We reported a case of 81-year-old Japanese man with Merkel cell carcinoma on the upper eyelid. Following excision of the tumor, Mustardé's switch flap was used for reconstruction of the defects and performed with total lateral lobectomy of parotid salivary gland. It is supported that this technique is useful for carcinoma of the upper eyelid.

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A first selection of a medical treatment for skin squamous cell carcinoma (SCC) is the surgical therapy.
This time, we reported 5 cases of SCC. Case 1 and 2 are penis SCC. Case 3 and 4 are SCC after burn of the scalp. Case 5 is SCC that occurs for radiation dermatitis.
I have a dream. The DREAM is continue doing the best therapy for my patients. And the treatment must be similar with method that I select for myself and/or my family. Dreames come true.

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We report a 72-year-old female who demonstrated a suquamous cell carcinoma on the right cheek. On clinical course, this case might be an oral florid papillomatosis with malignant change. It was excised with upper-neck dissection and reconstructed with cervicofacial flap and hinge flap at one-time. There has been no recurrence during 6 months of follow-up and this method was useful for wide cheek defect.

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Meibomian gland carcinoma is apparently one of the most malignant tumor of the eyelid. If it is not radically excised, recurrence is likely to occur.
In the present survey on the patient records in our hospital, we have encountered six patients with this tumor in the past 10-year period (1985-1995). Four of them were recurrent cases, and two were first-diagnosed cases in our department. For four patients, operations were undertaken with a surgical margin ranged between 5 and 10mm, and one case ultimately required exenteration because of its recurrence. We excised tumors as a rule with a safety margin of 5mm of normal-appearing tissue surrounding the primary lesion of the tumor. Taken together the present study and literature, it may be recommended to advocate a wide excision for the recurrent lesions at the lid margin or along the free border of tarsus that measures 1cm or more.

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We report a case of mycosis fungoides which diffusely invaded the liver for more than twenty years after the onset of the disease and which resulted in his death by the rapid progression of liver dysfunction. He was diagnosed as having mycosis fungoides by the long duration of parapsoriasis en plaque and histologic features of skin biopsy in seven years ago. However biopsy specimen of swollen axillary lymph node at that time included B-cell marker-positive Reed-Sternberg cell like-large cells and the histology resembled that of Hodgkin's disease or T-cell-rich B-cell lymphoma. The same histologic features were recognized in autopsy specimen of the extracutaneous lesions, such as lung, liver, spleen and abdominal lymph nodes. The investigation of gene rearrangement led us to the diagnosis of T cell lymphoma, but it was not defined whether it was the invasion of mycosis fungoides or another lymphoma originated in the lymph node. Interestingly EB virus infection was proven in Reed-Sternberg cell-like large cells, so that EB virus was suspected to play a roll in the making of the characteristic features of the extracutaneous lesions.

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Two cases of malignant lymphoma with skin and naso-pharyngeal involvement were reported.
Case 1: A 22-year-old man noticed subcutaneus nodules on the trunk and the upper arm 2 years ago. He began to have sore throat about one year ago. An endoscopic examination revealed white tumors on the middle pharynx. Atypical cells in biopsy specimens of the tumors from the skin were positive for CD45, CD3, CD4 and CD5, and negative for L-26 and CD19. The patient died from loss of blood from his pharyngeal lesion, after two courses of CHOP therapy and one course of MEPP therapy.
Case 2: A 44-year-old man had the nasal obstruction for eight months. He noticed numerous erythemas on his back and a mass expanding from his upper palate to his gingiva 2 months before admission. Atypical cells in biopsy specimens were positive for only CD8 and CD56, and negative for CD3, CD4, CD5, CD19 and CD45Ro. We considered that these cells originate from natural killer cell lineage. In addition, these cells were revealed positive for Epstein-Barr early region (EBER) RNA using in situ hybridization. He was treated with three courses of BACOP-BEP therapy, but he died of DIC after 2 months of his admission.
In conclusion, our patients' tumors were diagnosed as naso-pharyngeal malignant lymphoma associated with skin involvement. The present cases suggest that the management of naso-pharyngeal lymphoma is very difficult.

