A 35-year-old man had a slowly enlarging tumor that has been presented for more than ten years on his occipital region.
The nodule had been excised and a radiation therapy had been performed at a different hospital ten years ago. Eight years later, the nodule recurred and an non radical resection was performed. He noticed a gradually enlarging solid tumor in the vicinity of the previous surgical scar, and visited our department. A wedge biopsy of the mass performed, and a diagnosis of epihtelioid sarcoma was made.
Examination revealed a 35×15mm in size, asymptomatic, rosecolored, subcutaneous, hard nodule on his occipital area with cervical lymphadenopathy.
Laboratory examination including chest roentgenogram, abdominal echogram, chest computed tomography, and Ga67 scintigram showed no evidence of systemic metastasis.
Treatment consisted of a wide en bloc resection of the tumor with radical cervical lymph node dissection : a right cervical lymph node was positive for metastatic tumor. The patient has been well with no recurrence of the disease after 9 months since the operation.

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A 44-year-old man began to manifest scattered scaly erythemas on his extremities at age 41. Next year he developed huge subcutaneous tumors on the right popliteal fossa and left buttock extending to thigh. Because biopsy specimens showed granulomatous lesions admixed with lymphocytes, he was diagnosed as sarcoidosis and whole tumor was removed. Three months later, subcutaneous tumors recurred, erythemas increased in number and size, and multiple cutaneous tumors appeared. He was hospitalized for examination on suspicion of malignant lymphoma. Laboratory examination showed high serum lysozyme and angiotensin-converting enzyme level, negative tuberculin test, and no suggestive findings of visceral involvement. Biopsy specimens from inguinal tumor showed a dense infiltrate of lymphoid and histiocytic cells without atypia and epidermotropism throughout the dermis. Histiocytic multinucleated giant cells were also seen. Electron microscopy revealed hyperconvoluted nucleus of lymphoid cells. Immunohistochemical studies disclosed CD3 and CD4 antigens expression of lymphoid cells. Gene rearrangement analysis revealed rearranged bands of β and γ TCR. These findings indicate a diagnosis of a granulomatous variant of CTCL.

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Malignant heamangioendothelioma (MHE) of the scalp is a highly malignant neoplasm with few long term survivors. Because of its rarity and high mortality rate, little is known about effective treatment for disseminated MHE. Although IL-2 immunotherapy have been enthusiastically studied in Japan, its clinical effectivenss of preventing the metastasis is questionable. We report a patient with metastatic MHE of the scalp who achieved a long-term clinical remission after treatment with cisplatinum and ifosfamide. The 12-year course of his disease is the longest reported survival in Japan with documented metastatic MHE of the scalp. As several patients have been effective by general chemotherapy in the literature, some new chemotherapeutic agents should be undertaken to MHE patients in the future.

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We reported a case of meibomian gland carcinoma on the right upper eyelid in a 79-year-old woman. A microscopic examination of the tumor revealed multiple lobules consisting of atypical foamy and undifferentiated basophilic cells. Following excision of the tumor, the modified Mustardé's flap was used for reconstruction of upper eyelid. For vertical upper eyelid defect greater than 40%, it is possible to get good appearance by using this technique. For lower lid defects greater 40%, a cheek flap is used.
It is emphasized that the primary excision with an adequate safety margin in the treatment of this carcinoma is needed, because this tumor is apparently one of the most malignant tumor of the eyelid.

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A 37-year-old man with myelodysplastic syndrome visited our clinic complaining some exudative erythema on November 30, 1994. Some erythema on the head was painful.
Histologically his skin lesion showed moderate neutrophil and some blasts infiltration in the dermis with mild edema.
From these findings, this case was considered as Sweet's syndrome-like symptom occurred in the course of myelodysplastic syndrome.

