Skin Cancer

¹⁰B-p-ボロノフェニルアラニンによる¹⁰Bのメラノーマ細胞への取り込みとその集積機構

吉野和夫, 三嶋豊, 木村基哲, 伊藤祥輔, 本田千博

1998 年 13 巻 1 号 p. 8-11
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.8

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We have demonstrated the selective accumulation of ¹⁰B in melanoma after administration of p-Boronophenylalanine (BPA) -fructose complex into melanoma-bearing subjects. And, based on 11B-NMR mesurements, we have proposed the selective uptake and release mechanism of ¹⁰B in melanoma by complex formation of BPA with DOPA and decomposition of the complex to boric acid. We have further investigated the interaction of BPA with melanin monomers, DHICA and DHI by ¹¹B-NMR. The obtained ¹¹B-NMR spectra of BPA-DHICA and BPA-DHI mixed solutions clearly show the signals of both BPA-DHICA and BPA-DHI complexes. These findings support our proposed mechanism that BPA is captured in melanoma cells through their synthesized melanin monomers.

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旭川医科大学皮膚科における乳房外Paget病の統計的観察

浅野一弘, 深見洋一, 田村俊哉, 高橋英俊, 山本明美, 橋本喜夫, 飯塚一

1998 年 13 巻 1 号 p. 12-17
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.12

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A statistical survey of 27 patients with extramammary Paget's disease (EMPD) seen at Depertment of Dermatology, Asahikawa Medical Collage, between Nov 1976 and Oct. 1995 is reported. The frequency of EMPD among malignant skin tumors was 2.4%. The male/female ratio was 3.5: 1. The average age of the patients was 68.3 years old. The EMPD was mostly located on the genital area (22 cases) . Other locations were 1 on the axilla, 1 in the anal region, 1 on the both genital area and anal region, and 2 on the both genital area and axilla. Clinically, 5 cases (18.5%) showed tumor formation. Two cases (7.4%) had inguinal lymph node metastasis and one (3.7%) showed distant metastasis. Most of the patients were treated by surgical excision with satisfactory results. Lymph node dissection was performed on 9 cases. Concomitant malignancies were detected in other organs in 7 cases (25.9%) .

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癌告知およびインフォームド・コンセントについて

山本明史

1998 年 13 巻 1 号 p. 18-21
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.18

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Informed consent in cancer patients should be discussed presupposing notice of cancer to patients. At National Cancer Center Hospital, it is not already at the stage of discussing whether notice should be given to patients or not, but now at a time to consider in what way notice should be given and patients be then cared and followed. However, there is a criticism against informing the fact just as it is.
Under these circumstances, the psychiatrist of National Cancer Center Hospital made a manual on basic attitude in notice of cancer and Dermatology Division follows it in notifying cancer to patients. As the next step, informed consent on examination and treatment methods should be considered. Persuasive informed consent for patients and, as the result, their good reliance on physicians and nurses and positive intention to tackle with the treatment will be important to improve therapeutic results.

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Pseudoepitheliomatous hyperplasiaを伴った舌扁平上皮癌の1例

中島英貴, 広瀬康昭, 池田光徳, 山本康生, 小玉肇

1998 年 13 巻 1 号 p. 22-26
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.22

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A 52-year-old man with squamous cell carcinoma (SCC) complicated with pseudoepitheliomatous hyperplasia on the tongue is reported. Six times biopsies obtained from the tumors of the dorsal aspect of the tongue revealed no malignant changes in the hypertrophic epidermis. Histological findings of lichen planus were observed on a part of the tumors. Dental crowns containing patch test-positive mercury were irritating the ulcerating portion of the tumors. Serum SCC antigen level was elevated. The tumors regressed by administration of etretinete, but serum SCC antigen level was unchanged. After stopping the administration, the tumors proliferated again. Histological findings of SCC were observed in a biopsy sample obtained from the floor of the tongue. Serum SCC antigen was decreased after the tumors were resected. Lichen planus or irritations by dental crowns might have caused the SCC. Tongue carcinoma preferentially appears on the side and floor of the tongue. We have to be nervous to the biopsy site of tongue tumors.

