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BACKGROUND Several studies have reported the presence of hypopigmentation in extramammary Paget disease (EMPD). However, an in-depth analysis regarding its clinical implication is lacking. OBJECTIVE To evaluate the clinical characteristics of EMPD in the Korean population and to determine the implication of hypopigmentation on clinical outcomes. METHODS We retrospectively reviewed 124 cases of EMPD who underwent surgical treatment from a single tertiary hospital from December 2005 to March 2019. Baseline characteristics of the patients and hypopigmentation patterns were analyzed. Moreover, the number of stages of Mohs micrographic surgery (MMS) and recurrence rate were evaluated in relation to the hypopigmentation. RESULTS A total of 67.7% (n 5 84) of the patients showed hypopigmentation. The adjusted odds ratio for recurrence in the hypopigmented group was 5.980, which was statistically significant (95% confidence interval 5 1.347-26.553, p-value 5 0.019). Furthermore, the average number of MMS stages was 2.92 in the hypopigmentation group, compared with 1.82 in the nonhypopigmentation group (p-value 5 .0016). CONCLUSION Hypopigmented lesions may disguise the tumor margin, thus raising the recurrence rate after surgery and the number of stages of MMS. The hypopigmentation status must be considered when deciding the surgical margin.E xtramammary Paget disease (EMPD) is a rare

Behçet's disease (BD) is a chronic multi-systemic disorder that commonly presents with diverse clinical manifestations. These can range from inflammatory mucocutaneous lesions to serious internal organ disorders, such as gastrointestinal (GI) disease, neurologic disease, and vascular disease. 1 A number of previous studies have described the clinical manifestations of BD in patients from different geographic regions across the world, including Turkey, Iran, Japan, China, and England. However, the heterogeneity of these reports in regards to epidemiologic data, combined with the use of multiple diagnostic criteria, has limited clinicians' ability to utilize these data for aiding the prediction of disease progress and possible systemic involvement. 2,3 In particular, because infrequent, but fatal, systemic symptoms, such as neurological, GI, and vessel involvement, often precede mucocutaneous or ocular manifestations, it is difficult to predict the occurrence of these minor but severe symptoms in BD patients. [4][5][6][7] Here, to address these limitations, we analyzed the clinical manifestations in a cohort of full-blown BD patients, defined as having complete BD based on the Japanese criteria, 8 which automatically fulfill all other diagnostic criteria for BD, including the International Criteria for Behçet's disease (ICBD) 9 and the International Study Group (ISG) criteria. 1 We then performed unbiased clustering analysis to better understand the heterogeneous spectrum within complete BD, followed by subgroup analysis based on the identified clusters and logistic regression to uncover possible associations between various clinical factors and disease outcome. Critically, we anticipate that this approach will aid in the understanding of clinical outcomes in full-blown BD patients, which may ultimately explain the heterogeneity of this complex disease.

Although topical therapies are used to treat extramammary Paget's disease (EMPD), reliable treatment outcomes and the effects of these therapies on subsequent surgical treatments are unclear. To assess the clinical outcomes of topical treatment of EMPD and establish the treatment guidelines the medical records of 166 patients diagnosed

HA enzymolysis and treatment with other agents, such as alprostadil, LMWH, and physiotherapeutics, because there was a decrease in the severity of erythema and pain. ConclusionThe prevention of this side effect requires a proper injection technique and a deep understanding of the hand anatomy. To the best of our knowledge, there is no gold standard for the treatment of HA embolism. Nevertheless, every possible attempt should be made to dissolve the embolized filler and restore the blood supply.