Combined chemotherapy with carboplatin and paclitaxel (CP) is widely used overseas as a 2nd line chemotherapy for metastatic melanoma. We report the results from 9 stage IV melanoma patients treated with CP therapy who had progressed on a dacarbazine-containing regimen. Of the 9 patients, one achieved a partial response (PR), 3 had stable disease (SD), and 5 had progressive disease (PD). The median progression free survival (PFS) was 2.8 months and the median overall survival was 10.6 months for all patients. The regimen had clinically acceptable toxicity. Four (44%) of the patients achieved disease control under CP therapy. In addition, the PFS of patients with controlled disease (PR and SD) were 7.0 to 11.6 months, significantly longer than those of PD patients. These results implied that CP therapy could be an option in Japan for salvage chemotherapy for stage IV melanoma.
A 84 year-old-man had noted scrotum nodules about 4 years earlier. A clinical examination revealed solid tumors in the perineum and intrascrotum. The patient underwent tumor resection including the penis shaft and corpus cavernosum penis. Microscopic findings showed that the tumor cells were round or polygonal, and were arranged in cords, sheets and occasionally in tubules. Immunohistochemistry revealed that the tumor cells were positive for cytokeratin and mesothelial antigen. The pathological diagnosis was compatible with malignant mesothelioma. The incidence of malignant mesothelioma derived from the scrotum is very low.
Twelve patients with cutaneous squamous cell carcinoma had histological perineural invasion. Such invasion was related to an unfavorable prognosis and an aggressive course. Local recurrences secondary to perineural invasion may arise even in cases with primary tumors of smaller size. The possibility of perineural invasion should be considered in squamous cell carcinoma on the head and neck, because intensive local treatment may improve the prognosis. Careful microscopic examinations should be done to avoid overlooking perineural invasion.