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Spitz nevus is a rare form of benign melanocytic nevus, which can be difficult to differentiate from malignant melanoma because of the presence of bizarre nevus cells. We experienced such a controversial case of a 25-year-old man suffered from a nodule on the left ankle joint. The black nodule of 6-7mm in diameter had grown slowly during the past five years. Histopathologically, the excised specimen showed features of a dermal nevus. Tumor cells were mainly composed of epithelioid cells and partially of spindle cells. Cytoplasm of the tumor cells was large and eosinophilic. Although nuclei showed pleomorphism and multiplicity occasionally. We diagnosed the tumor as a Spitz nevus because of symmetry of the architecture, sharp lateral and deep margins, presence of maturation, and sparcity of the mitotic figures. Stroma of the tumor was filled with fibrous tissue. Then desmoplastic variety was considered.

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A case of lentigo maligna melanoma of the left cheek skin is presented. The patient was 80-year-old woman. Grossly, 10×10mm relatively distinct black nodule and 20×15mm vague brownish macule surrounded the nodule were observed. At scanning magnification, the tumor seemed to be symmetrical and well circumscribed. These finding made us to suspect this tumor as Spitz's nevus. However, the atypical melanocytes proliferated at the junction and infiltrated to the subcutaneous tissue. Furthermore, melanin production was prominent and distributed irregularly in the tumor. At high magnification, mitoses of the atypical melanocytes were numerous even at the deep lesion and atypical ones were found. At the lentigo maligna lesion, atypical melanocytes proliferation were found at the junction.
It is important to consider in many aspects when malignant melanoma and Spitz's nevus are to be differentiaed.

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A 17-year-old Japanese male was referred to our clinic because of growing pigmented nail band of his left great toenail, which appeared after an accidental trauma 5 years ago and spread gradually. Physical examination revealed cracking of the left great toenail and a subungual nodule.
The diagnosis of melanoma was made based on histological and immunohistological examination of the excisional biopsy specimen. Tumor cells were immunoreactive to HMB-45. His left great toe was amputated. He received seven cycles of a combination chemotherapy with DTIC, ACNU, VCR, and IFN-β. No recurrence has been observed for 2 years.

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We reported three cases of malignant melanoma in situ. Case 1: A 36 years old, female. Superficial spreading melanoma in situ on the upper back. Case 2 : A 56 years old, male. Acral lentiginous melanoma in situ on the left sole. Case 3 : A 59 years old, male. Ungual melanoma in situ on the right thumb. Histopathologically atypical melanocytes are within the epidermis in all cases. We treated them by local resection and skin graft.
We observed them with dermatoscope. The features of the lesions of superficial spreading melanoma in situ with dermatoscope were characterized by irregular pigment network, radial streaming and pseudpods in the periphery. And those of acral lentiginous melanoma in situ were characterized by diffuse pigmentation unconcerned with sulcus cutis and crista cutis and hyperpigmentation on the crista cutis rather than sulcus cutis. Dermatoscope proved to be useful for the correct diagnosis of early malignant melanoma.

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In the study, it was determined whether cytofluorometry of nuclear DNA contents and fluorescence microscopic findings of formalin-fixed paraffin-embedded unstained specimens and immunostaining of the same specimens with HMB-45 coud be used to differentiate amelanotic or melanotic Spitz nevus from amelanotic or melanotic nodular melanoma.
The mean of averaged nuclear DNA contents was 2.14±0.14C (2.00 to 2.39) in amelanotic Spitz nevus and 2.17±0.22C (1.96 to 2.62) in melanotic Spitz nevus, showing no significant difference between amelanotic and melanotic types. Histograms of nuclear DNA contents showed a diploid pattern in all cases of both amelanotic and melanotic types. The mean of averaged nuclear DNA contents was 3.64±0.52C (2.91 to 4.45) in amelanotic nodular melanoma and 3.22±0.55C (2.60 to 3.93) in melanotic nodular melanoma, showing no significant difference between the 2 types. Histograms disclosed an aneuploid pattern in all cases of nodular melanoma. The mean of averaged nuclear DNA contents in nodular melanoma was 3.43±0.56C, which was significantly higher, as compared with 2.16±0.18C seen in Spitz nevus (P<0.0001, Wilcoxon's test).
In terms of fluorescence microscopic findings of formalin-fixed paraffin-embedded unstained specimens and HMB-45 immunostaining, the junctional components of nodular melanoma showed fluorescence and strongly positive HMB-45. Although a portion of intraepidermal nests of spindle cells in Spitz nevus were composed of fluorescence-positive tumor cells, no fluorescence was observed in nests of epithelioid cell which were negative for HMB-45.
From these results, it was thought that precision of determination of benignancy or malignancy could be improved by a combination of cytofluorometry of nuclear DNA contents with fluorescence microscopic findings of formalin-fixed paraffin-embedded unstained specimens and HMB-45 immunostaining.

