We report a case of squamous cell carcinoma of the left leg caused by previous irradiation to the giant pigmented nevus. In treating skin cancers originated from radiation dermatitis, we think it is important to resect surrounding radiation dermatitis lesions as well as tumor itself.
Recent advances in the diagnosis and treatment of malignat melanoma were described in this review. Two newly developed instruments surely increase diagnostic accuracy and preoperative evaluation of primary lesions of malignant melanoma. One is epiluminescence microscopy using a dermatoscope or a videomicroscope, which gives us magnified features of various kinds of pigmented skin lesions. The other is high frequency sonography, which gives us information about tumor thickness of the primary lesions, the most important prognostic factor. Regarding treatment of melanoma, the concept of sentinel node biopsy may have great impact on the issues of elective lymph node dissection. Significance of interferon as a postoperative adjuvant therapy for high-risk patients was discussed. Recent data on the effects of the combination chemotherapy including tamoxifen and sequential biochemotherapy using IL-2 and interferon were briefly reviewed. Finally, several types of new treatment such as immuno-gene therapy based on the development of molecular biology was discussed.
As recent advances in the treatment of malignant melanoma, we described the experimental study of gene therapy and the clinical trials of anti-idiotypic monoclonal antibody. Firstly, IFN-β gene encapsulated liposome was used for vector in our study. Cultured human melanoma cell could produce IFN-β by transfection with human IFN-β gene in vitro. Moreover, growth inhibition of subcutaneously transplanted human melanoma cells was clearly shown by transfection with human IFN-β gene. These results suggest IFN-β is a promising candidate for gene therapy of melanoma. Secondly, we described the background of idiotype network and characterization of anti-idiotypic monoclonal antibody to anti-HMW-MAA mAb. Then we reviewed the clinical trials of anti-idiotypic mAb in the States. Finally, we summarized the frequency and the mechanism of HLA Class I down regulation in melanoma cells, since these results will give negative impact on the T-cell based immunotherapy.
We reported a total of 229 cases of malignant skin tumors that were pathologically diagnosed at the Department of Dermatology, Fujita Health University Hospital between January 1989 and June 1998. The incidence of malignant skin tumors was 0.73% of 31, 379 new patients during the period. The male versus female ratio was 1.17: 1. The commonest malignant skin tumors were squamous cell carcinomas (SCC) and which showed an increasing trend. The basal cell carcinomas (BCC) versus SCC ratio were 0.91, which resembled that of western Japan. We experienced 8 angiosarcomas. Among them 3 are alive during this period. They are all male patients who have been treated with interleukin 2.
In this study, six cases of Bowen's disease with clear cells and two cases of solar keratosis (bowenoid type) with clear cells were retrieved and analyzed immunohistochemically by the avidin-biotin-complex method, using a panel of monoclonal anti-keratin antibodies. In Bowen's disease, both tumor cells in conventional lesion and clear cells expressed differentiation specific keratin (CKs 1 and 10). Positive focal staining with antibodies against simple epithelial keratins (CKs 8, 18, and 19) or noncornifying stratified epithelial keratins (CKs 4 and 13) was noted in markedly stypical cells, but not in the other tumor cells including clear cells. With the antibodies 4.1.18 (CK 8) and 170.2.14 (CK 19) which recognized the outer most layer of the outer root sheath, any tumor cells except for above atypical cells failed to react. Furthermore, there was no difference in immunoreactivities between Bowen's disease and solar keratosis. Therefore, it is suggested that the presence of clear cells in Bowen's disease and solar keratosis may not indicate the follicular differentiation in those lesions.
A 41-year-old man developed thermal keratosis in an area of erythema ab igne on his left lower leg. The patient initially denied chronic exposure to heat sources. When questioned further, he admitted that he had warmed himself at an electric “kotatsu”, Japanese leg warmer with frame and coverlet, every winter in his school days. After a 1-month treatment with bleomycin sulfate ointment, the lesions of thermal keratosis completely cleared. To date, the patient has no evidence of recurrent disease.
We describe A 81-year-old woman with spindle cell squamous cell carcinoma (SCC) on the head, which arouse from old burn scars existing for 73 years. The tumor was an ulcerated nodule measuring 2.7×1.8×1.1cm in size. The tumor was surgically excised with a 1.5cm safety margin under general anesthesia. Histologically, the tumor was composed of atypical spindle cells which arranged in a storiform pattern. However, a direct transition from squamoid cells to spindle cells was observed. Immunohistochemical study revealed the positive expression of epithelial membrane antigen, keratin and involucrin in the squamoid cells. In contrast, involucrin was weakly positive in spindle cells.
