Cutaneous metastasis from renal cell carcinoma is unusual. Cutaneous metastasis is considered as a late manifestation. On rare case it may represent the initial presentation of renal cell carcinoma.
We report a case of 57-year-old male renal cell carcinoma patient with skin metastasis. He noticed his cutaneous lesion on his scalp about 7 months before visiting our hospital. The lesion enlarged and he gradually felt abdominal pain and dyspnea. From the result of pathological examination and abdominal ultrasonography, the metastasis from renal cell carcinoma was suggested. The disease progressed rapidly and he died of respiratory failure 11 days after first visiting our hospital.
We review the case reports about renal cell carcinoma patients with skin metastases in recent 10 years in Japan.

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A34-year-old woman had a brown-red nodule (8×7mm) surrounded by brownish macule (14×11mm) on her right lower leg. Histologically in the nodule, there were atypical melanocytes proliferated as solitary unit or in nests thorought the dermis, it showed many features of a Spitz nevus. However in the pigmented lesion atypical melanocytes proliferated mainly solitary in the epidermis, we considered it melanoma in situ.
Therefore we diagnosed the tumor as malignant melanoma and performed a wide resection and chemotherapy.

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We report a case of extramammary Paget's disease, representing a swollen left leg with reddish maculae on the thigh after resection of primary lesion on scrotum. Histologically, this lesion revealed the lymph duct's ectasis containing the mass of aggregated tumor cells, which were positive by immunohistochemical staining using PAS+Alucian blue, anti-CEA, and anti-c-erbB-2 antibodies. These were compatible with those of Paget's disease. Clinical appearance and histological findings of reddish lesion seen in this patient might be one of the characteristics of metastasis and infiltration of Paget's cells to lymph ducts.

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A case of two malignant melanoma as developed on the right cheek and lower eyelid was reported. A 57-year-old man had a black nodule, 13mm in diameter, on the center of his cheek. Histopathology revealed a malignant melanoma, nodular type, Clark's level IV, 3.8mm in thickness. No metastasis was found. The wide excision, skin graft and chemotherapy plus topical injection of IFN-β were done.
Two years later, he found another black nodule, 3.5mm in diameter, on a right lower eyelid. Histology showed many melanoma cells within the epidermis, and a small number of tumor cells was present in papillary dermis. Besides, the epidermis was acanthotic, and many lymphocytes infiltrated around the tumor. After the differential diagnosis from epidermotropically metastatic malignant melanoma, this case was diagnosed as multiple malignant melanoma on face.

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We attemped a chemohormonal therapy with dacarbazine, nimustine hydrochloride, cisplatin, and an anti-estrogen agent tamoxifen (DAC-Tam therapy) in a patient with stageIV melanoma.
After 4 courses of the therapy, skin, lymph node and lung metastasis disappeared or markedly decreased in size. However, imperception of legs followed by rapidly ascending paralysis of lower extremities appeared due to massive spinal metastasis. The patient died 6 months after initiation of the treatment.
Although chemohormonal therapy using tamoxifen is effective for melanoma metastasis, central nervous system reccurence seems to be a major obstacle.

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We report two cases with Squamous Cell Carcinoma (SCC) in situ caused by irradiation to hand eczemas, resisitant to any topical therapies.
Both of our cases clinically show palmer sclerosis and flexor restriction of the fingers, compatible to chronic radiation dermatitis. Although SCC arising in chronic radiation dermatitis is usually developed ten to twenty years after irradiation, in our cases SCC were found more than forty years after irradiation.

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We reported a cace of a 61-year-old man with squamous cell carcinoma (SCC) on the external ear, which metastasized to the parotid lymph node, although the tumor was 2cm in diameter at an elrly stage. During past 10 years, we have experienced 13 patients with SCC on the external ear. All patients were male with a mean age of 76.8 years. The tumor were located mostly on the helix. Two patients developed lymph nodes metastasis, but no distal metastasis. SCC of the external ear is an aggressive cancer with higher metasiatic rates than cutaneous SCC as seen in other parts of the body. Poor prognotic facters included specific growth pattern and perineural invasion.