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Balloon cell melanoma, a rare variant of malignant melanoma, was firstly described by Gardner & Vazquez at 1970. We report a case of 56-year-old female with SSM type balloon cell melanoma on the skin. The tumor was mainly composed of atypical balloon cell nests involving into the deep dermis. Tumor thickness was 4mm. lmmunohistochemically, the tumor cells war strongly positive for S-100 and HMB-45, positive for NSE, and weakly positive for CEA. Wide local excision and therapeutic neck dissection were performed (pT₄N₁M₀, stage III b). Until now the patient has been free of disease. We analyzed 7 cases in Japanese literature and 7+34 cases in English literature, and discussed the prognosis of balloon cell melanoma.

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We reported a 62 year-old male who had a verrucous malignant melanoma on his back of left hand, Remarkable findings of this case are summarized as follows; 1) the measurement of 5-S-CD value in the crust and the findings of touch-fluorescence method from the exudate were useful for the preoperative diagnosis of melanoma, 2) the accuracy of these methods was confirmed by the fluorecence microscopic findings of formalin-fixed paraffin-embedded unstained specimen and immunostainig for HMB-45 and NK1C3 with the same specimens, 3) the measurement of cellular DNA content and the cytofluometric histogram in the vertical growth portion exhibited 3.40C, aneuploid pattern, respectivily, whereas in the radial growth portion, it showed 2.40C, and diploid pattern, respectively. We emphasized that verrucous malignant melanoma is an important clinical form which requires a careful attention to avoid inadequate treatment, because this type of melanoma is sometimes misdiagnosed as a seborrheic keratosis.

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A case of a 84-year-old man with malignant schwannoma of the right sole and the right thigh was reported. There was no family history of von Recklinghausen's disease. The tumor of the right sole had been excised twice during past two years before he visited our hospital. The reccurent tumors were firm, flesh-colored nodules of the right sole and a subcutaneuos nodule of the right thigh.
These tumors were predominantly composed of epithelioid cells with some spindle cell area. Some neoplastic cells had wavy, buckled nuclei. No abnormal mitotic figures were observed. There was no evidence of origin from the peripheral nerve. The neoplastic cells were positive for S-100 protein and negative for desmin.

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A-84-year-old male had noticed a small white mass on the left sole 3 months before, which progressively increased in size. So he visited our clinic for treatment of the tumor. The tumor was 7×7cm sized, red colored, dome shaped tumor. His past history was negative for neurofibromatosis. Surgical resection was performed 3-5cm apart from the margin of the lesion. The histopathological findings revealed neurofibrosarcoma. Eleven months after the treatment, he has no evidence of recurrence or metastasis. Neurofibrosarcoma is the least documented type of neoplasm found in the foot. So we report a rare case of neurofibrosarcoma on the left sole without neurofibromatosis.

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A 46-year-old man was referred to us because of a nodule of 20 years' duration on his lumbar region which gradually increased in size since several months ago. Axillary and inguinal lymph nodes were swollen. Microscopically, nests of tumor cells were not continuous to the epidermis. In the upper dermis, the tumor cells without anaplasia surrounded a large area of necrosis and tended to form luminal structures and whorls of squamoid cells. In the deeper portion of the dermis, the tumor cells possessed large, obviously atypical nuclei. A diagnosis of malignant transformation of intradermal acrospiroma was made. Soon after the tumor excision and lymph node dissection, a local recurrence and a lymph node metastasis to the supraclavicular region was noticed. In spite of radiation and combination chemotherapy, the patient died of metastases to multiple organs 7 months after admission.

