A 54-year-old male visited a local internal medicine doctor, complaining of cough and chest pain lasting a few weeks. Computed tomography revealed a pulmonary effusion, multiple tumors on the thoracic wall, and swollen left cervical lymph nodes. He was referred to our hospital, and further studies, including video-assisted thoracic surgery (VATS), were carried out in the surgery department. However, prior to VATS, the patient was referred to us regarding a pale white tumor of 85×70×23 mm on the scalp, including an ulcerated lesion of 30×25×8 mm. A specimen taken from the scalp revealed malignant melanoma (MM), presumably arising from an amelanotic congenital melanocytic nevus, based on histological and immunohistochemical studies. In addition, specimens of thoracic tumors revealed immunoreactive patterns similar to those of the scalp specimen, leading to the diagnosis of the thoracic tumors as metastases from the scalp lesion. Chemotherapy was carried out three times; however, the patient died 4 months later due to disease progression. A giant congenital melanocytic nevus (CMN) with size exceeding 20 cm in diameter has a high-risk of malignant transformation. A medium-sized CMN also has malignancy potential, although the transformation occurs less than that of giant CMN, therefore, should be paid attention.

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A 59-year-old male reported a pale reddish-brown pigmentation spot in the proximal nail fold of the left middle that first appeared 6 months earlier, and a local physician consulted our department due to suspected malignant melanoma. Dermoscopic examination showed brown dots or globules scattered in a light brown background. In addition, an unclear dark brown atypical pigment network with some shade was observed with a slight white scale. The patient was suspected of having pigmented Bowen's disease and was biopsied. Histopathological examination showed parakeratosis, hyperkeratosis, melanin scattered in the epidermis, and epidermal hyperplasia accompanied by proliferation of atypical keratinocytes throughout the epidermis. Since atypical keratinocytes had not invaded the dermis, the patient was diagnosed with pigmented Bowen's disease. We performed an enlarged resection with a 1-mm margin. Typical features of Bowen's disease include vascular findings such as dotted and glomerular vessels, as well as a scaly surface and brown dots or globules. In pigmented Bowen's disease, further findings such as gray-brown unstructured pigmented lesions, pigment networks, and irregular flossy streaks are also observed. In some cases, it is difficult to discriminate this from malignant melanoma. Pigmented Bowen's disease is a rare subtype of Bowen's disease and is characterized by its dark brown color and gradually progresses to verrucous keratosis. Around 2% of all Bowen’s disease cases are accounted for by the pigmented subtype with many reports of this affecting the fingers and toes. For the diagnosis of pigmented Bowen's disease, dermoscopy is useful, and it is important to consider pigmented Bowen's disease as a differential diagnosis in daily examinations.

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A 25-year-old woman had taken acetaminophen for menstrual pain and eletriptan hydrobromide for migraine irregularly. Four days before her first visit to our hospital, she had a fever and took an over-the-counter cold medicine(loxoprofen sodium hydrate). The next day, skin eruption appeared on her palms, and she was treated with levofloxacin and acetaminophen by her family doctor. Two days later, she was referred to our hospital for eye discharge, pain in the palms, and pain during urination. She had fever; red eyes; erosions on the lips, oral cavity, and vulva; and a target-like rash on the palms. She was diagnosed with Stevens-Johnson syndrome based on histological findings of the palm skin revealing epidermal necrosis.Loxoprofen sodium hydrate was thought to be suspicious drug for this skin rash from the clinical course and the result of drug-induced lympocyte stimulation test. Treatment with prednisolone succinate sodium at a dose of 1mg/kg/day was initiated. Three days later, the dose of prednisolone succinate sodium was increased to 1.5 mg/kg/day because the blisters on the palms enlarged. Four days later, she started to eat. Thirteen days after the start of treatment, eye sebum began to decrease, and the dose of prednisolone succinate sodium was gradually reduced. Although the skin rash of Stevens-Johnson syndrome usually appears predominantly on the trunk, it appeared predominantly on the palms in our case. when we see a rash predominantly on the palms, we should be caucious about the progression to STS by checking systemic and mucosal symptoms.

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Numerous adverse reactions to the COVID-19 vaccine have been reported, but delayed injection-site reactions at the injection site (COVID arm) are not well recognized. Such reactions are characterized by pruritic erythema, induration, and tenderness that develop approximately 1 week after the first dose of COVID-19 vaccination, and they usually resolve in 4 to 5 days. Most patients develop similar or mild reactions after the second vaccine dose, and these reactions may occur sooner than the first-dose symptoms. In contrast to immediate hypersensitivity reactions, such as anaphylaxis and urticaria, these delayed reactions are not a contraindication to subsequent vaccination. Considering the promotion of mass vaccination, the number of patients with delayed injection-site reactions will increase. We should be aware of the characteristics of these reactions. Here, I report two cases of delayed injection-site reactions caused by COVID-19 vaccine.

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An online survey was conducted in 1,256 mothers whose first child was a student in fourth-year elementary to third-year junior high school to investigate their experience and knowledge of acne and its care for themselves and their children. Among the responses, 29.4% of mothers responded that they had experienced acne themselves and 49.7% responded their child is currently suffering facial acne. Among these children, 33.0% received medical treatment. Efficacy of medical treatments for inflammatory lesions were recognized by 82.4%, and for comedonal acne by 71.4%; 78.5% of the mothers were unaware that the current treatments of acne are different from those used at the time they were in their adolescence. More mothers (55.2%) who recognized the progress of recent acne medications obtained medical treatments for their child than those whose did not (25.1%) (P <0.05, chi-square test). More than 50% of mothers advise “washing face” for their children whose symptoms are mainly comedonal (54.9%) and mild (51.3%) acne. For moderate to severe acne, more than 70% of mothers recommend medical consultation. In response to a question as to whom their child felt most comfortable talking to about acne, 89.6% replied “their mother.” This survey revealed many mothers had insufficient knowledge about acne treatment. Mothers who recognized improvements in acne medications were more likely to seek medical treatments for their children, and those who did not were more likely to manage mild acne with skin care without medication. Mothers were the main source of advice about acne for their child. These results suggest that educating mothers regarding recent acne treatments may lead to their obtaining medical treatments for their children at an early stage of acne.

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