Spontaneous regression of lentigo maligna melanoma (LMM) is well known to occur occasionally. We experienced a possible cass of LMM located from internal canthus to lower eyelid and a red-bean sized black-brown nodule at adjacent bulbar conjunctiva was also present. The apparent continuity was not found between two lesions. In addition, histological findings suggestive of spontaneous regression were not recognized. This discontinuity of two lesions is most possibly explained by spontaneous regression of LMM, although we did not prove clinical and histological continuity. The other possible explanations are that two lesions occurred separately, or that malignant melanoma of bulbar conjunctiva was due to intransit metastasis.
We report a case of superficial spreading melanoma with partial spontaneous regression. A 30-year-old man presented with a eight year-history of gradually enlarging brownish macule on his back. Five years ago, a part of the macule began to elevate and formed a papule. Simultaneously, the center of the macule began to regress. Histopathological observation of the papule showed that many nests of melanoma cells were found in the epidermis and the upper dermis. Intence infiltrations of inflammatory cells were found periphery to the tumor. The observations of the pigmented macule showed that atypical melanocytes were scattered in the basal cell layer and many lymphocytes were found in the upper dermis. The observation of the regressed lesion revealed dense inflammatory infiltrates composed mainly of lymphocytes and melanophages, and dermal fibrosis. Tumor thickness was 0.85mm. Accordingly, we diagnosed this case as a stage I melanoma. Immunohistological analysis of the macule showed that tumor cells were positive for both S-100 protein and HMB-45. Infiltrations of CD4+ and CD8+ cells were mainly detected around the foci of tumor cells, and more CD4+ cells than CD8+ cells were seen. It seems likely that T-cell immunity may have been involved in regression of the tumor.
We report a 15-year-old girl patient with malignant blue nevus occurring on the right hip. Physical examination showed a black, partly shiny, round, hemisphered, slightly erosive, bleeding and elastic hard tumor, which was 51×50×13mm in size, on the right hip and right inguinal lymph node swelling, which was 58×29mm in size. We initially diagnosed as nodular type of malignant melanoma. The relatively well-demrkated tumor and swallen lymph nodes were totally and widely removed and treated with pre-and post-operative chemotherapy. The lesion resulted in a histological diagnosios of malignant blue nevus. Immunohistrochemical studies showed positive reaction of malignant cells for s-100 and HMB-45. Serum 5-S-CD level is a good marker of prognosis for malignant blue nevus. We discuss cases of malignant blue nevus.
We report a case of malignant melanoma who survived for 5 years with multiple skin metastases. The patient was a 85-year-old female. She noticed black macula on her rt. sole in March 1993. The lesion was resected and rt. groin dissection was performed. Histological examination revealed malignant melanoma (MNtype pT3N1M0 Stage III), and she recieved DAV (DTIC, ACNU, VCR) therapy before and after the operation. On June 1994, after DAV therapy, we recognized in-transit metastasis on her rt. groin. At first, skin metastases were limitted to rt. lower leg, but slowley extended to 1t. lower leg, abdomen, chest, both thighs and 1t. knee. So skin metastases were resected frequentry and many kinds of chemotherapeutics were applied. As the metastases were limited to the skin and subcutaneous tissues, she has survived for 5 years.
We report a patient, a 67-year-old man, with clear cell sarcoma. The patient had the tumor on his left heel for 1 year. We widely excised the tumor and dissected the left inguinal lymphnodes. Histologically, the tumor cells were found in a mass in the dermis to subcutaneous adipose tissue. There was no connection with the overlying epidermis. Tumor cells showed large and clear or eosinophilic cytoplasm. Mitotic figures are commonly observed. These cells were positive for S-100protein, NSE, vimentin and PAS. He underwent chemotherapy with DTIC, ACNU and VCR accmpanied with topical injection of IFN-β for 6 times. The patient did not show evidence of relapse for 1 year.
We reported a case of 58-year-old woman of clear cell sarcoma on the lateral side of the left knee. About 8 years ago, she had a small verrucous tumor on the left knee and tumor was excised by a local doctor. Histological examination was not performed. She noticed a subcutaneous tumor on the lateral side of previous operation scar around December 1996. The tumor was excised by same doctor at July 1997. Histological examination, fibrous tissue septa divided the tumor into well-defined nests and groups of pale-staining tumor cells. Immnunohistochemically, The tumor was positive for S-100 protein but negative for HMB45 staining. The tumor reccurented on the same place at November 1997, the patient was referred to our department. At this time, tumor measured 2cm under the previous operation scar. We performed an extended excision and inguinal lymphonodes resection. Histologically, we got same findings. But immnunohistochemically, The tumor was partially positive for HMB45 staining. In electron microscopy, some melanosomes were found in tumor cells. Although it is difficult to distinguish between clear cell sarcoma and metastatic amelanotic melanoma, we diagnosed this tumor as clear cell sarcoma.