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We reported a case of microcystic adnexal carcinoma occuring on the right upper lip of a 51-year-old man. Microscopically, small solid nests and strands of tumor were distributed throughout the whole dermis with infiltration into subcutaneous tissue. In the upper dermis, there were small cysts of varying size. In the middle dermis, there were small ductal structures or tadpole-shaped epithelial islands.
Immunohistochemically, CEA was focally positive some ductal structures. S-100 protein stain was negative. 34β E12 was positive in all three components of the tumors. 34 β H11 was moderately positive in some cysts and ductal structures. CA19-9 and EMA were positive in most cysts and ductal structures.
These observations confirm that this tumor appeared at least capable of eccrine sweat gland differentiation.

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We experienced a 32-year-old man with an apocrine adenocarcinoma of the skin presented as a subcutaneous tumor in the left axilla. The lesion was first noticed as a small subcutaneous tumor ten years ago and it has grown rapidly during the last year.
Histopathological examination revealed the structure as an adenocarcinoma which was composed of atypical cells with abundant eosinophilic cytoplasm and a figure of decapitation in a part of the tumor's mass. We have performed histochemistry, and the results showed PAS (+) (with resistance to diastase), CEA (-), S100 (-), EMA (+), GCDFP-15 (+) .
As the diagnosis of the tumor we suspected the most possibility with an apocrine adenocarcinoma of the skin and two other different diagnoses. One is skin metastasis of an adenocarcinoma from another organ and the other is an accessory brest cancer. The former was excluded because of no evidence of the internal lesion in physical examination. We also excluded the latter because that histologically normal mammary gland structure was abscent near the tumor in the secondarily resected tissue.

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A 88-year-old Japanese fisherman was referred to us with a nodule on his dorsum of the left hand with a history of 2 years. Histological examination revealed that well differentiated tumor cells with atypical nuclei invading through the almost entire dermis. Acantholysis as well as horn pearls were scattered within the tumor. Tumor was diagnosed as an actinic keratosis-derived squamous cell carcinoma (AK-SCC), T2N0M0, Stage II. Wide excision with 2 to 3cm margins was carried out for the primary tumor. Ten months later, a swelling of the axillary lymph node appeared, followed by pulmonary metastasis. The patient died about 2 years after the operation for the primary tumor.
Despite for the small size of tumor, AK-SCC on the dorsum of hand seems to develop easily metastasis into the axillary lymph node and the lung.

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A survey of malignant tumors was carried out by reviewing the outpatient records from 1986 to 1995 of the Department of Dermatology, Juntendo University Urayasu Hospital. Recorded malignant tumors included basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), Paget's disease and Bowen's disease.
1)The total number of patients with malignant tumors was 96 and the average incidence was 0.23%.
2) The age distribution of BCC peaked in those patients in their sixties, and peaks for SCC and Bowen's disease were in the seventies.
The male/female ratio of malignant skin tumor patients was 1:1 for BCC and SCC, and 1: 2.56 for Bowen's disease.
3)Our present study's site distribution of Bowen's disease, BCC and SCC resembled those of past reports in Japan between 1981 and 1995.
4) We compared our present study with Tada's statistical survey between 1971 and 1995. We found that the incidence of BCC, SCC and MM in our present study was less than that of Tada's statistical survey, especially with respect to SCC.
5) The average BCC/SCC ratio in nine hospitals in Japan was 1.67.

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A 62-year-old man visited our clinic for the treatment of a domeshaped tumor on his left frontal scalp. The histopathology of the biopsied lesion showed angiosarcoma. He was treated with surgical operation. 11 months later, the recurrence of the tumor from the center of the skin graft was observed. The recurrent lesion was treated with surgical operation and intralesional injection of recombinant interleukin 2 (rIL-2). There was no evidence of the local recurrence or metastasis during 18 months after the surgical excision. But iliac bone metastasis was noted with low back pain and confirmed by CT scan.
Metastatic bone lesion was treated by electron beam irradiation combined with systemic intravenous injection of rIL-2.
8 months later the patient died of respiratory failure. We guessed that the combination therapy of rIL-2 and surgical excision should improve the cure rate of angiosarcoma.