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Malignant melanoma in children occurs quite rarely, but it seems to have different characteristics from those in adults. For 33 years from 1962 to 1994, totally 405 cases of malignant melanoma visited Dermatology Division of National Cancer Center Hospital. Out of them, 15 cases (3.7%) were children of less than 18 years old. The disease type was NM in 9 cases, SSM in 4 cases, ALM in 1 case and unknown in 1 case. Compared with adult cases, NM is more and ALM is less. The site of occurrence was the head in 1 case, neck in 1 case, trunk in 3 cases, forearm in 1 case, palm in 1 case, thigh in 4 cases, lower leg in 1 case, sole in 2 cases and unknown in 1 case. The distribution was quite different from adult cases. Precursor lesions of congenital giant pigmented nevus existed in 4 out of 15 cases (26.4%), but not definitely in other 11 cases. In the former group of 4 cases, the disease type was NM in 3 and unknown in 1. Two of 3 NM cases died and the prognosis was poor. In the latter group of 11 cases, NM occurred in 6, SSM in 4 and ALM in 1. Although 2 cases died, the prognosis was relatively good.

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A 39-year-old female presented with a rapidly enlarging and easily bleeding tumor on her right thigh. On physical examination, there was a 3×2.5cm, parallelogramatic, black and dark red tumor on the lateral portion of the right thigh. The tumor was radically excised with regional lymph nodes dissection, followed by receiving chemotherapy with DAV etc. Up to the present time, she has remained disease-free. Gross pathologically, the lesion consisted of a nodule and a flat-elevated part. Histopatho-logically, the nodule had central and bilateral portions. The former consisted of A-type-like cells similar to A-type of nevus cell nevus and B-type cells of the nevus cell nevus. There was gradual transition between them. The bilateral portions composed of highly atypical tumor cells showed expansive growth. The flat-elevated part consisted of A-type-like cells and spindle-shaped cells in the epidermis and the papillary dermis. Tumor cells of the regional lymph node metastasis had almost the same characteristics as those of A-type like cells. The tumor cells in local recurrence were mainly spindle-shaped.
Immunohistochemistry showed common reactivity between A-type-like cells and tumor cells in the flat-elevated part, but the tumor cells in bilateral portion of the nodule had the characteristics different from those of A-type-like cells. These findings suggest that in this patient malignant melanoma arose from nevocytic cells in the dermis.

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This report deals with a case of malignant melanoma following injury in a 30-year-old female. She dropped a steel file on her rt. great toe to develop subungual hematoma at the age of 25. After nail avulsion, a granulomatous tumor was observed on the nail bed. Histpathologically, the tumor consisted of round or spindle shaped cells and had a little pigments. Immunohistochemically, the tumor was partially positive for S-100 protein and HMB-45, and was diagnosed acral lentiginous melanoma (ALM) . Amputation of rt. great toe followed by groin dissection were performed. Postoperative diagnosis was ALM Stage III (pT₄ N₀ M₀).

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We report a case of amelanotic malignant melanoma with complete loss of pigment on the left foot in 64-year-old male. The histopathology of the primary lesion after total resection showd that tumor thickness was 10mm and the junctional activity of the tumor cells on the basal layer and nests of tumor cells, but no melanin granules existed. By immunohistchemistry, tumor cells were positive for S-100 staining and partly positive for HMB45 staining. Melanosome and premelanosome were not observed by electron microscopic examination. Radical resection for left inguinal lymph nodes was carried out and tumor metastasis was confirmed histlogically.

