We introduced the double-bladed scalpel as a novel, simple method for complete histological margin control that improves the pathodiagnostic reliability of conventional intraoperative histological evaluation for 40 highrisk non-melanoma skin cancer patients in Hokkaido University. To clear a tumor, 22.5% of all the cases required two stages. The total mean surgical margins were 5.0±2.8 mm in basal cell carcinomas, 4.9±2.1 mm in squamous cell carcinomas, 5.7±2.3 mm in primary mucinous carcinomas, 7±4.2 mm in Merkel cell carcinomas, and 7 mm in one case of sebaceous carcinoma. The results also showed statistically significant correlations between anatomical distribution of the lesions (nose) and the number of additional stages required to clear a tumor in basal cell carcinomas. A comparison of the total mean surgical margins showed significant differences in histologic grading between aggressive and nonaggressive groups. Complete histological margin control using a double-bladed scalpel could be easily applied to standard intraoperative frozen section evaluation in many institutions where Mohs micrographic surgery is difficult to perform. It is far less time-consuming and can be easily used by surgeons with existing systems, even in Japan.
A 54-year-old Japanese male presented with multiple skin tumors on the trunk and extremities in September of 2010. These tumors had started to appear 8 months earlier and were increasing in size and number. He was diagnosed with acute adult T-cell leukemia (ATL) in 2008; OPEC and LSG 15 chemotherapy resulted in complete remission and he had been well controlled with oral 25 mg etoposide 3 days per week. Physical examination revealed multiple, red or brown cauliflower-like tumors, nodules, and plaques up to 4 cm in diameter on the trunk and the extremities; some of which were ulcerated. There were multiple small, flat, darkbrown, verrucous nodules on his penile shaft. Histological examination of the red tumors on his thigh showed the typical findings of Bowenʼs disease, and the other nodules were diagnosed as Bowen carcinomas (squamous cell carcinomas). All of these tumors were excised. Three of them were further analyzed for the presence of humanpapillomavirus (HPV). PCR analyses with DNA sequencing revealed abundant HPV DNA from all of these tumors. The types were identified as HPV 26 and 67. He had no family history of epidermodysplasia verruciformis and no EVER1, EVER2 gene expression in peripheral lymphocytes. Because HPV 26 and 67 are both known as high-risk HPV types, an infection of these viruses are supposed to be involved in the development of multiple Bowenʼs disease in this immunosuppressed patient.
Some studies have reported the presence of antiphospholipid antibodies (Abs) in primary Sjögrenʼs syndrome patients. We have previously shown that the presence of antiphospholipid Abs, including lupus anticoagulant (LAC), anti-cardiolipin (aCL) Abs, and anti-phosphatidylserinea-prothrombin complex (aPSPT) Abs, may play some role in cutaneous vasculitis. At our university hospital, we evaluated the clinical, serological, and immunohistological findings in six primary Sjögrenʼs syndrome patients who had cutaneous vasculopathy. According to the guidelines provided by the Subcommittee on Lupus Anticoagulant/Phospholipid Dependent Abs, we measured LAC in plasma. Serum aCL Abs, anti-β2-glycoprotein I (anti-β2GPI) Abs, and aPSPT Abs were analyzed by enzyme-linked immunosorbent assay. We detected LAC in 5 (83%) of the 6 patients. All 6 patients were positive for aPSPT Abs. High serum levels of IgM aPSPT were found (19.4±5.9 U/ml; normally, less than 10 U/ml) in five (83%) of the patients. Direct immunofluorescence (DIF) examinations of four patients revealed IgM deposits in the affected vessel walls in all four of them. The present results suggest that aPSPT Abs may play some role in the development of cutaneous vasculopathy in primary Sjögrenʼs syndrome.