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血清CEAが高値を示したeccrine porocarcinomaの1例

松本和也, 浦野芳夫, 中西秀樹, 大浦一, 榊哲彦, 久保宜明, 沫田由美子, 田中伸二, 荒瀬誠治

1998 年 13 巻 1 号 p. 27-31
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.27

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A 71-year-old Japanese man was seen in May 1995 with a 3-year history of a tumor developing on his left cheek. Although he had the tumor excised in 1994 by a local doctor, it locally recurred and enlarged to a 3×3cm, domeshaped tumor. After a diagnosis of eccrine porocarcinoma was made on the basis of clinical and histological findings, excision of the tumor with 3cm of margin was performed together with superficial lobectomy of the left parotid gland and left radical neck dissection. The expression of carcinoembryonic antigen (CEA) was immunohistochemically observed in the cytoplasm of tumor cells. A serum level of CEA was elevated to 10.3ng/ml (normal, <5ng/ml) before surgery and returned to normal after surgery. CEA levels remained normal and there was no evidence of local recurrence or metastasis 2 years after surgery. Serum CEA may be used as a tumor marker of eccrine porocarcinoma in some cases.

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臨床的浸潤範囲と組織学的浸潤範囲に大きな差が認められたMicrocystic adnexal carcinomaの1例

川畑久, 瀬戸山充, 西正行, 寺崎健治朗, 山口圭子, 島田英彦, 東裕子, 大竹直樹, 神埼保, 下稲葉耕作

1998 年 13 巻 1 号 p. 32-36
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.32

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A 51-year-old male was referred to our clinic in November, 1996, because of slowly progressive indurated erythematous plaque with smooth, shiny surface and small teleangiectasia for 3 years duration. In microscopic examination, the tumor cells were present in the whole dermis and showed basaloid tumor strands with inmature eccrine differentiation. This biopsy specimen was interpreted as microcystic adnexal carcinoma (MAC), and the tumor was excised with 5mm tumor-free-margin in accord to previous mapping biopsy by 4mm trephine punch. But the margin of resection were involved tumor cells in deeper dermis and subcutis. Additional wide resection was performed with 5mm wider margin and the tumor was completely excised.
MAC is invasive in deeper and pathological invasion much differs from clinical apperance.

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慢性放射線皮膚炎に多発性基底細胞癌と脂腺癌およびMicrocystic adnexal carcinomaを生じた1例

小口美抄枝, 野網淑子, 宇原久, 斎田俊明, 北澤健

1998 年 13 巻 1 号 p. 37-41
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.37

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A 65-year-old Japanese man presented with an asymptomatic nodule of 3-month history on the right side of the nose. He had received radiation therapy for hemangioma of the nose when he was 17 years old. On physical examinasion, the nodule was dome shaped, dark-red colored and 15mm in size. Multiple black nodules varying from 1 to 3mm in size were also scattered on the poikilodermatous skin of his cheek and nose. In addition, an indurated plaque, 10 mm in size, was detected on the right nostril. Histopathologically, the nodule showed solid nests composed of atypical basaloid cells and foamy-vacuolated cells. The black nodules were revealed to be basal cell carcinoma. In the plaque lesion of the nostril, multiple discrete nests were found in the entire dermis and subcutis. The nests were partly continuous with the epidermal keratinocyte, and composed of atypical squamoid and basaloid cells with small keratinous cysts in the upper part. Interestingly, the neoplastic cells composing the discrete nests in the lower dermis showed vacuolated cytoplasm, indicating sebaceous differentiation.

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外陰部に発症した稀な類上皮肉腫の1例

島田賢一, 石倉直敬, 塚田貞夫, 上野輝夫, 服部邦之

1998 年 13 巻 1 号 p. 42-47
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.42

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Epithelioid sarcoma is rare neoplasm and was first recognized as distinctive entity in 1970 by Enzinger. This tumor occures cheifly in young adult and is characterized by a slowly enlarging nodule growth with early necrosis and ulceration of the overlying skin. Only 13 cases of vulvar epithelioid sarcoma have been reported. In this paper we describe the case of epithelioid sarcoma of the vulva.
A 55-year-old woman was presented with a small ulcerated lesion in diameter with 2 cm painless subcutaneous nodule in left labium major, she had noticed it since 10 years before. An excisional biopsy revealed it epithelioid sarcoma. The treatment consisted of wide local excision and bilateral inguinal lymphnode dissection. There is no residual tumor, and no lymphnode metastasis. Histologically, there was neither residual tumor nor lymphnode metastasis, no further treatment was done.
Although follow-up period is short, there has been no evidence of local recurrence of metastasis.