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A violanceous erosive-elevated lesion, 16×14×8mm, occurring on the left thigh in a 20-year-old man (case 1) and a blackish erosive-raised lesion, 16×15×10mm, arising on the right lower jaw in a 31-year-old man (case 2) were examined by HPLC measurement of 5-S-Cysteinyldopa (5-S-CD) levels in gauze exudates and by the touch fluorescence method from the surface of the lesions. As a large number of fluorescent melanoma cells were observed under the fluorescence microscopy, and 5-S-CD values showed high level in gauze exudates in both 2 cases, the definite diagnosis of malignant melanoma was made before operation. Pathological findings showed superficial spreading melanoma, stage III, pT_4aN₁M₀ in case 1, and nodular melanoma, stage III, pT_4aN₁M₀ in case 2, respectively. The fluorescent melanoma cells in unstained formalin-fixed paraffin-embedded specimen were classified into 5 types.These types of cells, except for round (epithelioid) cells, were positive for HMB-45 immunostaining. From these results, it is confirmed that the findings of the touchfluorescence method and the measurement of 5-S-CD levels in gauze exudates areuseful for the preoperative diagnosis of malignant melanoma, and that the observationof unstained specimen under the fluorescence microscopy is a simple and valuablemethod for demonstrating the melanogenic activities in melanoma cells, which areverified by the positive findings of HMB-45 immunostaining.

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A 73-year-old man, suffering from seven years history of multiple nodules and swelling around the right orbit, visited us in June, 1993. Histologically, the tumor resembled to a metastatic adenocarcinoma because of the admixture of a lot of “signet ring cells”. But thorough systemic work up, including radiographic studies of the gastrointestinal tract, we failed to reveal any primary internal carcinoma. A wide resection was performed and the specimen was studied histochemically and ultrastructually. Although we could not determine the precise origin of the carcinoma, we concluded that our case was a primary infiltrated adenocarcinoma of the eyelids named “signet ring carcinoma of the eyelids”.

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Merkel cell carcinoma is a high-grade malignant tumor with rapid local progression and high incidence of metastasis. Despite this, 5 cases of spontaneous regression have been reported. Previous reports of spontaneous regression of merkel cell carcinoma are occurred in woman except only one case.
We describe a 75-year-old woman with merkel cell carcinoma that spontaneously regressed.

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A 64-year-old man had a rapidly growing tumor on his nasal apex. He had been treated for his lung cancer with left pneumonectomy and mediastinal lymph node clearing 6 months before. Since histological findings of the nose tumor and the lung tumor were very similar, the nose tumor was diagnosed as a metastatic skin cancer originating from lung cancer.
We also studied 22 cases of metastatic skin cancers in our hospital experienced for 8 years. The mean age at their first visit was 63.4 years old. The most frequent primary tumors were lung cancer (31.6%) . Abdomen and chest were the most common metastatic lesions, unless face and back metastasis was less common. The avarage time of the appearance of the skin lesions after detection of the primary tumors was 28.7 months. The avarage time of death after the appearance of skin metastasis was 6.9 months. When metastatic skin cancers in nasal area are found, we had better to speculate the presense of kidney cancer first, and secondarily the presence of lung cancer as primary cancers.

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A statistical observation of 571 admitted patients with malignant tumors diagnosed at Department of Dermatology, Miyazaki Medical College during the past 18 years (1977-1995) is reported. Malignant tumors include 164 cases of malignant lymphoma (ML) and other hematological diseases, 146 of squamous cell carcinoma (SCC), 101 of malignant melanoma, 52 of basal cell epithelioma, 46 of Paget's disease, 13 of angiosarcoma, 11 of malignant fibrous histiocytoma (MFH), 11 of sweat gland carcinoma, and 27 of others. One hundred fifty-nine cases of them died; 93 of ML and other hematological diseases, 19 of malignant melanoma, 17 of SCC, 11 of angiosarcoma, 5 of Paget's disease, 4 of sweat gland carcinoma, 3 of MFH, and 7 of others.

