Surgical treatment of malignant melanoma and other skin tumors has recently become less extensive, and sentinel node biopsies have been performed in many institutions particularly to determine the need for lymphadenectomy. Previously, a simple method with dye was often used to identify lymph nodes. In recent years, however, the usefulness of a combination method with dye and radioisotopes (RI) has been reported. Since April of 2002, we have also successfully used the combination of dye and RI. This combination allows accurate identification of sentinel nodes and effective determination of surgical sites in cases of primary tumors on the head or neck with complex lymphatic drainage, primary tumors on the trunk with multiple regional lymph nodes, or tumors with interval or aberrant nodes. Herein, we review the results of dye-and RI-guided sentinel node biopsies in patients with malignant melanoma and report their usefulness.
We reported three cases of eccrine angiomatous hamartoma (EAH), a benign proliferation of eccrine structures and angiomatous channels in the dermis, and identified 46 Japanese cases in a literature review. In Case 1, a 74-year-old man presented with a sacral nodule. In Case 2, a 70-year-old man presented with a reddish plaque on the right heel. In Case 3, a 22-year-old man presented with a violaceous plaque on the right lower leg. Analysis of all 49 cases revealed a male : female ratio of 17 : 32. Age at presentation ranged from birth to 74 years (mean : 20.3 years), and 36 of the 49 lesions (73.5%) developed before 10 years of age. Most lesions (91.8%) were located on an extremity, and 73.5% were solitary. Lesional pain and sweating occurred in about 60% of patients. Cases were separated into two groups : patients younger than 10 years of age and patients 10 years of age and older. The latter group was more likely to have lesions of the sole and less likely to have lesions of the finger. Hypertrichosis was rarely seen in the older group.
Onychomycosis is very common in elderly patients. In this study, we evaluated the clinical efficacy and safety of itraconazole 400mg pulse therapy for toenail onychomycosis by comparing patients aged <60 years (younger group) and those 65< years (elderly group). Laboratory examinations were performed before the start of pulse therapy and after each pulse. Reduction of the opacity ratio was examined in patients with big toenail onychomycosis, and clinical safety was assessed in all the patients. Reduction of the opacity ratio at 4,8, 12, 24, and 36 weeks after the start of pulse therapy was 0.40±0.82, 2.64±2.06, 3.68±2.93, 4.40±2.92, and 4.80±3.35 in the younger group and 0.30±0.57, 1.45±1.28, 2.83±1.76, 4.83±2.61, and 5.03±2.77 in the elder group. There were no significant differences between the two groups. Adverse drug reactions were observed in 2 patients (5.4%) in the younger group and 2 patients (6.3%) in the elderly group, but they were mild and improved without treatment after itraconazole was discontinued. The frequency of adverse reactions was not significantly different between the two groups. It appeared that itraconazole 400mg pulse therapy is effective and safe for the elderly patients.
We report two cases of taxane-induced scleroderma that resembled skin sclerosis. Case 1: A 37-year old female had received docetaxel and paclitaxel for the treatment of metastatic breast cancer. This patient presented with edematous and sclerotic skin on the bilateral extremities six months after administration of docetaxel. Case 2: A 66-year old female had received docetaxel for the treatment of metastatic breast cancer. This patient presented with edematous and sclerotic skin on the bilateral lower extremities and left upper arm four months after administration of docetaxel. Cutaneous biopsies from both patients revealed diffuse dermal fibrosis and perivascular mononuclear cell infiltrates in the dermis. Neither patient demonatrated Raynaud’s phenomenon, and all relevant autoantibodies to scleroderma were negative. A brief review of the current literature is presented.
We reported two cases of acquired lymphangiectasia associated with rheumatoid arthritis. The first case was a 63-year-old woman who had red nodules and papules on her right elbow. The second case was a 52- year-old man who had erythema on his right knee and red nodules and papules on his left knee. Both patients had been treated for rheumatoid arthritis. Histologically, the skin lesions consisted of widely dilated vascular structures developing with inflammatory cell (mainly lymphocytic) infiltration in the superficial dermis. In the first case, the cutaneous lesions were totally excised without any surgical treatment of the elbow joint. In contrast, in the second case, the skin lesions were cured by arthroscopic synovectomy and joint replacement. Neither case had any recurrence of the skin lesions. Acquired lymphangiectasia has been reported to be mainly caused by operation or radiotherapy. Our two cases are the first report of acquired lymphangiectasia associated with rheumatoid arthritis.
We reported a case of pemphigus vulgaris (PV) successfully treated with double filtration plasmapheresis (DFPP). A 50-year-old man developed blisters and erosions on his face, oral mucosa, scalp and trunk from June of 2000. Clinical, histological and immunofluorescence findings confirmed the diagnosis of PV. He was initially treated with predonisolone (PSL) 60mg/day, and his cutaneous and mucosal lesions gradually improved. However, when the dose of PSL was tapered, his cutaneous and oral lesions exacerbated. After three cycles of exacerbation of his lesion, we chose DFPP therapy. After DFPP, his clinical symptoms cleared promptly. The titer of anti-desmoglein(Dsg)-1 autoantibodies by ELISA decreased from 180 to 25 and that of anti-Dsg-3 autoantibodies from 3,780 to 180. We consider that DFPP is very useful for the treatment of PV. In the present case, there was a good correlation between the titer of anti-Dsg autoantibodies and clinical symptoms. When the titer of anti-Dsg-1autoantibodies exceeded 140 and that of anti-Dsg-3 autoantibodies exceeded 2,400, the cutaneous and mucosal lesions appeared. It was possible to predict the recurrence of symptoms from the titer of anti-Dsg autoantibodies and to plan the therapy in advance.