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頭部に多発した多形型横紋筋肉腫の1例

倉本浩子, 丸山優, 大西清, 岡田恵美, 岩平佳子

1998 年 13 巻 1 号 p. 48-52
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.48

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Of the soft tissue tumors, pleomorphic rhabdomyosarcoma is relatively common, similar to liposarcoma. We report the case of a patient who was pleomorphic rhabdomyosarcoma developed on the head. As soon as the tumor was removed, multiple tumors were recurred and died.
Case: 66-year-old male
Feeling a lump under the skin on the top of his head, around December 1994, the patient consulted a dermatologist. A biopsy carried out January 1995 found no malignant image. The patient was referred to our department to have the lump removed as a corrective measure. At the time, the tumor measured 4cm by 4cm with a height of 2cm. It lacked elasticity and mobility. We performed an extended excision on March 7. At the pathological observations, the found tumor cells full of large, polymorphous and acidophilic cytoplasm. The tumor cells had clear of nucleolus and showed a positive reaction to desmin by special dyeing. The tumor was diagnosed as pleomorphic rhabdomyosarcoma. Despite postooperative chemical treatment, the tumor redeveloped 3 months later. It had developed in several points and spread to the lungs. The patient died of respiratory failure on June 22, 1996.

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進行期悪性黒色腫に対するDacarbazine, ACNU, CisplatinおよびTamoxifen併用化学療法―有効例と投与スケジュールの実際―

山崎直也, 山本明史, 和田隆, 石川雅士

1998 年 13 巻 1 号 p. 53-56
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.53

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Malignant melanoma has been refractory to most chemotherapy. Single agent chemotherapy usually has provided a response rate of less than 20%.
Attempts to improve on the response have resulted in the institution of many trials with combination chemotherapy regimens. In the last few years several groups have reported good response rates to a combination of decarbazine, carmustine, cisplatin and tamoxifen.
We report our experience with a patient with lymph node metastases beyond the regional lymph nodes treated with dacarbazine, nimustine, cisplatin and tamoxifen. After 3 courses of the therapy, lymph node metastases markedly decreased in size. This combination regimen, comprising dacarbazine, nimustine, cisplatin and tamoxifen is fairly effective, we are still accruing patients into this regimen.

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先天性表皮水庖症の家系に生じた悪性黒色腫の1例

福本智恵, 大西誉光, 大隅正義, 渡辺晋一, 高橋久

1998 年 13 巻 1 号 p. 57-60
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.57

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We described a case of malignant melanoma appearing on the sole of a patient with epidermolysis bullosa simplex.
The patient was a 46-year-old man who had a pigmented skin lesion on his left heel. The lesion had rapidly enlarged for a year. At his first visit to us, a dome-shaped, blackish, firm tumor, 80mm to 90mm in diameter was observed. Histologic examination showed that the lesion was malignant melanoma. In addition, his family history revealed that his grandmother, mother and daughter had congenital bullous dermatoses. The daughter was diagnosed as having epidermolysis bullosa simplex by clinical and histologic examinations in our department. He also had the same history.

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動注化学療法を施行したWerner症候群に合併した鼻腔内悪性黒色腫

吉田司, 井上靖, 清原祥夫, 鈴木正, 土田哲也, 池田重雄, 飯沼壽孝

1998 年 13 巻 1 号 p. 61-65
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.61

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A 31-year-old man with Werner's syndrome had acral lentiginous melanoma in situ on right thumb in 1983, and the lesion was excised completely. In October 1993, he developed malignant melanoma in nasal cavity as another primary lesion. The tumor was excised in February 1994, but the re-operation was needed because of the local reccurence. After the re-operation, the reccurence in nasal cavity and multiple metastases to liver were found. We performed administration of CBDCA, DTIC, ACNU, IFN-β with intra-arterial infusion (bilateral external carotid artery and hepatic artery). The treatment suppressed increasing of the tumor temporally. However, multiple metastatic lesions in pancreas, lung and brain were found one month after the arterial infusion therapy, and he died in December 1995.

