We analyzed the clinical course of 158 patients who died of skin cancer in Niigata Cancer Center Hospital from 1997 to 2020. The average age at death was 71 years, and melanoma accounted for 51% of all cases. Only 55% of patients lived in Niigata city; the others lived in remote areas. The proportion of patients who died in our hospital, in other hospitals including hospices, or at home were 54%, 36%, and 8%, respectively. There is an increasing trend for patients to choose to die in their local areas are increasing. It is necessary to establish more advanced medical cooperation that allows patients make the choice of dying in their home towns.

The effectiveness of hydroxychloroquine (HCQ) treatment for lupus erythematosus was investigated. We treated 17 patients (aged 27 to 55 years, mean: 42.4 years, 2 males and 15 females) with erythematosus with hydroxychloroquine (HCQ) between July 2017 to December 2018 at Niigata University Medical & Dental Hospital. These included fifteen cases of discoid lupus erythematosus and two cases of lupus erythematosus profundus. Thirteen of the patients continued treatment with HCQ. The average length of treatment was 6.6 months. Our results showed that HCQ was effective in treating lupus erythematosus and reduced the cutaneous lupus erythematosus disease area and severity index (CLASI) activity score (median 78% decrease). Active introduction of HCQ for lupus erythematosus should be considered.

A 69-years-old man who had been diagnosed stage IV rectum malignant melanoma. This melanoma recurred in his inguinal lymph node and lung. A total of 22 courses of nivolumab were administrated; however, his melanoma progressed. Therefore, we switched the chemotherapy from nivolumab to ipilimumab as a 2nd line treatment. After the second administration of ipilimumab, acute renal failure developed. Renal biopsy revealed tubulointerstitial nephritis consistent with previous reports of renal dysfunction due to ipilimumab. Renal function has improved with steroid pulse therapy and hemodialysis. The renal dysfunction due to ipilimumab is less common than other immune-related adverse events, and no effective treatment has been established. In our present case, steroid pulse therapy was effective; however, it is necessary to accumulate more cases.

A male in his twenties from abroad was referred to us with a two-week history of right hand pain and a six-week history of multiple shiny nodules on his face, distal limbs, waist and abdomen. These nodules scored high on the skin smear tests, and histological examination revealed histiocyte granuloma with many bacilli. PCR test specific for Mycobacterium leprae was positive. These findings were consistent with the lepromatous type of leprosy. Erythema nodosum leprosum (ENL) appeared three weeks after he started the multi drug therapy, accompanied by various symptoms including neuritis, fever, and joint pain. ENL recurred and then became chronic afterwards. Leprosy and leprosy reactions can cause permanent damages if not treated properly. Early detection and treatment have minimized the sequelae in this case.