We report a case of malignant fibrous histiocytoma (MFH) on a digit. A 60-year old man had a rapidly growing, red tumor on his right index finger. Histopathological and immunohistochemical findings revealed that it was MFH and the finger was amputated.
We report a case of 59-year-old male with malignant schwannoma of the back associated with von Recklinghausen's disease. In 1995, the first surgical resection was performed. The tumor was diagnosed as cutaneus neurofibroma. But in 1997, the tumor rapidly recurred and the second resection was performed. The histopathological findings were consistent with malignant schwannoma. Six months after the second resection, he has no evidence of recurrence or metastasis.
A case of extramammary triple Paget's disease of perianal area and bilateral axilla is repored and discussed. A 66 year-old man was referred with the diagnosis of Paget's disease of perianal region, in which wide hypopigmeted lesion was observed around the half side of the anus. After making the temporary colostomy. We perfomed wide tumor excision and the full thickness skin graft for the anal duct and split shickness skin graft for the perianal area. During the procedure, some hypopigmented spots were found on left axilla, also the Paget's cells were identified later. Under the diagnosis of triple Paget's disease, the additional wide tumor excision was performed on both axilla. The postoperative result is good and the function of anal sphincter is satisfied.
A 70-years old man referred to our hospital complining of peni anal nodule was diagnosed as having an anal canal cancer. He had underwent transanal tumorectomy involving the skin lesion. The histological findings revealed that the tumor was poor-differenciated adenocarcinoma and pagetoid cells were found in the anal epidermis adjacent to the tumor. Pagetoidcells and anal canal tumor also stained positive for PAS. CEA. Alcian blue and cytokeratin20. This case was suspected of the intraepidermal invasion, socalled pagetoid spread, followed by anorectal carcinoma.
Mucinous carcinoma of the skin is a rare sweat-gland neoplasm with a tendency to recur, but metastases to regional lymph nodes and widespread metastases are uncommon. We experienced a case of mucinous carcinoma of the skin in the axilla with metastases to the axillary lymph nodes. A 69-year-old man had a 2-year history of a slowly growing papule on the left axilla. Physical examination revealed a dark purple-red, elastic hard, dome-shaped tumor with 7.5×6×1.5cm, on the left axilla. The tumor with left axillary lymph nodes were totally excised. Histopathology revealed small islands of tumor cells floating in large pools of mucin, separated by thin fibrovascular septa. The patient had no recurrence after 1 year, however, CT scan revealed several small lesions in the lungs considered as metastases of mucinous carcinoma.
We reported a case of mucoepithelioid carcinoma arising from a minor salivary gland in the lower lip. A 44-year-old woman presented at local medical doctor, because of a mass in the lower lip. Histopathological diagnosis of a mucoepithelioid carcinoma was made on examination of a biopsy specimen. Then, she was presented to our clinic. There was a white submucosal tumor measuring 15mm in diameter, in the lower lip. The tumor was excised with a 5mm safety margin. A microscopic examination of the tumor revealed mucous, epidermoid and intermediate cells. The most common location is the parotid gland in the major salivary glands and the palate in the minor salivary glands. She is followed by taking 5-FU internally now.
We reported a case of merkel cell carcinoma (MCC) admixed with squamous cell carcinoma (SCC). The patient was a 82-year-old women who developed a red, domeshaped tumor, 18mm in diameter, on her left cheek. Histologically the tumor showed undifferentiated small cell malignant neoplasm that coexisted with SCC. Sweat gland differenciation was shown in a part of SCC. An immunohistochemical study showed that MCC was positive for neuron specific enolase and synaptophysin, SCC was positive for carcinoembryonic antigen and cytokeratin 20. An ultra-structual study showed dense core granules within the cytoplasm of MCC.
We describe a case of Merkel cell carcinoma which took an unusual pattern of metastasis. An 80-year-old man presented with a recurrent tumor on his pubic region accompanied with right inguinal lymph node swelling. In spite of wide local excision and bilateral inguinal lymph node dissection, he died of disseminated intravenous coagulation one month after the operation. Autopsy revealed marked enlargement of the liver Histologic examination revealed massive metastasis in multiple organs, including liver, lung, pancreas, spleen and bone marrow. In the liver, tumor cells diffusely infiltrated, forming extremely small nests. Such metastatic lesions could not be detected by CT scan performed a few days prior to death, while an ultrasound scan of the liver at that time disclosed numerous hyperechoic micronodules.