A case of ungual malignant melanoma was described. A 66 year-old female visited to our hospital because of a 2cm sized blackish nodule with nail destruction on her left thumb.
Amputation of the left thumb at the distral end of metacarpal bone and left axillar lymphnode dissection was performed under a clinical diagnosis of ungual malignant melanoma. On histological examination, the tumor was composed of pigmented anaplastic melanocytes, which invaded the bone underneath. Immunohistochemically, the cells were positive for S-100 protein and HMB-45. No metastatic lesion was detected on her left axilla. She received 4 courses of combination chemotherapy, DAY (DTIC, ACNU, VCR) along with local IFN-β injection. Six months later, she noticed a swelling on her left axilla and we re-performed lymphnode dissecton followed by a combination chemotherapy CDV (CDDP, DTIC, VDS).
She is now in good condition without evidence for metastasis for the last 13 months.

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Chemotherapy for extramammary Paget's carcinoma has not been established yet. We report a effective case with oral low dose etoposide therapy.
A 69 year-old male visited our hospital with a scaling erythema and a subsequent nodule on his pubic lesion. Biopsy specimen revealed extramammary Paget's carcinoma. Tumor resection and left inguinal lymphadenectomy were performed. 8 months after operation, purpuric erythema developed on his left thigh and tumor cells were histolopathogically proven in the dermal lymph vessels. Oral tegafur uracil and tamoxifen were tried, but not effective.
Chronic administration of low dose oral etoposide was tried to control the spreading of cutaneous tumors and lymphnode metastasis. The tumors regressed gradually and serum CEA level decreased to almost normal level. Only slight myelosuppression was found, and no severe adverse reaction was seen. After 5 months from administration of oral etoposide, nodules on the left thigh enlarged again. The patient died about 2 years after operation, but we conclude oral low dose etoposide therapy is worth trying.

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The Prognosis and Stastistical Investgation Committee (a part of Japanese Skin Cancer Society), the Ministry of Welfare Malignant Melanoma Research Group and the Japan TNM Committee have conducted an annual survey in Japan. The first survey covered the years 1967-1972, the second 1975-1987, the third 1987-91, the latest 1992-94.
During those periods, there were 3, 079 cases of basal cell carcinoma, 2, 214 squamous cell carcinoma, 2, 197 malignant melanoma, 566 mycosis fungoides, 1, 938 actinic keratosis, 1, 261 Bowen's disease and 608 Paget's disease. The present study provides a comparison by each years and described mainly on malignant melanoma.
The number of patients developing malignant melanoma are on the increase, and in 1987 the number of females contracting this began to out-number the males. In terms of disease type in Japan, there had been relatively few cases of lentigo maligna melanoma or superficial spreading melanoma, but recently the number has been on the rise. But in Japan there has been no change in the number of cases of acral lentiginous melanoma and nodular melanoma, which are many.
In 1987, the TNM classification was revised, and statistics are being compiled and the survey data gathered accordingly. Having earlier studied the prognosis, in this investigation the main focus was a comparison by period of age, sex, sites, disease types and stage.

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Malignant melanoma in childhood is very rare and is often misdiagnosed as Spitz nevus because of their histological similarities. Our patient was 14-year-old girl who had enlarging, raised, pigmented nodule on her left foot. Histopathologically, it showed some features of Spitz nevus. The tumor cells were composed of atypical, pleomorphic epithelioid cells. Mitotic figures were very sparse and small nevoid cells were seen in the deeper potion. But the cyto-fluorometric analysis of nuclear DNA content showed pattern IV, aneuploid pattern. The results of fluorescence microscopy of unstained sections and immunostaining with HMB-45 also suggested the malignant change.

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A case of acral lentiginous melanoma in situ. A 79-year-old woman had 20mm × 40mm pigmented plaque with color variegation from brown, black to amelanotic area. Histopathologically, this color variegation corresponds to the amount of atypical melanocytes in the skin.

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A 50-year-old Japanese female of acral lentiginous melanoma in situ involved into deeper eccrine duct epithelium on the right middle finger was described. Histopathologically, increased number of atypical melanocytes were proliferated involving both lower epidermis and deeper portion, 643μm from epidermal basal layer, of eccrine sweat duct epithelium, which is a rare histological finding in usual ALM. It is well known and interesting that malignant melanoma in situ, especially ALM in situ often proliferate involving into superficial portion of eccrine duct epithelium, however, our case was exceptional.
We supposed that ALM in situ cells could proliferate with affinity to eccrine duct epitherlium. Taken together, we need careful treatment and follow-up for ALM in situ with proliferation into the deeper portion of eccrine duct as our case.

