The role of sentinel lymph node (SLN) biopsy in patients with cutaneous squamous cell carcinoma (cSCC) remains unclear. To evaluate its contribution, we retrospectively studied 33 patients with clinical N0 cSCC who underwent SLN biopsies between April 2003 and August 2009. SLN metastasis was confirmed in 6 of the 33 patients. These 6 patients subsequently underwent regional lymph node dissection and did not develop distant metastasis in the follow-up period. The SLN metastasis positive and false negative were 18 and 3%, respectively. Five-year survival rate in patients with SLN metastasis was 100%. Our findings suggest that SLN biopsy provides a technique to identify patients with subclinical nodal metastasis whose survival may be prolonged by immediate lymph node dissection. A randomized controlled trial is needed to demonstrate whether early detection of subclinical nodal metastasis improves the disease-free or overall survival in patients with high-risk cSCC.
A 72-year-old Japanese woman had had psoriatic arthritis since the age of 55. She was judged to need a biologic therapy, because her arthritis was so severe. A QuantiFERON-TB test indicated she had a latent tuberculosis infection (LTBI). She began to take isoniazid sodium methanesulfonate (600 mg/day) 22 days before the start of infliximab therapy and continued for 204 days. After the seventh course of the infliximab therapy (on 276th day after start of the therapy), she developed fever and general fatigue. Her serum CRP, CA125, and sIL-2R were increased to 14.14 mg/dl, 165.9 U/ml and 3,830 U/ml, respectively, and abdominal CT revealed ascites accumulation. Adenosine deaminase and CA125 in her ascites were increased to 111.7 U/l and 425.0 U/ml. Although staining and PCR of her ascites for TB were negative, laparoscopy revealed multiple white nodules and peritoneal adhesion. A histopathological examination of a peritoneal biopsy showed epithelioid cell granuloma with necrosis, and the biopsy’s PCR for TB was positive. These findings confirmed a diagnosis of tuberculous peritonitis, and anti-TB drugs (IHMS, RFP, EB, PZA) were started. The TB infection was cured promptly. Because dermatologists expect a new era of biological therapy for psoriasis, we must recognize the importance of tuberculosis prevention, early diagnosis and treatment.
There are only a handful of reported studies on the order of applying corticosteroid ointments and moisturizers. Therefore, dermatologists and pharmacists instruct the application order according to experience. In our study, we applied corticosteroid ointment and moisturizers in different orders, and examined the relationship between the application order and adverse reactions in hairless rats. Body weight, weights of the spleen and adrenal gland, and thickness of the skin were selected as indications of adverse reactions. We applied corticosteroid ointment and moisturizer to the skin separately and also premixed them. Clobetasol propionate ointment was used as the corticosteroid ointment, and heparinoid and urea creams were used as the moisturizers. The results showed that the adverse reactions were independent of the order of application. In addition, there was no significant differences in adverse reactions when the corticosteroid ointment and moisturizer were mixed together before applying to the skin compared to layered applying.