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Twelve cases of aneurysmal fibrous histiocytoma of the skin, from 7 male and 5 female patients with an age range of 24-65 years (mean: 38.5 years), are described. Anatomical distribution ; lower limb/limb girdle (6 cases), upper limb/limb girdle (4 cases) and trunk (2 cases) . Lesional size ranged from 0.2cm to 6cm (mean: 1.5cm) . Two patients noticed rapid growth in tumor size as well as tenderness.
Histologically, prominent blood-filled spaces were obserbed in the cellular area of the lesion. The spaces lacked an endothelial lining and were surrounded by the area with prominent deposition of hemosiderin pigments, numerous siderophages, and multinucleated giant cells with hyperchromatic nuclei. In seven cases (58%), in addition to the cellular area, fibrous area was observed in the periphery of the lesion. We presumed that, in adittion to repeated minor trauma, a mechanical stress to the cellular area from adjacent fibrous area might be another factor in the formation of blood-filled spaces in aneurysmal fibrous histiocytoma.

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Scalping flap is usually applied for reconstruction of medium-sized defects of scalp after excision of malignant skin tumors. In this report, we described the usefulness of scalping flap which was vascularized with both superficial temporal and posterior auricular vessels of the same side as the tumor. In addition, sensory nerves were well preserved in this flap. Two patients were presented with malignant skin tumors on their temporal area. The size of their defects were about 5cm in diameter. This flap is considered to be superior to that designed on the opposite side of the temporal area in the following points; easily rotated to cover the defect due to better elasticity, well-preserved sensibility, and the hair stream similar to the surrounding skin. Therefore, this approach improves the overall effectiveness of reconstruction of medium-sized defects on the temporal area, compared with other scalping flaps.

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Surgical excision of the scalp often produces many problems aesthetically and functionally in case the defect became large. Because of special characteristcs of this area; hairly, less elasticity of the skin, and easily injured, the reconstruction could be more difficult. We reported the reconstruction of squamous cell carcinoma (SCC) on the scalp with occipital V-Y flap. Two patients were shown with remarkable results.
Occipital flap based on occipital artery has the advantages of short operation time, with one stage, excellent texture matching with hair because of local flap. Moreover the donor defect can be closed primarily by V-Y advancement flap. Both patients already recovered, went out without hat or wig and were enjoying their life.

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We used an orbicularis oculi muscular pedicle musculocutaneous island flap to reconstruct the relatively large skin defect in the orbital region. In seven patients, the defect of the medial parts of the orbital region was covered by a medial island musculocutaneos flap. A lateral island flap repair to correct the defect of the lateral lower eye lid was used in three patients. These two flaps were outlined on the upper eye lid using the same incision line as rhitidectomy. The cosmetic results were exellent; but two patients reconstructed by a flap of more than 15mm looked open eyed.
This is the best method to recostruct both the medial orbital region and the lateral lower eye lid. Because the orbicularis cculi muscular pedicle musculocutaneous island flap is a thin flap and the same tissue as the orbital skin. It fits the concave medial orbital parts. Moreover, some blepharochalasis of elder patients were corrected after this operation.

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We reported a case of a 74-year-old male with pseudoglandular squamous cell carcinoma on the scrotum. An erythematous lesion was first noticed about ten years before visiting our clinic. During the enlargement of the erythematous lesion, several bean-sized nodules also occurred. A biopsied specimen from the nodular lesion showed many tubular lamina lined with several layer of epitheliums, histologically diagnosed as pseudoglandular squamous cell carcinoma. Histological finding of another specimen from the slightly erythematous hyperkeratotic lesion was compatible with Bowen's disease. For treatments, the whole skin of scrotum was excised surgically and a combined chemothrapy with carboplatin and fluorouracil was employed. Histological finding of Bowen's carcinoma was co-existed adjacent to that of pseudoglandular squamous cell carcinoma in the excised specimens. These findings suggest that the lesion of Bowen's disease may develop in the patterns of pseudoglandular squamous cell carcinoma and Bowen's carcinoma.