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A case of a 65-year-old woman with double cancers of malignant melanoma and cervical cancer was reported. She had black tumor, which was 10mm in diameter, on her left forearm and underwent resection at a clinic. The histological finding showed malignant melanoma. She uederwent wide local resection and chemotherapy. Careful physical and radiographic examination revealed to have a cervical cancer with stage IVa. We also described 7 more cases of double cancers of melanoma and internal cancer from our department data file.

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A 61-year-old male patient with malignant melanoma on his right heal had been aware of a black macule there for 40 years. Since 17 months after local excision of the primary lesion and radical dissection of the right femoral, inguinal and external iliac lymph nodes, many in-transit matastases (IM) have appeared on the right ventral and medial femoral region and the anterior region of the knee one after another. The histological findings of the primary lesion and IM revealed that dermal melanocytelike neoplastic cells were lined up along collagen bundles with configuration of a common blue nevus. The presence of obvious junctional activity of the tumor in the primary lesion denied the tumor origin from a long-standing blue nevus. The impaired lymphatic circulation following the lymph-node dissection may be one possible cause of the development of the IM in our case, but we rather think that the IM had already occurred before the dissection because of the evidence of tumor metastasis in 5/12 dissected lymph nodes.

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This article is a case report of a 78-year old Japanese woman with a history of malignant melanoma resected from her right 2nd toe followed by an ilioinguinal lymph node dissection in 1980. The lymph node dissection, however, was not quite successful, because numerous nodes were proved metastatic tumors. The histological specimen obtained from the primary lesion was found to be acral lentiginous melanoma, Clark's level III, 0.8mm in thickness, pT₂N₂M_1a, stage IV. She underwent combination chemotherapy using DTIC, nitrosourea and vincristine (DAV) for 5 years and vaccination with BCG (Japanese lnstitute for BCG, Tokyo) for 7 years.
Although metastatic tumors in paraaortic lymphnodes were not completely dissected, no evidence of distant metastases including recurrence of regional lymph node metastasis was noted prior to the appearance of intransit metastases in her right leg 13 years after the initial surgical procedures. In addition to the excision of intransit metastases, she was treated with DAV and intracutaneous injection of interferon-β. Late recurrence (i.e. 10 or more years after definitive surgery) is not unusual in malignant melanoma, but is rare in an advanced stage of melanoma such as our case.

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A 38-year-old female patient with eccrine sweat gland carcinoma is reported. The patient had a tumor on the scalp during the last 3 years and underwent local excision at the Department of Brain Surgery 10 days ago. The patient was presented to us in October of 1992. Physical examination revealed 23 mm long, reddish, post operative scar. In the center of the scar there was a slightly protruded and firm area. A 1.5 cm sized lymphnode was palpable in the right supraclavicular fossa. Total excision with 3 cm of margin and right radical neck dissection were performed. Histopathologically, irregular shaped nests of tumor cells were proliferated from the dermis to the epicranial aponeurosis with prominent fibrous stroma. The tumor nests possessed ductal structures. Tumor cells showed nuclear atypia and mitotic figures. CEA, EMA and CA19-9 were expressed in the luminal surface of ductal structures or the cell membrane of tumor cells. Electron microscopic examinations revealed the intercellular lumina, lined by microvillous projections. 1 year later, the patient had a recurrence into the cranium directly under the primary focus and underwent craniectomy. 1 year and a half later, the lung metastasis was detected and combination chemotherapies were performed. Soon thereafter, skin, bone and brain metastases were detected. 2 years and 3 months later, the patient died of cerebral herniation.

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A 72-year-old male with malignant mixed tumor of skin is reported. The tumor presented as a 5cmφ sized red nodule on the base of penile shaft. It was excised with 30mm surgical margin and bilateral groin dissections were performed. Histologically, the tumor had epithelial and mesenchymal components. Epithelial component was composed of polygonal cells, glandular cells, basaloid cells and squamoid cells, having cytotic atypia and mitosis. Mesenchymal component was composed of myxomatous change and cartilaginous matrix, which were positive in alcian blue and toluidine blue stainings. Immunohistological stain was also performed.
He has no local recurrence nor metastasis at one year after treatment, but further attention to the recurrence must be paid.

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We reported a case of squamous cell carcinoma of the heel developing at the site of fifty years history of frostbite scar. A 71-year-old Japanese man presented a 7×7cm, ulcerated, fungating, easily bleeding tumor of his right heel of 12 month duration. When he had detained at Siberia after the Second World War, he had suffered frostbites of the feet at the age of twenty-two. We resected the lesion and used to reconstruct the heel with the flexor digitorum brevis muscle island pedicle flap. There were no recurrences or metastasis 2 years later.