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We report on the case of a 65-year-old man with basal cell carcinoma (BCC). He had noticed a wound on the right side of his chin about one and a half years before. We diagnosed it incorrectly as eczema at his first visit. Seven months later the patient revisited our outpatient clinic. He had a poorly demarcated plaque on his right chin and also had a small black nodule on his right cheek. Both lesions were excised and histopathological analysis confirmed him to have BCC.
A total of 108 BCCs in 97 patients (51 males and 46 females) were treated over a period of 12 years from 1985 to 1996 in the Department of Dermatology, Nippon Medical School Hospital. 1) Approximately 0.11 % of all the outpatients had BCC. 2) The age of these patients ranged from 18 to 89 years and the age peak was in the 6th decades in both sexes. 3) Approximately 77 % of the carcinomas developed on the head, face and neck. 4) A solid-type BCC was observed in 80 % of cases. 5) Nine cases (10.5 %) that were initially diagnosed as other tumors proved to be BCC upon histopathological examination.

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We encoutered 32 patients with organoid nevus in a 5 year period (1992-1996) at Prefectural Nobeoka Hospital. Six patients among these had secondary tumor originated on the organoid nevus. The patients comprised 4 men and 2 women (mean age ; 43.8years).
We reported two cases of basal cell epithelioma originated on the organoid nevus. Case 1: A 62-year-old man with a verrucous tumor on the alopetia measuring 28×15mm on the occipital region. Case 2: A 62-year-old woman with a black nodule measuring 20×20mm on the alopetia measuring 40×25mm on the temporal region. Surgical resections of these tumors were perfomed, and the lesions were pathologically diagnosed as basal cell epithelioma.

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We report a case of malignant melanoma in the right conjunctiva and osteosarcoma on the right lower leg with Werner's syndrome.
He has several symptoms typical to Werner's syndrome. He received the right leg amputation for osteosarcoma at the age of 50-year-old. He became aware of a black tumor in the right conjunctiva. Histopathological examination of these two tumors revealed typical osteosarcoma and melanoma, respectively. Although, sixty-nine multiple carcinomas including melanoma have been reported only two patients who have osteosarcoma and melanoma were reported, as cases associated with Werner's syndrome.

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A 80-year-old man occured with squamous cell carcinoma, basal cell carcinoma and solar keratosis is reported. He had a 16×14mm sized nodule on his left hand, two black papules, 6×7mm and 3×4mm, on his nose and hyperkeratotic pigmented macules on his scalp. Histpathologically, the tumor on the hand showed hyperkeratosis, papillomatosis and acanthosis with atypical squamoid cells. They contained many individual cell keratinization and mitotic figures. Both papules on the nose were composed with basaloid tumor cell nests. The peripheral cell layer of the nests showed palisade arrangement of the nuclei. The macule on the scalp showed hyperkeratosis, parakeratosis and cellular atypicality in the basal cell layer. The upper dermis showed inflammatory cell infiltration and solar degeneration. The occurrence of squamous cell carcinoma, basal cell carcinoma and solar keratosis in one person seems to be rare.

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We reported 30 cases of genitary Paget's disease which were admitted to Saitama Cancer Center from 1983 to 1997. The male and female ratio was 3:1. The average age of 30 cases was 69.4 years old. Skin manifestation of 23 cases were erosive erythematous lesions, 4 cases had nodular lesions, 2 cases had vitiligo-like lesions. We categorized 30 cases into stages in according to Oohara TNM classifications. The number of cases in each stages were Stage I: 16 cases, Stage II: 8 cases, Stage III: 2 cases, Stage IV: 4 cases. All stage I-III patients were alive by surgery alone, instead all stage IV patients died. The necessity of prophylactic lymphonode dissection of T3 patients was discussed. Also, we suggested the efficacy of 2cm surgical margins of genitary Paget's disease.

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We present 79-year-old man in whom bilateral axillary Paget's disease developed 19 years after the operation of genital Paget's disease. In our experience of 161 extramammary Paget's disease, 8 cases are diagnosed as double or triple Paget's disease. In 5 cases, we found multiple lesions at their first visit. In 3 cases, axillary lesion revealed during follow up period. Long dormancy in this case suggests multicentric and independent occurrence of double or triple Paget's disease.

