The incidence of multiple malignancies among patients with malignant melanoma (MM) is 4.8%in Japan and has reportedly been as low as that of other skin cancers, although little has been known about the exact incidence. However, compared with other reports, the incidence of multiple malignancies seemed to be higher among patients with MM than among those with other malignancies in our hospital. Therefore, we performed an observational study to explore the incidence of multiple malignancies among the 130 patients with MM who were treated at our hospital from 2005 to 2012. Twenty (seven males and 13 females) out of the 130 patients with MM (15.4%) were treated in our facility for multiple malignancies. Fifteen cases (five males, 10 females) had double malignancies including MM; five (two males, three females) had triple malignancies. Of these twenty patients, fifteen (five males, 10 females) had malignancies preceding the MM, two (two females) had concurrent malignancies, and four (two males, two females) had subsequent malignancies. Four of the six patients who had concurrent malignancies developed subsequent malignancies within one year of the initial diagnosis, and two patients developed the second malignancy within five years. Therefore, it is important not only to check for the recurrence and metastasis of MM, but also to regularly and carefully follow up MM patients, because they appear to have a higher risk for other malignant tumors.
In some cases, schwannomas may be clinically indistinguishable from other subcutaneous tumors, including epidermal cysts and lipomas. In such cases, high-resolution ultrasonography is often helpful for diagnosis. Schwannoma is usually a well-defined, homogeneous, hypoechoic mass that shows posterior acoustic enhancement on sonography. On color Doppler imaging, increased blood flow is reported in schwannomas. We report some experiences of schwannomas in which arterial flow in the lesion was depicted on spectral Doppler sonography. This is specific to schwannomas, because benign subcutaneous tumors other than vascular tumors rarely have intralesional arterial flow. In conclusion, spectral analysis aids the diagnosis of subcutaneous tumors.
We report a 80-year-old Japanese woman with a two year history of progressively spreading, generalized papular and sclerodermoid eruption on the face, arms, and back. A skin biopsy revealed proliferation of fibroblasts, increase in thick collagen bundles, and mucin deposition. Serum immunoelectrophoresis showed monoclonal gammopathy of the IgG kappa type. Other biochemical examinations, including thyroid function tests, were normal. Clinical, laboratory and pathological parameters were consistent with generalized lichen myxedematosus. The patient was initially treated with oral azathioprine and injection of triamcinolone for 24 months without appreciable effect. We then started high-dose intravenous immunoglobulin treatment (high-dose IVIg) at 4-week intervals at an administration rate of 2 g/kg divided over 5 days. Some clinical improvement, including softening of her skin and planarization of papules, was observed shortly after the first infusion. After three sessions of the treatment, skin induration was greatly reduced and the motion range of her mouth and eyelids had increased with no side effects. Her quality of life improved significantly. However, the papules and induration recurred six months after the interruption of high-dose IVIg. The symptoms subsided again following low-dose IVIg at 0.4 g/kg once a month. High-dose IVIg followed later by low-dose IVIg may be an option for the treatment of generalized lichen myxedematosus.