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A malignancy, regarded as spindled squamous cell carcinoma, occurred in a skin ulcer in a 71-year-old female with Buerger's disease. Ulcers had often appeared at the medial malleolus of the right lower leg since she was 25 years old. The patient was previously diagnosed with Buerger's disease by angiography. A granulomatous lesion appeared after tretinoin tocoferil ointment was used for the ulcer at 70 years of age. Because the biopsy suggested a malignant tumor, below-knee amputation was carried out. The immunohistochemistry revealed staining for vimentin but not for keratin, suggesting that tumor had originated from the mesenchyma. The definite diagnosis was difficult. However, the histopathology by hematoxylin-eosin staining partially showed tumor continuity with epidermis, keratinization and intercellular bridges. Consequently, the spindled squamous cell carcinoma was speculated to have displayed abnormal expression in the immunohistochemistry.

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A 77-year-old Japanese male patient visited us with a 2-year-history of a tender nodule existing at the preauricular portion of the left ear. On physical examination, there was a smooth, brownish, dome-shaped nodule 15×15mm in size with a cratral scab. There were no palpable regional lymph nodes. The lesion was totally excised with more than 1cm safety margin, whose defect was covered by a skin flap made from behind the ear. Histopathological exmanination reveald that a solid feature of BCC adjacent to well differentiated SCC showing marked keratinization. These findings were typical of a collision tumor.

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A 74-year-old man developed an erythematous plaque on his left cheek in 1985. In 1995, this eruption formed a scaly pigmented irregularly shapen erythematous plaque, 5×8mm in size. The histopathology of the eruption revealed the proliferation of atypical clear cells (PAS+) in the outer root sheath area. The results of a cytokeratin antibody immunohistochemical study were as follows, 34β4 (-), AE3 (+), 34βE12 (+), 35βH11 (-), AE1 (+), 170.2.14 (+) . The reactivity to involucrin was observed in the central area of the tumor. These observations suggest outer root sheath differentiation of this tumor. The cytokeratin study is useful to characterize a malignant trichilemmoma.

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A 36-year-old Japanese female with pilomatrical carcinoma is described. she noted a bean-sized asymptomatic subcutaneous nodule on her right upper arm about three years before visiting our hospital. She left the nodule as it was. But, about 2 years and a half later, the nodule rapidly enlarged and elevated. Soon later, the nodule was eroded and ulcerated. Biopsy performed at a hospital suggested malignant tumor, and she was refferd to us.
At the first visit to us, an ulcerated elastic hard nodule, 77×71×21mm in size, was seen on her right upper arm.
Histopathologic examination revealed that the lesion had reached the deep layer of the subcutaneous tissue. The nodule was composed of sheets and nests of basaloid cells with cystic spaces containing shadow cells. The sheets and nests were various in size and shape. The basaloid cells predominated over the shadow cells. The basaloid cells were compactly arranged. Atypical nuclei, many mitotic figures and some necrotic foci was detected in the nests of the basaloid cells. Infiltrative proliferation into the surrounding desmoplastic stroma was observed.
She underwent the wide resection of the nodule. There has been no evidence of recurrence for 1 year after surgery.

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A case of Merkel cell carcinoma with regression after biopsy a 73-year-old woman is reported. The tumor was noticed on her right upper arm and became flesh colored, 14×12×13mm, dome-shaped nodule in three months. Biopsy specimen revealed large tumor cells were found in groups and bands without infiltration of lymphocytes through the dermis and stained for neuron specific enolase, cytokeratin, S-100 protein and chromogranin. This tumor was diagnosed as Merkel cell carcinoma. The tumor partially regressed during the month before excision. The excision specimen revealed dense clusters of lymphocytes around the tumor nests. Although the lymphocytes around the tumor nests showed even infiltration of CD4+ and CD8+ cells, the majority of the lymphocytes which had infiltrated into the tumor nests were CD8+, Electron microscopy revealed tumor cells contaning a few dense-core granules in the cytoplasm and both tumor cells and lymphocytes showed apoptosis. Neither tumor recurrence nor metastasis has been observed during the follow-up period of 11months after surgery. Eleven previously reported cases of Merkel cell carcinoma which showed regression were reviewed.

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We report a case of Merkel cell carcinoma associated with Bowen's disease that developed in a 95-year-old female. The patient had an ulcerated nodule in the erythematous plaque of her left shoulder. Histological examination revealed Bowen's disease with a deep infiltrating small cell tumor. Ultra-structural studies demonstrated dense core granules within those small cells. The transition between the two tumors was not identified. It has been reported that in certain organs (skin, stomach, intestine, uterus), neuroendocrine tumors (Merkel cell carcinoma, carcinoid, small cell carcinoma of the lung) are often co-existence with other epithelial malignancies such as squamous cell carcinoma or adenocarcinoma.

