We performed a clinicopathological study involving 1,227 lesions of basal cell carcinoma (BCC) diagnosed at the Sapporo Institute for Dermatopathology. Based upon the clinical and histopathological findings, we divided the lesions into five categories: nodular, superficial, morpheic, fibroepithe-liomatous, and infundibulocystic. The male: female ratio was 1:1.26, and the average age at resection was 70.1±13.9 years. The lesions were most frequently located on the face (69.1%). In distribution, 77.3% of the lesions were nodular type, 9.8%, superficial type, 9.7%, morpheic type, 2.1%, fibroepitheliomatous type, and 2.0%, infundibulocystic type. The average age at resection of the morpheic type (72.7±12.0 years), was significantly older than that of the nodular and superficial types. On the face, 83.3% the of lesions were nodular. On the trunk and extremities, 50% of the lesions were nodular type, and 35% were superficial type. The nodular, morpheic and infundibulocystic types of lesions were located most frequently on the face, but, those of the superficial and fibroepitheliomatous types, on the trunk. Half of the nodular type lesions were clinically diagnosed as BCC. The superficial type were diagnosed as BCC in 51.3% of the cases and as Bowen’s disease in 20.5%. Ten cases had a total of 24 multiple lesions.
We clinically studied 11 biopsy cases seen in the International Medical Center of Japan from 1997 to 2003 for suspicion of acute graft-versus-host disease. The relationship between the biopsy findings and clinical features, including skin stage, types and regions of rash, the presence or absence of diarrhea and laboratory data was evaluated. Seven cases had histological findings of GVHD, and 4 cases did not. Although none of the clinical features except γ-GTP levels had a strong relationship with the histological findings, γ-GTP levels were increased in 8 cases, including 7 cases with positive biopsy findings. Three cases had no detectable elevation of γ-GTP levels. These cases had no histological findings, eitheir γ-GTP may be useful for predicting the histological findings of acute GVHD.
Quality of life is an important outcome in the treatment choice for basal cell carcinoma (BCC), which is rarely fatal. In this study, a comparison was made between patients with BCC undergoing a procedure with total excision in Hokkaido University (Japan) and those undergoing Mohs surgery in Miami University (United States). We have analyzed the age, gender distribution, site of the lesion, histopathological subtype, and clinical appearance. Outcome measures including surgical margin, type of anesthesia, operative time, and type of reconstruction, were also analyzed. There were striking differences in the clinical characteristics of BCC, with a significantly higher rate of the pigmented subtype in Japan. Patients who underwent Mohs surgery had significantly smaller surgical margins but a much higher rate of the total operative time. As a result, significantly more general anesthesia and skin grafting were performed in the total excision group as compared with Mohs surgery group. We conclude that quality of life outcome is one of the most important factors for the selection of therapeutic measures. Therefore, Mohs micrographic surgery is a valuable option among the various therapies available in Japan.
We report three cases of extramammary Paget’s disease (EMPD) with smaller hypopigmented lesions separated from the main erythematous and erosive plaques. These lesions were confirmed to have no continuity with the erythematous plaques by histopathological examination. It should be noted that satellite lesions of EMPD may present as small hypopigmented macules. If missed, a postsurgical recurrence can arise, even when the range of the major lesion was accurately detected.