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Two cases of malignant hidroacanthoma simplex are reported. The first case was a 73-year-old man with a tumor on his left thigh of six months duration. The tumor was brown black keratotic, measuring 1.0×1.0cm. The other case was a 86-year-old man with a tumor on his back of four months duration. The tumor formed a grouped, red papular lesion measuring 1.5×1.5cm. On histological examination, the tumors in both cases showed a well-defined, intraepidermal nest formed by small, cuboidal cells. Some of the cells had atypical nuclei and abundant cytoplasm, but dermal invasion of the cells was not seen. The epidermis was acanthotic and hyperkeratotic. Differentiation of the tumor cells to small ductal structures and cystic areas were also seen in both cases.

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We report three cases of eccrine porocarcinoma seen at our hospital.
Case 1: A 77-year-old female had a 40×35 mm clearly-demarcated erythema on the lateral aspect of her left thigh, with a 15×17 mm region of erosion in its center. The lesion was locally excised deeply to the fascia, and circumferentially to a distance of 3cm beyond the tumor margin. Histopathologically, the lesion was diagnosed as an eccrine porocarcinoma. Swelling of the inguinal lymph nodes was observed at 14 months after surgery, and lymph node dissection was performed. Two years have now elapsed since the original surgery, and no recurrence or metastasis has been observed.
Case 2: A 74-year-old female had a black-brown swelling of about 12×10 mm with an irregular surface on the medial side of the left lower eyelid. A basal cell epithelioma was suspected, and the lesion was excised circumferentially to a distance of 5 mm from the tumor margin. Histopathologically, the lesion was diagnosed as an eccrine porocarcinoma. At present, two years after surgery, no recurrence or metastasis has been observed.
Case 3: A 70-year-old female had a slightly prominent, 13×8 mm, red plaque with a central erosion on the posterior aspect of her left leg. The lesion was excised deeply to the fascia, and circumferentially to a distance of 3 cm from the tumor margin. At present, 27 months after surgery, no recurrence or metastasis has been observed. Histologically, all lesions showed clearly demarcated encapsulated nests, the tumor cells were dysplastic, there was no tendency for keratinization, and ductal structures were observed in the tumor foci.

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Eccrine porocarcinoma is a rare neoplasma which differentiates toward intraepidermal eccrine sweat duct. We experienced a 73-year-old man who suffered from a tumor on the right forearm. The tumor was 95×76×60mm in size, dark red and pedunculated, and had been growing slowly in the last 40 years. Histopathological findings showed the irregularly outlined nests which were continuous to the epidermis. The tumor cells had atypical nuclei and clear cytoplasms. The clear cells were partially vacuolated. In addition to ductal and cystic structures, cuticle formation was also present.
Wide local excision and lymph node dissections of antecubital and axillary areas were performed, and postoperative adjuvant radiation was added to the regional lymph node areas. However, 1.5 years later after operation, he died of lung metastasis.

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We report on a 47-year-old Japanese female with Bednar tumor (pigmented dermatofibrosarcoma protuberans) on the right shoulder. Clinically, the lesions were composed of a reddish multilobular, firm nodule which had recurred after surgical treatment 40 years ago, and a black plaque with induration beneath the previous surgical site. Histopathologically, both of lesions were characterized by a proliferation of spindle-shaped cells arranged in a tight storiform pattern, admixed with a small population of melanin-containing dendritic cells. Two types of cells in the tumor were identifiable also by an electron microscopy. The majority of tumor cells resembled fibroblasts charaterized by blongated cytoplasm with developed rough endoplasmic reticula and irregularly shaped nuclei. The other type of cells possessed both melanosomes and premelanosomes, suggesting that the cells have an ability of melanogenesis. Immunohistochemically, most of spindle-shaped cells were positive for CD34 and negative for Factor XIIIa and S-100 protein. The melanin-containing dendritic cells were positive for S-100 protein. There were clusters of Factor XIIIa positive cells adjacent to the melanin-containing dendritic cells. These findings suggest that the melanin-containing dendritic cells may not derived from spindle-shaped cells, and that the Factor XIIIa positive cells may affect the function or activity of the melanin-containing dendritic cells.

