 1064-nm Nd:YAG laser application for photoaging-associated facial pigmentation treatment in Korean subjects. Forty-seven Korean subjects with photoaging-associated facial pigmentation underwent picosecond 1064-nm laser application. The clinical improvement of 17 patients was assessed by objective measurements such as melanin and erythema indices. All subjects received six biweekly treatments with the laser in a three-pass fashion delivering approximately 2000 to 2500 shots using a zoom handpiece with a spot size of 7 mm, fluence ranging from 0.4 to 0.7 J/cm2, and a repetition rate of 10 Hz. Clinicians evaluated the improvement of pigmentation using the pigmentation area and severity index (PSI), and subjects reported their satisfaction level on a four-point scale. Statistical analyses were performed using the SPSS version 19.0 for Windows software program (IBM Corp., Armonk, NY, USA). Forty-seven subjects (45 females and two males) completed this study with a 12-week follow-up period. The average decrease in PSI value at 12 weeks after treatment was 6.85 ± 6.35 points (p

Laugier-hunziker syndrome (LHS) is a sporadic and acquired melanotic pigmentation of lips and oral mucosa which is not associated with gastrointestinal hamartomas in contrast to Peutz-Jeghers syndrome. Treatment using Q-switched neodymium: yttrium-aluminum-garnet (QS-ND:YAG) laser, Q-switched alexandrite laser and, cryotherapy have been reported. However, to the best of our knowledge, there is no report regarding long-term follow-up for recurrence. Herein we report the clinical features and the treatment of recurrent pigmented lesions in LHS patients. A patient diagnosed with LHS seven years ago presented with recurrent labial macules. She had undergone QS-ND:YAG laser 7 years ago and the labial macules have been gone several years. A physical examination revealed the macules were mainly on new locations and the spots on the site where the laser was previously done rarely recur. The untreated pigmented macules on gum were maintained in the same shape for seven years. Recurrent lesions of the lips and previously untreated macules on the gums were successfully treated again with the QS-ND:YAG laser as done in 7 years ago. Our case shows a long-term clinical course of laser-treated labial macules in LHS and treatment response of recurred lesions.

Background:There are limited data regarding the difference in progression pattern between acral melanoma and nonacral melanoma.Aims:The objectives of this study were to compare the progression pattern between acral and nonacral melanoma and evaluate its impact on clinical outcomes.Methods:Clinical and histopathological features, survival outcomes and prognostic factors of 492 patients with acral melanoma or nonacral melanoma were retrospectively evaluated using the Asan Medical Center database.Results:The male-to-female ratio and the mean age was 1:0.92 and 60.2 years for acral melanoma (n= 249), and 1:0.85 and 58.4 years for nonacral melanoma (n= 243), respectively. The demographic difference was not significant. Although prediagnosis duration was longer and the advanced stage was more common in acral melanoma than that in nonacral melanoma, the vertical growth phase was more common in nonacral melanoma than that in acral melanoma, whereas, the horizontal diameter is longer in acral melanoma than that in nonacral melanoma. Dissemination to lymph nodes was more common in acral melanoma than that in nonacral melanoma. Lymph node involvement was associated with deeper Breslow thickness in nonacral melanoma but not in acral melanoma. The degree of correlation of prediagnosis duration with horizontal diameter was remarkable in acral melanoma, but with Breslow thickness in nonacral melanoma. Overall survival was worse in acral melanoma than that in nonacral melanoma. The prognostic value of Breslow thickness was more remarkable in nonacral melanoma than that in acral melanoma.Limitations:This study is a retrospective, single-center design.Conclusion:Acral melanoma has a longer radial growth phase compared with nonacral melanoma. However, acral melanoma is commonly associated with lymph node dissemination which contributed to worse survival in acral melanoma than nonacral melanoma.

Introduction: In traditional East Asian medicine, the color and shape features of a tongue reflect the health of the body. The repeatability of computerized tongue diagnosis is highly dependent on the image acquisition process. In this study, a method for providing frontal and profile feedback gridlines for the tongue image acquisition process was proposed and the resulting color and shape repeatability was assessed. Methods: Eight subjects were recruited and 120 images were acquired. For each subject, 15 tongue images were acquired with three different gridline types, including no gridline (Group I), frontal gridlines (Group II), and frontal and profile gridlines (Group III) in a pseudo-randomized order. To evaluate repeatability, intra-class correlation coefficients (ICCs) were calculated from the mean values and histogram fitting parameters for Commission Internationale de l’Eclairage L*a*b*, profile angles, and tongue area ratios (TARs) of four edge regions, respectively. Results: The ICCs for all the color features in Group I were lower as compared with those in Group II and additionally, the ICCs for all the color features in Group III were larger compared with those in Group II. The ICCs of the shape features were lower than those of the color features. The ICCs of TARs in Group I were lower than those in Groups II and III. From the tip to the root of the tongue region, the ICCs of mean luminance tended to decrease in all the groups, but the intensity of the decline in Group III was lower than those in Group I and Group II. Conclusions: The proposed tongue image acquisition process with frontal and profile gridlines improved the repeatability of color and shape features and potentially improve diagnostic accuracy of computerized tongue diagnosis. © 2014 Elsevier GmbH. All rights reserved.