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A 79-year-old Japanese male presented our clinic with a painful eruption on the left edge of the tongue. The lesion was a shallow ulcer surrounded by a elevated indulated border. The size was 40mm in diameter. The histopathological examination of the tumor showed squamous cell carcinoma. He was treated by radiation and resection of the left side of the tongue. One and half year after operation, he is still alive

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A 75-year-old woman came to us with a slowly enlarging erythemato-erosive lesion on the perianal area of about 6 month's duration. On examination, the lesion showed erythemato-erosive plaque with peripheral pigmentation measuring 7.4×6.3cm in size. No lymphadenopathy on the groins were palpable. Histologically, the epidermis was mostly replaced by atypical keratinocytes. Intradermal eccrine duct and follicle were

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A 57-year-old female case with a malignant eccrine tumor of the chest was reported. On clinical inspection she noticed the tumor 6 months before, and the tumor had gradually become bigger with some slight tenderness. First surgical excision of tumor was performed under the general anesthesia, followed to be diagnosed eccrine spirocarcinoma histologically. However, she noticed small tumor on the left axilla 11 months after the first operation and second surgical wide excision with lymphosectomy was performed to confirm metastasis. After second operation, she had radiation therapy and no recurrence has been observed for these 2 years. The classification of malignant eccrine tumor was reported by Mishima and Morioka 1968. Since this report, some cases have reported in Japan. In this report, clinical and histological findings of our case was studied and discussed.

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A case of eccrine porocarcinoma is reported. A 78-year-old man had had a red tumor on his right preauricular region during the last 2 months, which was 25×15mm in diameter and was covered with yellowish necrotic mass. Histopathologically, the tumor had a down-growth up to the deep dermis and it was composed of atypical cells which had the intracellular canaliculi in part. Cytoplasms of tumor cells showed PAS-positive and CEA-staining was positive in cytoplasms and intracellular canaliculi in part. EMA was positive in tumor cytoplasms of peripheral lesion. On electron micrograph, intracellular canaliculi had numerous microvilli in some tumor cells. These findings were compatible with eccrine porocarcinoma.
p53 protein was overexpressed in nuclei of almost all tumor cells and the PCNA labeling index was 80% in tumor nuclei, which was higher than SCC cases in the previous reports.

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A statistical summary of 25 patients with extramammary Paget's disease seen at Department of Dermatology, Toho University Omori Hospital, between 1975 and 1994 is reported. The male/female ratio was 2.6:1. The average age of the patients was 67.2 years. All cases had single lesions; 24 cases (96%) occured on the genitalia and 1 (4%) occured on the axillae. Clinically, 8 cases (32%) showed tumor formation. Seven cases (28%) exhibited invasive carcinoma. Four cases (16%) had inguinal lymph node metastasis but none of the 25 cases had other organ metastasis. One case (4%) had adenocarcinoma of the lung. Cytokeratin was investigated immunohistochemically in 11 lesions from 10 patients. In these 10 patients, Paget's cells were thought to be neoplasms that had originated from simple epithelial cells.

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A case of 89-year-old woman with triple extramammary Paget's disease of the bilateral axillae and genital region was reported.
The erythematous lesions were noted on right side of the axilla, left side of axillar region with walnut-sized, easily bleeded tumor and genital region. Furthermore, another subcutaneous bean-sized mass suggested regional lymph node metastasis were palpable on the left axilla. Histopathological findings of each erythematous lesions demonstrated Paget cells which showed positive with PAS, d-PAS staining and alcian blue staining in the epidermis. Tumor of the left axilla demonstrated aggregatively invaded into the dermis. During a physical examination for internal malignancy and metastasis of Paget's disease, she died of the cerebral infarction.
This case suggested that the other lesion on another side of axillar and genital regions should be care for the invisible or small lesions of extramammary Paget's disease being.

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The patient was an 87-year-old male. He noted mild reddening and induration at the flexor base of the penis since the end of December, 1991. It enlarged as a continuous subcutaneous funicular induration of the size of a finger extending from the middle to the lower part of the scrotum. A biopsy was obtained by a local physician in March, 1992, but the pathologist overlooked tumor cells in the epidermis and dermis, and the patient was referred to our department in August, 1992. Examination of biopsy specimens at our department indicated extramammary Paget's carcinoma, but on close examination, no metastasis to other organs was noted, and the CEA value was normal. In September of the same year, extensive resection was performed, followed by split thickness skin grafting. The bilateral shallow and deep inguinal lymph nodes were dissected about 1 month later. In the resected specimen, most of the Paget's cells were arranged in cords from the dermis to subcutaneous tissues, and few Paget's cells were observed in the epidermis. Edema developed in the femoral region from April, 1995, but the CEA level was normal. CT revealed metastasis in para-aortic lymph nodes and common iliac lymph nodes, and radiation therapy was performed.

