The 245 patients with malignant melanomas treated at Shinshu University from 2000 to 2009 were reviewed. The patients with metastasis had been treated with conventional cytotoxic regimens and/or radiation but not with anti-CTLA-4 antibodies, anti-PD-1 antibodies or BRAF inhibitors. The disease-specific five-year survival rate was 100% among the stage 0 patients, 98% in stage I, 82% in stage II, 59% in stage III, and 18% in stage IV. Postoperative metastasis occurred in 51 patients. The median period until an initial metastasis was 13 months. The first metastasis occurred within 1 year in 49% of the patients, and at ≥5 years in 12% of the patients. The locations of initial metastases (the ratio of patients with metastasis in a particular organ to the total number of patients) were as follows: lung in 55%, skin and subcutis in 35%, lymph nodes in 24%, and brain in 12%. The methods that detected first metastasis were as follows: regular images (CT or PET) without any symptoms in 89% of lung metastasis and 64% of lymph node metastasis, and physical examination in 94% of skin and subcutaneous metastasis. These results suggest that the long-term follow-up with physical examinations and regular lung imaging are important for managing malignant melanoma patients. In addition, these data may be useful as a benchmark for comparing survival benefits afforded by novel therapies including immune-check-point inhibitors and molecular-target therapies, the use of which has begun in Japan.
Pemphigus vulgaris (PV) is a blistering disease of the skin and mucous membranes caused by autoantibodies against desmoglein 3 (Dsg3) and/or desmoglein 1 (Dsg1). Indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) are widely used to measure the titers of Dsg3 or Dsg1 antibodies in PV. Although the titers of these autoantibodies are generally correlated with disease activity, some patients with a high ELISA index do not necessarily have severe symptoms. We experienced two patients with PV in remission with a high ELISA anti-Dsg3 antibody index and negative IIF, and analyzed the auto-antibodies with a focus on the discrepancy between the ELISA and IIF findings evaluated by newly a developed method. Most of the antibodies of the two cases recognized Ca2+-dependent conformational epitopes and the antibodies of Case 1 targeted mature Dsg3 protein. The detail of Case 1 were previously published in JAMA Dermatology. We speculated on some possibilities for the specific characteristics of the auto-antibodies from these cases and report the cases here with some literature review.