We retrospectively investigated the clinical characteristics and prognosis in 260 cases of metastatic skin cancer. The common primary cancer sites were breast (86 cases, 33%) and lung (76 cases, 29%). In 17% of cases, skin metastases preceded the diagnosis of the original cancer.
The median survival time (MST) after the diagnosis of skin metastases was 7 months. MST for breast cancer (56 months) was significantly longer than in other cases because of its originally good prognosis. None of the prognostic factors, including the number of skin metastases (multiple vs single), the timing of cancer diagnosis (skin metastases vs primary cancer), and treatment for skin metastases (curative resection vs palliative resection) significantly affect survival. We condude that the main purpose for treating metastatic skin cancer is to maintain the quality of a patient's life.
Objective: To assess the effectiveness and safety of long-term treatment with calcipqotriol hydrate/betamethasone dipropionate ester fixed dose combination (Dovobet®, Cal/BDP) ointment in patients with plaque psoriasis in the actual clinical setting.
Study methods: In patients 20 years of age or older who had psoriatic lesions involving the trunk and/or four limbs, Cal/BDP ointment was applied once daily. After at least four weeks of treatment, those who achieved remission were switched to maintenance therapy. If a relapse/recurrence was noted during the maintenance therapy period, the patient resumed the use of Cal/BDP ointment and continued with this treatment for one year.
Results: After four weeks of treatment, significant improvements were observed in the percentage change in the modified Psoriasis Area and Severity Index (m-PASI) scores, Physician's Global Assessment (PGA) scores, and Dermatology Life Quality Index (DLQI) scores; these improvement effects were maintained for one year. None of the patients experienced severe deterioration of atrophia cutis, peripheral vasodilatation or erythema, and no serious adverse events were noted.
Conclusions: Our findings suggested that long-term treatment with Cal/BDP ointment is useful in the actual clinical setting and it has a favorable tolerability profile.
A 63-year-old man presented with irregular brown streaks over the entire left great toe nail plate and with Hutchinson's sign. Our initial diagnosis was melanoma in situ, and the nail was surgically removed just proximal to the distal phalanx. A pathological examination revealed solitary proliferation and nest formation of oval-shaped tumor cells on the basal layer of nail bed, expanding from the nail matrix to the toe tip. There were also increased numbers of spindle-shaped cells in the dermis, accompanied by collagen fibers. The tumor cells stained positively for S-100 and negatively for Melan-A. Some epidermal tumor cells were positive for HMB-45; dermal tumor cells were negative. Based on these findings, desmoplastic melanoma was diagnosed. Four months after surgery, the tumor cells had metastasized to the left inguinal lymph nodes, followed by metastasis to the lungs 19 months after surgery. This case is unique because the desmoplastic melanoma affected the toe nail bed, showing pigmentation and mild nail deformity.