We describe a 77-year-old woman with a history of asthma and chronic obstructive pulmonary disease, who presented at our hospital with itchiness, erythema and a mass on the external genitals. A biopsy showed that cancerous cells had invaded the dermis and finally, she was diagnosed with extramammary Paget’s disease (EMPD). The patient wanted to avoid surgery, therefore radiation therapy was chosen after considering her health status and complications. The erythema and the mass disappeared after the radiation therapy, indicating clinical remission. However, she presented seven months later with local recurrence and lymph node metastasis in the left groin was also confirmed by a lymph node biopsy.
After appropriate discussion with the patient and her family, a minimally invasive surgical approach was decided this time. To minimize the surgical invasion, we radioisotopically identified a sentinel lymph node before starting the surgical procedure and dissected only the lymph nodes at the left groin. Post-operative imaging (PET-CT) revealed residual lymph node metastasis, and thus she underwent additional radiation therapy at the same region.
In general, EMPD spreads horizontally but when it infiltrates vertically as in our patient, it rapidly advances. Therefore, recurrence and metastasis should be carefully checked. Scintigraphic assessment of the sentinel lymph node helped to decide the type of surgical procedure and using a Gamma probe to identify the location of radioisotope uptake during the operation facilitated dissection of the regional lymph node.
Since 2000, this facility has actively been using chemical peels for cases of acne that do not respond to general treatment. Of 231 patients we treated with chemical peeling, 184 had acne, for which we used glycolic acid and salicylic acid for the peels. Treatment was continued in 165 cases, of which57 resulted in complete response, and efficacy was noted in 81 （84% efficacy rate）. Adverse reactions were noted in 18 cases, including erythema and dryness, but half of those patients were able to continue treatment. In addition to amelioration of the disease, we noted the benefit of improving the texture of the patients’ skin, leading to high patient satisfaction and many wishing to continue the treatment. We will present the most impressive complete response cases, emphasizing the usefulness and safety of chemical peels based on our years of clinical experience.
A 79-year-old man was referred to our hospital with scaly erythema on his trunk and extremities, general fatigue, and severe muscle weakness. He had elevated levels of serum creatine kinase (13366 U/L) and aldolase (36.0 U/L). Computed tomography showed lung cancer that seemed to have spread to the pleura, mediastinal lymph nodes, and liver. Histopathological examination of a needle biopsy specimen of the lung cancer confirmed squamous cell carcinoma. Muscle biopsy results were negative. However, Magnetic resonance imaging of his thigh muscles suggested myositis. Based on these findings, the patient was diagnosed with malignancy -associated dermatomyositis (DM). He was treated with oral prednisolone at 60 mg per day; cutaneous manifestations improved, but muscle weakness persisted and dysphagia appeared. The lung cancer was treated with chemotherapy; however, the patient died 2 months after his first visit. This patient showed positivity for anti-TIF1 antibody, which has been reported to be a marker of malignancy -associated DM. Many malignant tumors associated with DM develop after diagnosis of DM. Therefore, testing for anti-TIF1 antibody is beneficial in predicting the risk of malignant tumors in patients with DM.