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We reported a case of a 68 year-old man with Merkel cell carcinoma. He noticed a tumor on his left leg about seven months previously. As the tumor expanded gradually, he visited Mie University Hospital. At his first visit, the lesion composed of a smooth, easily bleeding tumor in the center and a violet plaque around the tumor. Light microscopy showed two diffirent parts in the lesion, which are Merkel cell carcinoma and squamous cell carcinoma. Immunohistochemical examination showed positive reaction of CEA on the part of Merkel cell carcinoma.

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The prognosis of metastatic angiosarcoma of the scalp is extremely unfavorable. No effective chemotherapeutic protocol for metastatic angiosarcomas has yet to be established. We herein report a case of metastatic angiosarcoma, a 67-year-old Japanese female, who received a combined chemotherapy with peplomycin, cis-platin, adriamycin and vindesine (P-CAV). After 2 course of P-CAV therapy, primary lesion, regional lymphnode metastases and bone metastases were disappeared dramatically. But a few months later, another metastases of brain and lung were developed instead of adding 2 course of CIV (CBDCA, IFM, VDS) chemotherapy, and the patient died of 5 months clinical course. Although the chemotherapy might not prolong the survival of this case, P-CAV chemotherapy may be useful for angiosarcoma of the scalp.

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Liposarcoma in the face region is extremely rare. We reported a case of recurrent liposarcoma of the right cheek of a 54-year-old man. He received first tumor excision in another hospital in May, 1994. In the histologic examination, the tumor mass consisit of lipoblast, uniformly shaped, small round microvacuolated cells containing atypical hyperchromatic vesicular nuclei were present from lower dermis to subctaneous tissue. The histopathologic classification was round cell type. Partially, transitions toward the myxoid type and screlosing type were present. One year later, local recurrence occured, but there was no metastasis. Second wide local excision was performed in June, 1995. Few changes occured in the histological findings of the second excision and it revealed round cell type.

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We reported our treatment for a surgical defect after excision of malignant tumor of the eyelid. Typical cases of surgical defect around the upper and lower eyelids were presented. For small defects, direct suture is usually applied. On the other hand, for larger upper eyelid defects greater than 40%, a switch flap from the lower eyelid (Mustardé rotation flap) is used. For lower eyelid defects greater than 40%, a cheek flap with good texture and color match is usually used.
Results were satisfactory in both clinical and cosmetic aspects by using these techniques.

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We recently treated case of Merkel cell carcinoma of the right cheek. The patient, an 83-year old japanese woman, complained of a nodule on her left cheek measuring 40×40×10mm. The tumor was a cutaneous nodule with reddish-purple overlying skin. Histologically, the tumor invaded the dermis and subcutaneous tissue and did not exend into the epidermis. The tumor cells were small sized and showed a monotonously uniform appearance. They had round nuclei and scant cytoplasm. We performed wide local excision, radical neck dissection and used the radial forearm flap for reconstruction of the right cheek.

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A patient with extramammary Paget's disease showed perianal nodules surrounded by erythema. rIFN-α-2a (300 million IU) was intralesionally injected three times a week. After the administration of 17, 700 million IU IFN-α, the skin lesions regressed leaving infiltrating plaques. Histologically, Paget cells were not observed at the site of erythema, but survived in the thickened epidermis. The intradermally infiltrating Paget cells remained. Then, the infiltrating lesions were excised under local anesthesia. Paget cells, however, were observed in the epidermis and in the dermis adjacent to the surgical suture. Paget cells completely disappeared and remission has been lasting for 6 months after electron beam irradiations (total 58 Gy). Intralesional IFN-α injections are effective on erythematous, superficial stage of extramammary Paget's disease, whereas it is very hard to get complete remission of advanced lesions by the intradermal IFN-α injections.

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A 64-year-old man noted an erythematous plaque on his scrotum almost 30 years ago. The center of the lesion gradually elevated with papillomatous surface in recent several years. Physical examination revealed fist-sized erythematous plaque with dyschromatosis and some finger head-sized papillomatous nodes on the scrotum and dorsal surface of the penis. The biopsy of the lesion confirmed the diagnosis of extramammary Paget's disease. Wide excision of the lesion including inguinal lymph node dissection were conducted. Histologically, the node showed acanthosis with mild papillomatosis, and Paget cells proliferated in the lower epidermis and focally in the dermis, while the plaque did not show any acanthotic changes. Nodules with verrucous surface displayed anastmosing downward proliferation of epidermis containing sparse Paget cells. Immunohistochemically, in situ and dermal Paget cells expressed K7, K8, K8/18, K10/11, K18, and K19, while they failed to express K1, K4, K13, K14, K17, and K20. The epidermal keratinocytes in the plaque expressed the same keratin as normal skin. Whereas, in the node basal keratinocytes expressed K10/11, K13, K17, and suprabasal keratinocytes reacted with K17. These data indicate that the proliferation of Paget cells could alter the expression of cytokeratins in neighboring keratinocytes.

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