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Japanese patients with extramammary Paget's disease often show hypopigmented lesion just outside of erythema lesion where tumor cells grow in the epidermis. We made histological examination on the hypopigmented area of two specimens obtained surgically from two patients. As the results, the epidermis in the hypopigmented lesion has Paget's cells in a lower number than the reddish lesion. And the intraepidermal invasion of the tumor cells was clearly limited to the boundary between hypopigmented and clinically normal lesions in the two cases. Therefore, it may be possible that reduction of the width of excision from the edge of the hypopigmented lesion than reddish lesion.

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Three cases of basal cell carcinoma appearing in the axillary region were studied together with 16 cases collected from the Japanese literature. The most frequent histopathological type was the superficial spreading type, followed by the solid type. Most lesions were either linear or bandlike in appearance, and the speed of proliferation of basal cell carcinoma in the axillary region was revealed to be faster than that of the face and the head published by Ono.

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Dermatofibrosarcoma protuberans (DFSP) is a rare tumor of the skin, the characteristics of which are slow local but aggressive growth and a strong tendency of local recurrence. Between 1983 and 1994, 16 patients of DFSP were treated in the Plastic and Reconstructive Surgery Department of Hokkaido University Hospital and other two hospitals in Sapporo. We present a retrospective study of these patients. A mean follow-up period is 3 years and 6 months with a range of 10 months to 11 years 6 months.
Ten patients were males and 6 patients were females. The average age was 38.9 years. The youngest was 11 years old boy and the oldest was 67 years old man. Tumors had from 1 month to over 20 years clinical course. The occurrence of the tumors of 4 patients was in children. Six patients with recurrence had been initially treated elsewhere. The location of the tumor were four head and neck regions and twelve trunks. Two patients had experienced bruise before the ocurrence of the tumor.
All patients were treated surgically. We excised the tumor widely. Ordinarily, the excision included a 3cm or more margin of normal tissue all around the tumor. In depth, the first healthy anatomical structure (fascia, muscle, periosteum or other tissues) was excised under the corresponding surface.
Radiotherapy was performed for 2 patients because of the narrow surgical margin.
No chemotherapy had been done.
Two patients relapsed, both underwent re-excision.
No patient developed regional lymph node or distant metastasis.

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Two cases of pigmented dermatofibrosarcoma protuberans (pigmented DFSP) were reported. The first case was a 15-year-old male with a recurrent small subcutaneous tumor on the right upper arm. The original tumor, which was measured 3cm in diameter, bluish colored and elastic hard, had occurred at the age of eight. It was removed marginally and diagnosed as “blue nevus” by histological examinations; it recurred on the surgical scar after several months. Then, it was further excised with a wider surgical margin including fascia ; however, recurred again on the scar of skin grafting three years after the operation. The histological examinations showed a uniform proliferation of spindle-shaped fibroblast-like cells arranged in a storiform pattern, and interspersed melanin-containing spindle cells. The original tumor was histologically reevaluated and diagnosed as pigmented DFSP. The second case was a 30-year-old female with a slowly growing subcutaneous tumor on the right upper arm. It was multinodular, 2.5cm in diameter, reddish and partly bluish in color, and elastic hard. The histological findings were similar to those of the first case. Each case was treated by surgical excision with an appropriate surgical margin. The fibroblast-like tumor cells of both cases were positive for CD34 antigen and negative for S-100 protein on immunohistochemical examinations. Electron microscopic studies of the second case revealed that the pigmented cells had numerous mature melanosomes in their cytoplasm and were surrounded by an extracellular sheath or a basal lamina, indicating that those cells were dermal melanocytes. On the other hand, the spindle-shaped tumor cells showed a fibroblast-like appearance and no evidence of neuroectodermal differentiation.