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While the survival rate of malignant tumor patients is recently improving along with progress in the medical care technology, the incidence of secondary cancer after the cure of the first cancer is also increasing because of the aging of patients. An increase in the incidence of malignant tumor of other organs in addition to primary malignant skin cancer has also been noted in my department. I report on the polyoncosis cases I experienced during the 2 years from January 1995 to December 1996.
Of the malignant skin tumor patients treated during the 2 years, polyoncosis was observed in 2 of the 3 patients with Paget disease and 5 of the 30 patients with squamous cell carcinoma. The types of duplicate cancers included lung cancer (3), gastric cancer (2), laryngeal cancer (2), hepatocelular carcionoma (1), prostate carcinoma (1) and multiple myeloma (1) . One patient had 3 cancers and another had 4 cancers. The age of patients ranged from 66 to 81 years old (mean 72.2 years old) .
A high healing ratio of malignant skin tumor can be obtained in many cases by considerably less invasive methods. On the other hand, radical invasion is needed to cure the malignant tumor of other organs, and the treatment method is restricted by various considerations including the age, lesion, progress of cancer, prognosis, general condition and the will of patient. In this regard, I try to communicate with the patient and his/her family, and obtain their understanding so that he/she can receive the treatment satisfactory to him/her.

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A patient of psoriasis vulgaris with triple cancers of squamous cell carcinoma, eccrine porocarcinoma and esophageal carcinoma was reported.
In literature, until now there are 14 reports of malignant skin tumor associate with psoriasis vulgaris, and all cases except one had carcinogenic factor, such as PUVA, Goeckerman therapy and arsenic medication. And 9 cases of reports had squamous cell carcinoma. Thus, our report is rare case because she had no carcinogenic factor and two malignant skin tumor including eccrine porocarcinoma presented.

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We reported a case of metastatic adenocarcinoma on the umbilicus in a 65-year-old man. He was referred to our hospital with a chief complaint of a painful node on the umbilicus. A biopsy specimen taken from the node revealed the atypical cell nests scattered in the skin ranging from the superficial dermis down to the fat tissue. The tumor cells formed glandular structures in various sizes. An endoscopic examination revealed gastric cancer of Borrmann typeIV which invaded the middle, upper and posterior of the stomach. These findings above mentioned suggest that the umbilical lesion represented metastasis from gastric cancer. We reviewed 80 cases of metastatic umbilical carcinomas and 32 cases of gastric cancer metastasized to the umbilicus that have been previously reported in the Japanese literature.

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A case of extramammary Paget's disease on the left axilla and genital region.
65-year-old man was visited to our department because of 8-year history of erythematous plaque and nodule on his genital region. Histological examination on his genital tumor revealed infiltration of Paget's cells into the dermis. A sample excised from left inguinal lymph nodes showed evidence of tumor cell involvement. And a sample excised from erythematous plaque on his left axilla revealed Paget's disease.
We also studied cases of extramammary Paget's disease in our department for about 5 years.

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We report a case of mammary Paget disease with non-invasive ductal carcinoma (comedo carcinoma) . The patient was reconstructed by de-epithelized transverse rectus abdominis musculocutaneous flap successfully and cosmetically.
A 49-year-old female showed the erosion with slight itching on her left nipple. On the pathological study of a skin biopsy, mammary Paget disease was diagnosed. Furthermore, it was expected that the lesion progressed to the intraductal region on the findings of the graphical studies. After resection of left mammary gland with left nipple and areola, the tissue defect was successfully reconstructed by de-epithelized transverse rectus abdominis musculocutaneous flap. On the pathological studies postoperatively, the intra mammary lesion was diagnosed as non-invasive ductal carcinoma.

