In recent years, outpatient chemotherapy has become generally acceptable in Japan. We reviewed the patients who underwent outpatient chemotherapy for advanced malignant tumors or adjuvant chemotherapy. For advanced malignant tumors, including adenoid cystic carcinoma with bone metastasis, leiomyosarcoma with lung metastases, and cutaneous melanoma with lymph node metastases, chemotherapy was useful for maintaining the quality of life (QOL)．For adjuvant chemotherapy, most of the anticancer agents were applied orally, although it is still controversial to decide its indication and to perform adjuvant chemotherapy for skin cancer or soft tissue sarcoma. Outpatient chemotherapy will become a useful treatment not only to maintain QOL but also to restrain the cost of medical care.
Nevoid basal cell carcinoma syndrome (NBCCS) was first reported by Jarisch in 1894. The major symptoms of NBCCS are multiple basal cell carcinomas, multiple jaw cysts, various skeletal malformations, calcification of the falx cerebri, and palmo-plantar pits. We experienced two cases with NBCCS. Case 1: A 18-year-old man had had multiple brown nodules on his scalp for two years. Histopathological examination revealed them to be basal cell carcinoma. CT examination on his scalp showed calcification of the falx cerebri. Additional symptoms supporting the diagnosis of NBCCS were palmar pits and ocular hypertelorism. Case 2 : A 17-year-old man also had multiple basal cell carcinomas, calcification of the falx cerebri, palmar pits, and positive family history. Their symptoms appeared following the medulloblastoma, a relatively unknown manifestation of NBCCS. Only 12 cases of NBCCS with medulloblastoma, including our two cases, have been reported in Japan. Among the clinical features observed in these patients of NBCCS with medulloblastoma, the following are considered to be important: the earlier occurrence of medulloblastoma than in sporadic cases, multiple BCCs of the head following craniospinal radiation for medulloblastoma, and the high incidence of radiation-induced meningioma.
Thirty-three patients (four men and 29 women) with livedo lesions were evaluated in our department from July of 1997 to August of 2004. Mean onset age was 42.6 years (range 14–87 years). Lesions were located on the legs in 21 patients, feet in 15 patients, forearms in 10 patients, and thighs in 8 patients. All of the skin lesions showed incomplete networks, having branched, wedge-shape, linear, or round configurations. The histopathological findings classified the lesions into two main categories: vasculitis or thrombotic vasculopathy. Although livedo lesions are generally found on the legs, we found lesions associated with rheumatic arthritis on the upper extremities and trunks as well, while those with cholesterol crystal embolization and antiphospholipid syndrome were distributed on the legs and feet. The clinical diagnoses of livedo lesions associated with rheumatic arthritis, some collagen diseases, and cholesterol crystal embolization were relatively easy. We believe a livedo lesion can be a symptom of a core disease, and thus histopathological, blood, or a comprehensive physical examination to confirm the core disease is important.
We report a 51-year-old woman with a more than ten year history of pigmented papules on her genital region and hyperkeratotic white papules on the soles of both feet. She had undergone gastrectomy, chemotherapy and radiation therapy for malignant lymphoma of the stomach three years previously. When she visited our department, we observed numerous papules on the soles and erythema and erosin on the genital region. The histopathological findings showed irregular acanthosis, clumping cells, and dyskeratoic cells in the epidermis in the genital lesions and vacuolization of keratinocytes in the soles. From these findings, we made a diagnosis of bowenoid papulosis and planter warts. From a biopsy of the cervix, she was also diagnosed with cervical dysplasia. Using polymerase chain reaction (PCR), we detected human papillomavirus (HPV) types -16, 70, and 91 in the genital lesions, HPV-16 and 91 in the cervix, and HPV-4 and 63 in the soles. It is rare for bowenoid papulosis, planter warts, and cervical dysplasia to be present in one patient. In this patient, we detected multiple HPV types in each lesion. As HPV 16 is known to be a high risk carcinogenic, mucosal, membranous type of HPV, we consider that simple vulvectomy and hysterectomy is needed for this patient.
We report here our experience in treating squamous cell carcinoma (SCC) at Department of Dermatology, Fujita Health University Hospital. This study was carried out in the period from July of 2002 until June of 2005. The sentinel node biopsy (SNB) was performed on nine patients. Through a combination of the dye method, pre-operative scintigraphy and the use of a gamma probe during surgery, the sentinel node (SN) was conclusively (100%) identified. The SN was found to have cancer cells in only one patient. In this patient, the other lesional lymph nodes were dissected. There were no traces of cancer cells in the dissected lymph nodes. In the other eight patients, the SN was found to be free of cancer cells so the dissection of the other lymph nodes was not deemed necessary. There was no incidence of recurrence and metastasis in any of the nine patients (1～31 months : average 15.8 month)．Recently, many research papers have focused on the study of malignant melanoma, but there have been few studies conducted on the SNB of SCC. Because of this, we think that it is important for us to establish guidelines for the SNB of SCC to create a uniform standard.
“Fukinoto” is a wild vegetable and often eaten with all of its pollen as “tempura-style”. We reported two cases of oral allergy syndrome to “Fukinoto”. In the skin prick test, a positive reaction was observed for the pollen of “Fukinoto” in both cases, and, in Case 2, the reaction was also positive for heated pollen. In immunoblotting, we detected bands at 15 kDa and 20 kDa, possibly corresponding to pollen allergens. From these findings, we suspect that the pollen in “Fukinoto” contains an allergen and that the patients were sensitized directly through the oral mucosa.