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A 52-year-old male patient with adenocarcinoma on the lower abdomen is reported. The tumor had occurred 10 years previously followed by a new nodule next to it, a year ago. The surface of the original tumor is papillomatous, flatly-raised in shape, and the color is brown, while the surface of the new nodule is smooth, hemispheric in shape, and the color is red. He also had metastatic lesions of bilateral inguinal, iliac, and paraaortic lymph nodes. Survey of internal organs did not disclose any malignant lesions and the resection of the tumors and the dissection of the lymph nodes were performed.
Histologically, numerous nests of tumor cells were found in the dermis with a small number of the tumor cells in the epidermis. Furthermore, the Indian filing of tumor cells was found occasionally in the dermis. The inflammatory cells around the tumor nests were scarcely.
The metastatic adenocarcinoma was suspected from the histological findings. However, we concluded that this tumor was cutaneous origin, probably apoeccrine gland origin, mainly due to the long clinical course and the lack of internal malignancies.

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A 75-year-old woman had a nodule on her cheek. Histopathological examination revealed lobular proliferaton of clear cells in the center and basaloid in the peripheral area of the tumor. The clear cells were PAS positive, diastase sensitive. The basaloid cells showed palisading. Tumor cells were CEA (-) S-100 (-) . Nuclear atypio was seen. We diagnosed it as a malignant trichilemmoma.
Immunohistochemical stining using various monoclonal anticytokeratin antibodies with formalin-fixed and paraffin-embedded block specimans was performed. All the tumor cells were positive to simple epithelial cytokeratin such as CK8, 18. Clear cells were positive to differentiated stratified epithelial cytokeratin such as CK1, and simple epithelial cytokeratin CK19. Staining pattern was different from epidemis, but similar to outer root sheath between is thmus and infundidulum.

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The case of a 84-year-old Japanese female with acral lentiginous melanoma in situ is reported. The patient noticed a pigmented plaque ten months ago. At the first visit to our clinic, a 4×2cm-sized, irregulary shaped and pigmented plaque with color variegation from black to light brown was observed on the sole of her right foot. The lesion was totally excised with an approximate 1cm safety margin. We did not cover the surgical defect with a skin flap, but applied artificial dermis “Terdermis ® ”.
Histopathologic findings showed pagetoid arrangements of round and oval atypical melanocytes proliferating mainly in lower epidermis. However, atypical melanocytes were absent in upper dermis. Patients with malignant melanoma in situ can be treated by the excision of the lesion with a narrow margin. We performed a full thickness skin graft on the artificial dermis to close the surgical defect after the determination of the diagnosis of ALM in situ. The patient had no difficulty in walking after the operation.
Thus, we obtained satisfactory results owing to the application of the two-step operation.

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A 15-year-old boy developed a gray-black macule on his right sole. Its size was 12×5mm and there was a verrucous point at the center of the lesion when he first visited our hospital. Moreover, the lesion showed slight color-and border-irregularity. Histopathologically, the lesion is almost symmetrical in shape and well demarcated. The tumor cells are almost epitheloid with large nuclei and larger in size than ordinary nevus cells. The tumor cell nests exist in the epidermal-dermal junction through the lower dermis. Maturation of cells is poorly recognized. However, some eosinophilic globules are recognized and there is little inflammatory-cell-infiltration around the nests. Immunohistochemically. HMB-45 antibody demonstrates positive especially at deeper nests and S-100 protein strongly demonstrates positive. Fluorescence microscopy of an unstained specimen demonstrates almost negative. The tissue level of 5-S-cysteinyldopa was 77.1ng/mg. Cellular DNA content is 2.68C which is higher than that of Spitz nevus reported before. The number of aneuploid cells are more than that in usual Spitz nevus reported before. The number of aneuploid cells are more than that in usual Spitz nevus. However, from the histopathological findings especially its symmetrical shape, we diagnosed this lesion as Spitz nevus, although it is important to continue careful follow-up study for this case.

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A case of cellular blue nevus is reported. The patient is a 12-year-old Japanese girl. When she was born her mother noticed a blue spot on her buttock of the right side. Since the mother considered the spot as a mongolian spot, the patient had not been consulted any doctors until the patient noticed a subcutaneous nodule at the center of the lesion. Pathological diagnosis was cellular blue nevus. Epidermal melanocytes were intact. Although the nuclei of the dermal melanocytes were large, no atypical mitosis was found. Necrotic foci were not seen. Thus we diagnosed the lesion benign.