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We report a case of an 88-year-old man with lentigo maligna melanoma. He noticed a blackish pigmented spot on his left mandibular angle twenty years ago. The lesion gradually enlarged reaching 5×3cm sized irregular pigmented patch expanding to his ear lobe. Two 1.6cm and 0.8cm sized nodules were also noted on the pigmented patch. An ulceration was noted on a large nodule. No palpable lmphnode was detected. Surgical resection of the lesion was carried out with 2cm-3cm wide margin. Lymphnode dessection and chemotherapy were not performed. Histological examination revealed a lentigo maligna melanoma with tumor thickness 7mm. A reverse transcription polymerase chain reaction (RT-PCR) was performed before the operation, detecting tyrosinase mRNA in the patient's blood. Total body examination disclosed that he had liver metastasis. The RT-PCR method for the detection of tyrosinase mRNA seems to be a useful tool for evaluation of melanoma with metastatic potential.

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We reported a case of 67-year-old man with malignant fibrous histiocytoma (MFH). He noticed a subcutaneous tumor on the right lateral lower leg three years ago. Tumor was totally excised by a primary physician about two years ago, and histological examination revealed the tumor to be MFH. The lesion recurred one year ago and he presented us on february 24, 1994. Physical examination revealed 45×45mm, well-demarcated, elastic hard, subcutaneous tumor with pain. A detailed evaluation showed no evidence of metastatic disease, however a invasion to the peroneus muscle was suggested. Surgical resection of the tumor was carried out along clinically 3cm normal skin margin, including peroneus longus, brevis and soleus.
Postoperative radiation therapy was performed before the reconstructive surgery for fear of microscopic subclinical residual tumor. The defect was reconstructed with a free LD flap. Two years and six months postoperatively, there has been no sign of recurrence. We think that the free flap transfer is useful for the defect after tumor excision.

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Statistical analysis was performed on the cases with stage II and III malignant melanoma in Yokohama City University School of Medicine. Survival rate was not affected by lymph node dissection on patients with stage II and III malignant melanoma using Kaplan-Meirer method. But 5-year survival rate and 10-year survival rate of patients with stage III, N1 malignant melanoma were slightly improved by lymph node dissection.

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A case of multiple calcifying epithelioma on upper arms and cheek.
10-year-old boy was visited to our department because of 2 weeks history of subcutoneous tumor on his right cheek, 6 months history of subcutoneous tumor on his left upper arm and 1-year history of subcutoneous tumor on his right upper arm. Excision specimens of these subcutoneous revealed typical calcifying epithelioma, that is, basaloid cells and goast cells were evident. Epidermal cyst was co-existed with the tumor on his right cheek.
We also studied cases of calcifying epithelioma in our department for about 5 years.

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A late phase II, multicenter clinical trial was conducted at 10 study sites nationwide in order to find the optimum dose and method of administration as well as to study the clinical effect of OH-6000 in patients with adult T cell leukemia (ATL) whose lesions were confined to the skin. In principle, OH-6000 was administered intramuscularly at a dose of 1-2×10⁶ IU once per day (5 times or more per week) for a period of 8 weeks or longer.
Of 22 cases eligible for analysis, 5 achieved complete response (CR) and 7 showed partial response (PR). Thus, the response rate was 54.5% (12/22) and the CR rate was 22.7% (5/22). The effect was continued for 171, 104, 1169, 50 and 335 days in the 5 cases that achieved CR.
A response was observed in 8 of 15 subjects who showed no response with a previous therapy such as steroid treatment, radiation therapy, chemotherapy, etc., among those which have been used up to now.
With respect to the safety, Pneumonia Interstitial following OH-6000 treatment was observed for the first time. Other adverse reactions included neutropenia, leukopenia, etc., and these were similar to the adverse reactions shown in the results reported in the previous studies.
Daily administration of 1×10⁶ IU of OH-6000 was considered to be appropriate. Administration of OH-6000 should be temporally suspended, or the drug should be given intermittently, or the dosage should be reduced when it is thought to be necessary.
From the above findings, it was evident that OH-6000 is highly useful clinically for patients with ATL whose lesions are confined to the skin, although some adverse reactions can be expected for which precautions may be required in administration.

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