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We report the case of a 79-year-old Japanese woman without von Recklinghausen's disease who had abdominal skin metastasis derived from a malignant schwannoma in the subcutaneus tissue near her rectum. Three years and 8 months after surgical removal of the subcutaneus tumor near the rectum, metastasis to the both lungs and the liver was recognized. After 6 months of chemotherapy (CYVADIC method), skin metastasis was observed. The skin tumor was removed, and the tumor cells were histochemically positive for S-100 and NSE, but vimentin-negative.
Most malignant schwannomas reported by dermatologists are derived from neurofibromas of patients suffering from von Recklinghausen's disease. Most malignant schwannomas in the absence of von Recklinghausen's disease arise from the trigeminal nerve and stomach. Therefore, malignant schwannoma in the subcutaneus tissue near the rectum, as in this patient, is very rare. This is the first reported case of skin metastasis of malignant schwannoma.

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A case of epitherioid sarcoma treated with radiation was reported. A 66-year-old man with a 19×14cm tumor on his right forearm visited our hospital. A biopsy from the tumor region showed epithelioid sarcoma. MRI of his forearm showed that the tumor invaded muscles and periosteum of radius. CT showed multiple metastasis of the lung. Therefore, surgical treatment including amputation was not indicated. The tumor or metastatic region did not decrease, though the patient underwent chemothe-rapy with IFOVA (ADR, VCR and IFO) . Radiation therapy (total 3500rad.) to his forearm region was done. After the radiation therapy, the tumor mass decreased remarkably and no tumor cell was observed in the histopathological specimen. MRI of his forearm showed no abnormal sign. However, tumor metastasis was still seen in his chest CT.
Discussion: Epithelioid sarcoma usually occures in the soft tissues of young adults, particularly involving the hands and forearms. In Enzinger's report, there was a 10% incidence of regional lymphnode involvement, a 85% incidence of local recurrence and an over 25% incidence of distant metastasis. Chemotherapy or radiation therapy have never been employed in this tumor. However, this patient underwent radiation therapy and his tumor decreased dramatically. Histopathological specimen harvested from tumor origin, after radiation therapy, never showed abnormal cells.
In conclusion, we experienced a case of epithelioid sarcoma who got decrease of tumor with radiation therapy.

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A case of leiomyosarcoma in a 24-year-old female is reported. A red nodule was noticed on her right palm 10 years ago. After simple resections ulcer formations were developed repeatedly.
Histopathological examination revealed a mass of tumor cells with ulcer formation in the dermis to muscular layer. Tumor cells with eosinophilic cytoplasm were spindleshaped or epithelioid. Their nuclei were atypical and occasionally contained mitotic figures. Tumor cells were stained red with Azan-Mallory and Masson's trichrome. A boxed-in appearance was noted with silverstaining. Immunohistochemically, keratin, epithelial membrane antigen, vimentin, desmin and α-smooth muscle actin were positive in both spindle-shaped and epithelioid cells. The patient underwent amputa-tion of the right hand, because the diagnosis of leiomyosarcoma was established histologically.

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The treatment of Adult T cell Leukemia·Lymphoma (ATL) has not been established yet. Because the ATL cell develops resistance to any antineoplastics in a short time, when ATL goes into an acute exacerbation, the patient will become unresponsive to any treatment and the results will be miserable. Therefore, it is the best policy, at the present time, to prevent the ATL carriers (HTLV-I carrier) or ATL patients in the smoldering or chronic stage from going into acute exacerbations. Aging is a factor in decreasing the hosts' immunity, favoring development of ATL from ATL carriers. The development will further decrease the immunity, and goes into vicious circles. A good indicator of the immunity of ATL carriers or ATL patients is the activity of the natural killer cell (NK activity) . There is a possibility that the activation of the NK activity will prevent the ATL carriers or ATL patients from going into acute exacerbation. At our department, varicella vaccine has been used to activate the NK activity based on our observation that the development of herpes zoster will increase the cellular immunity. After the vaccine injection, the NK activity of ATL patients, whose NK activity is low, will be increased, together with the improvement of the condition. This may be a promising treatment policy.