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A case of a 28-year-old pregnant woman with malignant melanoma was reported. She had black tumor from childhood, and the tumor was getting bigger associated with her pregnancy. We resected the tumor and confirmed the histological diagnosis of malignant melanoma. After artificial abortion, she underwent subtotal integmentectomy and lymph node disection and chemotherapy. We also analyzed 11 malignant melanoma cases associated with pregnancy from our department data file.

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Invasive malignant skin tumor on eyelid have to be performed wide excision included palpebral skin, palpebral conjunctiva, tarsal plate and other adnexal tissues. In such cases, functional and aesthetical reconstruction are needed.
Palpebral conjunctiva is usually reconstruction by using oral mucosal graft, nasal septum muco-chondrol graft and hard palatal mucosal graft. Oral mucosal graft can be contruction easily. Nasal septum muco-chondrol graft is harvested difficult and have a risk of perforation of nasal septum. Palatal mucosal graft is able to just fitting to the curve of eye ball, have a possibility of suspension for lower lid.
We believe that palatal mucosal graft is a best choice of the material for reconstraction of palpebral conjunctiva after resection of lid malignant tumor.

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We report 11 cases of dermatofibrosarcoma protuberans (DFSP) . A mean follow up period is 2 years and 6 months with a range of 5 months to 6 years 2 months.
4 patients were males and 7 patients were females. The average age was 35.4 years. The youngest was 16 years old girl and the oldest was 67 years old women. Tumors had from 4 month to 15 years clinical course. The tumor size ranged from 5×4mm to 8×4.5×3cm. The location of the tumor were two head and neck regions, two arms, six trunks and one thigh. Two patients had experienced bruise before the ocurrence of the tumor.
All patients were treated surgically. We excised the tumors widely. No recurrence was seen in all cases under the follow up period of 5 months to 6 years.

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We reported a cas of a 60-year-old man with adenoid cystic carcinoma (ACC).
The patient had tumor on the jow, noticed form 3 month ago. The findings of histopathology at simple excision was a typical picture of ACC.
The tumor cells persented three distinct patterns : cribrif orm, tubular, solid.
The result of immunohistochemical study were as follows, S-100 protein (+), EMA (+), CEA (+) .
We think that primary lesion of ACC was esophargus and we could find multiple metastasis at skin, brain, lung and liver.

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Dermatofibrosarcoma are seen as protuberant nodules in the skin.
We report a 39-year-old male with a dermatofibrosarcoma protuberans showing a depressed lesion on his right shoulder.
Histopathologically, the thickness of the dermis and the fat is reduced to less than 50% of the surrounding dermis and fat. The tumor was composed of uniform fibroblast-like spindle cells arranged in a storiform pattern and pigmented dendritic cells. Immunohistochemical examination revealed that tumor cells were positive for vimentin and CD34.

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We report a case of a 26-year-old man suffering von Recklinghausen's disease associated with multiple malignant shcwannomas of various malignant potency. In 1986, two malignant tumors over 5 cm in diameter in the postperitoneal space were resected. In 1995, a rapidly growing tumor appeared on his left thigh and reached an adult head size. Besides, CT scan revealed two fistsized tumors in the abdominal cavity. The left thigh was amputated at the level of hip joint. Four months later, multiple metastatic tumors appeared in the lung and the patient died 10 months after the amputation due to rapid enlargement of these metastatic tumors. Four tumors, developed in the post-peritoneal space and the abdominal cavity in 1986 and 1995, grew slowly and showed histologically a low grade of malignancy with low mitotic rates, whereas the tumor on the thigh and metastatic lung tumors, both of which rapidly increased in size, showed frequent mitotic figures and high cellularity. Thus, histologic grades of malignancies well correlated with clinical behaviors of the tumors in this patient.

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The nuclear DNA content of 47 primary malignant melanomas was measured by DAPI (4', 6-diamidino-2-phenylindole) -DNA microfluorometry and mean of the nuclear DNA content (DNA index: DI), standard deviation (SD), coefficient of variation (CV) were calculated. The Kaplan-Meier life table method revealed that the DI and the SD significantly correlated with the patient survival. A Cox proportional hazards multivariate analysis demonstrated that the relative death rate of the SD was 5.2, but it lost the significance when the DI was applied to the model. Since the correlation coefficient between the DI and the SD was high (0.835), the SD was a dependent variable on the DI. To evaluate nuclear DNA content as a simple value, the DI is the most useful among the three.

