Cutaneous angiosarcoma (CA) is a rare soft tissue sarcoma that typically occurs on the head and neck, particularly on the scalp. It is more common in older patients, and it has a poor prognosis. This report presents three rare cases of CA that appeared on the cheek and the back. The first case was a male with CA on the cheek, and he had liver metastasis. Although he received hepatic intra-arterial infusion therapy with recombinant interleukin-2 and paclitaxel or docetaxel, the therapeutic efficacy was poor. The second and the third cases were males with CA on the trunk. They received several types of treatment; there were no recurrences and no metastases during the observation periods. However, one of them died from acute exacerbation of interstitial pneumonia during chemotherapy and radiation therapy. Herein we report our latest therapeutic observations in patients with CA: hepatic intra-arterial infusion therapy, the feature of CA on the trunk, and the risk of interstitial pneumonia during radiation and chemotherapy for CA.
We opened a foot screening out-patient clinic in April of 2009 in order to evaluate, prevent, and treat foot problems of varying etiology; it serves as a gate keeper that coordinates with the proper medical experts. The aim of this study was to evaluate the background and risk factors for foot ulcers in 282 patients [mean age 69.8 (9–96, median 73); male: 35.8%, female: 64.2%] who visited our clinic before the end of October, 2011. The following factors were statistically analyzed as possible risk factors for foot ulcers: diabetes mellitus, impaired arterial blood flow, neuropathy, and bone deformity. In our clinic, diabetes mellitus was found more frequently in males, and significantly higher associations of impaired arterial blood flow and neuropathy were found with diabetes mellitus. Impaired arterial blood flow (Odds ratio; 3.44) and neuropathy (Odds ratio; 1.95) were significantly associated with occurrence of foot ulcer.
Twenty four patients who underwent sentinel lymph node biopsy for cutaneous head and neck malignant melanoma in the Division of Dermatology, National Cancer Center Hospital from December 2002 to September 2010 were reviewed. The identification rate of sentinel lymph node biopsy was 100%. The number of identified lymph nodes ranged from 1-6 (average 2.9). Some of the cases included multiple sentinel lymph nodes. Parotid lymph nodes were observed in 16 (66.7%) out of all 24 cases. When a primary site was located on the middle of the face, the sentinel lymph node was identified in as high as 14 (93.3%) out of 15 cases. When the primary site was an occipital or parietal lesion, the sentinel lymph node was identified at level V in all cases. In addition, the superficial lymph nodes (superficial parotid lymph nodes/postauricular lymph nodes/superficial cervical lymph nodes) characteristic of a skin malignant tumor were identified in 9 (37.5%) out of 24 cases. In 8 (33.3%) of 24 cases, the sentinel lymph node results were positive, and all of them underwent selective neck dissection. The 5-year survival rate of all 24 patients was 86.5%.
Twenty four patients who underwent sentinel lymph node biopsy for cutaneous head and neck malignant melanoma in Division of Dermatology, National Cancer Center Hospital from January 1984 to September 2010 were reviewed. Radical neck dissection was performed in 4 cases, selective neck dissection in 12 cases, and the combination of sentinel node biopsy and selective neck dissection in 8 cases. Some of the cases included multiple metastatic lymph nodes. Parotid lymph node metastasis was observed in 15 of 24 cases. When the primary site was middle face, the incidence of metastasis was as high as 12 (85.7%) out of 14 cases. In addition, when the primary site was located on the occipital or parietal region, level V metastasis was observed in 5 (71.4%) out of 7 cases, and occipital lymph node metastasis in 2 (28.6%) out of 7 cases. Deep parotid lymph node metastasis and level IV metastasis were observed in only 1 case (4.2%) each, so, if there is no obvious finding of metastasis, this area can probably be omitted from neck dissection. The rate of recurrence in regional lymph nodes was 34.8% and that of distant metastasis was 60.1% out of 24 cases. The difference in the probability of survival between patients who underwent neck dissection with clinical lymph node metastasis and those who underwent neck dissection with sentinel node biopsy positive was not significant.