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Mycosis fungoides (Alibert-Bazin-type) is an indolent disorder, in which main organ involved is a skin. Early lesions of mycosis fungoides show somewhat characteristic features, such as variation in size, shape and color, an erythematous plaque and lesion location (trunk, buttock and thigh) . The tumor cells of mycosis fungoides, small and medium-sized cells with cerebriform nuclei, are detected in an epidermo-dermo junction. But it is difficult to find the tumor cells in dermal infiltrating cells. Although Pautrier's microabscess is a diagnostic pathological feature in mycosis fungoides, it is not always found in the early lesions of mycosis fungoides. If a patient is thought to have mycosis fungoides by clinical features, the patient can be followed for a long time, even though tumor cells could not be found by microscopy.
Cutaneous B cell lymphoma can be diagnosed using a molecular biological assay.
T/NK cell lymphoma of the skin is a quiet rate lymphoma and sometimes confused with a benign skin disorder, such as lichen planus and plasmacytosis by clinical features. The tumor cells of T/NK cell lymphoma is not a granular lymphocyte, and do not express T-cell antigens such as CD2, CD3, CD5, CD43 and CD45RO and B-cell antigens such as CD19, CD20 and CD22. They only show CD56 on the cell surface.

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The authors treated 341 patients with solar keratosis, 164 with Bowen's disease, 326 with basal cell carcinoma, 243 with squamous cell carcinoma, 50 with extramammary Paget's disease, 19 with cutaneous adnexal carcinoma, 93 with malignant melanoma, 48 with metastatic skin tumor, and 46 with malignant soft tissue tumor, during the past 19 years. The tumors in 685 pateints (51.5%) were seen on the face. This review described the extent of tumor excision and coverage or reconstructive procedures for a carcinoma in situ, skin cancer, malignant melanoma, and soft tissue sarcoma, as well as static repair for facial paralysis due to tumor excision.

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We already reported this case as a malignant hemangioendothelioma (MHE) case where effects of one shot intraarterial recombinant interleukin-2 (IL-2) injection therapy were remarkable compared to conventional local injection of IL-2 or intraarterial therapy. We first used thermography to observe the therapy course of this case. The patient was 77-year-old female with MHE at the left forehead. At the first examination, tumor region and its circumferential erythema demonstrated high temperature on thermography. After one shot intraarterial IL-2 injection for 17 times, high temperature region on thermography was markedly reduced and the erythema disappeared. Pathological finding of the region revealed no tumor cells. Since thermography could detect aggravation of the disease due to discontinuance of thetherapy at an early stage as enlargement of the high temperature region, the method was estimated valuable asasupplemental diagnostic method for observation of the disease course.

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We have experienced 6 cases of acral lentiginous melanoma (ALM) in the past 23 years. There was no sex defference; 3 male cases and 3 female cases. The age of the patients ranged from 30 to 75. Of the 6 lesions, 5 occurred on the sole of the foot and one on the finger. The size of the lesions ranged from 1.5×0.9mm to 60.0×63.0mm and histological examination revealed their tumor thickness from 0.41mm to 10.00mm. One of the 6 cases only had a regional lymph node involvement, the others had none. All lesions were resected at 2 to 5cm out of their margin. Two cases evaluated as Clark level IV or V developed metastasis after operation. One of them of which tumor thickness was 10.00mm died from brain metastasis. The others have been disease free for 2 to 19 years after operation.
Cascinelli members of WHO melanoma program, have reported world wide stastical evaluation of the prognosis of the tumor thickness. However, they did not show any precise data about ALM that is the most common type in the Japanese. We reported 6 ALM cases discussing their tumor thickness and prognosis. To know the prognosis of ALM, furthermore investigations are required.

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