Tongue diagnosis is an essential process to noninvasively assess the condition of a patient's internal organs in traditional medicine. To obtain quantitative and objective diagnostic results, image acquisition and analysis devices called tongue diagnosis systems (TDSs) are required. These systems consist of hardware including cameras, light sources, and a ColorChecker, and software for color correction, segmentation of tongue region, and tongue classification. To improve the performance of TDSs, various types TDSs have been developed. Hyperspectral imaging TDSs have been suggested to acquire more information than a two-dimensional (2D) image with visible light waves, as it allows collection of data from multiple bands. Three-dimensional (3D) imaging TDSs have been suggested to provide 3D geometry. In the near future, mobile devices like the smart phone will offer applications for assessment of health condition using tongue images. Various technologies for the TDS have respective unique advantages and specificities according to the application and diagnostic environment, but this variation may cause inconsistent diagnoses in practical clinical applications. In this manuscript, we reviewed the current trends in TDSs for the standardization of systems. In conclusion, the standardization of TDSs can supply the general public and oriental medical doctors with convenient, prompt, and accurate information with diagnostic results for assessing the health condition.

Study of Skin Elasticity and Perspiration of Elderly Female according toSasang Constitution (SC) Chang-Jin Jung, Bon-Cho Ku, Jae-Chul Lee, Jaeuk-U. Kim, Young-Ju Jeon, Keun-Ho Kim, Jong-Yeol Kim, and Young-Min Kim Korea Institute of Oriental MedicineObjectivesSasang Constitution (SC) is determined by various physical and psychological attributes. Recently, skin propertieshave been used effectively to describe SC types in clinics. In this paper, we investigated the constitution dependenceof skin elasticity and skin perspiration by using quantitative measurement devices. MethodsThe skin elasticity of forearm and the skin perspiration of forehead and philtrum were measured in 223 elderly female subjects. To determine the subject’s constitution, we adopted the classification results from a newly developeddiagnostic tool. For the clarity of constitution, we excluded low-scored subjects in their SC classification. Results & ConclusionsAs a result, the elasticity hysteresis of forearm (EHFa) of Taeum-in group was significantly less than the EHFa of Soeum-in group. Soeum-in group has high perspiration difference between philtrum and forehead (Diff.PhFh) compared to Taeum-in group in a significance level of .05. Taeum-in and Soeum-in group were significantly classified by EHFa and Diff.PhFh using a Support Vector Machine.Key Words: Sasang Constitution, Body Mass Index, Skin elasticity, Skin hysteresis, Perspiration

Introduction. According to traditional East Asian medicine (TEAM) theory, the tongue represents conditions of qi and blood. In the present study, the relationship between the tongue and the qi and blood in conditions with no apparent disease was investigated.Methods. A total of 454 elderly people with no apparent disease were recruited. Two Korean oriental medicine doctors classified subjects into a normal group (n = 402) and a sleep disorder group (n = 52). Three to five weeks after the experiment, 153 subjects were rerecruited for a second experiment. Two-dimensional color histograms, whose seven variables represent the color distribution in Commission Internationale de l'Éclairage 1976 (L*,a*,b*) color space, were produced from tongue images.Results. The color of the tongue body in the sleep disorder group appeared paler than that in the normal group, and the tongue coating in the normal group was less widely distributed compared with that in the sleep disorder group. The differences in tongue color between the normal at first experiment and sleep disorder at second experiment conditions were similar to the differences between the normal and the sleep disorder groups.Conclusions. The tongue states in the sleep disorder group indicate a qi and blood deficiency according to TEAM theory.

Background Human skin properties have been used as an important diagnostic component in traditional medicine as they change with health conditions. Sasang constitutional medicine (SCM) puts emphasis on the recognition of the constitution-specific skin features prior to the diagnostic decision of health. In this work, in search of skin-characteristics effectively reflecting SCM features, we compared several skin properties such as perspiration, visco-elasticity, elasticity, and elasticity hysteresis, in several candidate body parts. Methods We conducted a clinical study in which a total of 111 healthy females aged 50 – 70 years participated with their Sasang constitution (SC) types determined objectively by the Sasang constitutional analytic tool. Perspiration on the skin surface was estimated by using a capacitance sensor to measure the amount of moisture on the palm, forehead, and philtrum before and after a heating stimulus. We acquired the visco-elasticity, elasticity, and elasticity hysteresis at the forearm by Dermalab’s elasticity sensing device. An analysis of covariance (ANCOVA) was conducted to evaluate the effect of SC on the nine skin features acquired. Results The visco-elasticity of the forearm of the Soeum-in (SE) group was significantly lower than that of the Taeeum-in (TE) group (F = 68.867, p