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We reported two cases of malignant hemangioendothelioma (MHE) . Case 1 was a 84-year-old female patient who had dark red or purple plaque, 18×14mm in diameter on her parietal region. The lesion was excised, and recombinant interleukin 2 (rIL-2) applied topically. At 15 months after the operation, she expired due to lung metastases. Case 2 was a 78-year-old male patient who had palm-sized dark red plaque with several nodules and ulcers. In spite of combination of wide resection and topical rIL-2 injectiion, he expired 2 months later.

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We reported a case of an 80-year-old woman with angiosarcoma on the abdomen. She had received a subwide-range total hysterectomy and postoperative irradiation at age of 72 for the uterin cancer. She noticed a subcutaneus induration on the abdomen since then. She was referred to us for a red black tumor on the induration of three months duration. Total resection of the tumor, irradiation and immunochemotherapy with IL-2 were performed under the diagnosis of angiosarcoma. Nine months later, two tumors as same as the first one recurred near by the primary lesion. Irradiation and immunotherapy had some good effect to reducing the size of the tumors. We speculated that the healing process of endthelial cells after irradiation damages might be related to the occurrence of angiosarcoma.

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A case of primary cutaneous CD30 (Ki-1)-positive lymphoproliferative disorder associated with destructive tumor in the C₁ vertebral body was described. A 50year-old Japanese man who had multiple red papules on his trunk and extremities for 2 years developed an ulcerated tumor measuring 65×48 mm on his left calf. Histological examination of the tumor showed a polymorphous cell infiltrate containing a considerable number of anaplastic large cells. Immunohistochemically the anaplastic large cells showed CD30 (Ki-1)-positive staining. The histological examination of the red papules showed different findings depending on the time of biopsy. First specimen taken from his right forearm on the admission showed perivascular mild mononuclear cell infiltrates. Second specimen taken from his left forearm 1 year later showed a polymorphous cell infiltrate including anaplastic large cells. The specimen obtained from ulcerated tumor showed a clonal gene rearrangement in a β chain of the T-cell antigen receptor genes. Shortly after the admission, the patient had right neck pain. Radiographs, CT, MRI examinations revealed a tumor mass which destructed the right C₁ vertebral body. Both neck and leg tumors responded well to radiation and chemotherapy.

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A sixty-year-old male with pagetoid Bowen's disease is reported. A reddish-brown plaque of 35×40mm was noticed on his left lower leg about 3 years previously. Brown or black thick scales were present at the center of the plaque. Light microscopy of the biopsy lesion taken from the plaque by a practicing doctor revealed large pagetoid cells within the hypertrophic epidermis. The atypical and clear pagetoid cells suggested the diagnosis of extramammary Paget's disease, pagetoid melanoma or pagetoid Bowen's disease.
Immunohistochemical studies; the pagetoid cells were positively stained with keratin but negatively stained with S-100 protein, or carcinoembryonic antigen. We therefore, diagnosed the lesion as pagetoid Bowen's disease. When examined the excised specimen, the center of the lesion showed the features of typical Bowen's disease. However, pagetoid cells were present at the margin of the lesion. Electron microscopically, aggregated tonofilaments were observed around the nuclei of the pagetoid cells: the cells showed the feature of atypical keratinization.

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A 25-year-old man visited our clinic with complaint of a rapidly enlarging tumor on the right lower back. The tumor was tender, firm, and measured 15×10×4cm. Histological examination of the biopsy specimen revealed a subcutaneous tumor composed of compact nests of atypical clear cells. Rosette was not detected. Immunohistochemically, the tumor cells expressed NSF, S-100 protein and vimentin. Clear cell sarcoma was suspected from these histological findings. Following 9 cycles of chemotherapy, he underwent radical excision of the tumor. The tumor of the excised specimen proved to be composed of small round cells that formed Homer-Wright rosettes. Ultrastructurally, interdigitating cytoplasmic processes containing dense core granules were observed, which established the diagnosis of PNET. In spite of additional chemotherapy and radiotherapy, he died with multiple metastases to the lung 5 months after excision.
PNET is a highly aggressive neurogenic tumor that affects the central and sympathetic nervous system and soft tissues. Although PNETs are usually small round cell tumors, present case demonstrated that they may show histological features of clear cell tumor.

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