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成人T細胞白血病 (ATL) 患者の皮膚病変に対する治療法の比較検討

片平充彦, 田中昭人, 瀬戸山充, 神崎保

1998 年 13 巻 1 号 p. 66-71
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.66

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We studied and compared the effects of chemotherapy, radiotherapy, ultraviolet irradiation therapy (PUVA therapy), therapy with biological response modifiers (BRM) and other therapies for the skin lesions in 22 patients with adult T-cell leukemia (ATL), April 1994 trough July 1997.
Patients with a complete response (CR) or partial response (PR) were 15 out of 23 (65%) for chemotherapy, 5/5 (100%) for radiotherapy, 11/13 (85%) for ultraviolet irradiation therapy, 5/7 (71%) for BRM, and 7/21 (33%) for other therapies. All therapies except “other therapies” showed high response rates. The response rate was lower in recurrent skin lesions with chemotherapy. Patients with complete responses after radiotherapy developed leukemia possibly due to a decrease in immunological competence caused by radiotherapy. On the other hand, a good response was seen in recurrent foci with PUVA therapy. BRM therapy did not cause drug tolerance in the lesions or any serious adverse reactions.

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爪部悪性黒色腫の1例

吉川周佐, 清原祥夫, 鈴木正, 土田哲也, 池田重雄

1998 年 13 巻 1 号 p. 72-77
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.72

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A 73-year-old female noticed longitudinal melanonychia of right thumb four years ago. The periungual grayish dark pigmented macule developed gradually in recent two years. She visited our clinic in January 1997, and the diagnosis of ungual melanoma was made clinically. Amputation and DAV-Feron therapy (DTIC, ACNU, VCR, IFN-β) were perfomed. We observed the lesion with dermatoscope, and the interesting findings were obtained. The longitudial melanonychia showed no specific finding in dermatoscopy, but in the lesion of Hutchinson's sign, crista dominant heterogeneous pigmentation was observed. This finding is consistent with that of acral lentiginous melanoma in situ. Interestingly, in that lesion, thin spiral pigmented structure was also found. This structure reflected the casting-off melanin in the eccrine duct of corneum histologically. The other four cases of ungual melanoma were studied using dermatoscope. We also mentioned these findigs, and the usefulness of dermatoscopy for the diagnosis of ungual melanoma was discussed.

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皮膚科領域におけるインターフェロン (IFN) -γ療法

瀧川雅浩

1998 年 13 巻 1 号 p. 78-83
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.78

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Interferon-γ is a multifunctional cytokine produced by Th1 cells. We have observed clinical efficacy of this cytokine in the treatment of Ki-1+ lymphoproliferative disorders, eosinophilic pustular folliculitis and chronic prurigo.

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菌状息肉症に対するガンマーインターフェロン療法における全国多施設調査報告

石原和之

1998 年 13 巻 1 号 p. 84-90
発行日: 1998/06/30
公開日: 2010/08/05

DOIhttps://doi.org/10.5227/skincancer.13.84

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“Multi-Center Clinical Trial of IFN-γ on Mycosis Fungoides in Post-Marketing Surveillance”
A clinical trial was performed at 36 institutes to investigate the efficacy and safety of IFN-γ (Biogamma^®) in 69 patients with mainly CTCL.
The general improvement rate (CR and PR) was 37.7%, which was lower than that of phase II trials, which was 60.7%. This may be explained by the fact that the present study had about twice as many patients in advanced stage of the disease, such as tumor phase, than phase II.
Patients administered 2million JRU of IFN-γ over 12 weeks showed the high improvement rate.
Adverse effects and their frequency were almost same as those in premarketing clinical trials.
Patients receiving a combination therapy, such as IFN-γ and PUVA, showed lower improvement rate as compared with those treated with IFN-γ alone. As much severe patients were assigned to the combination therapies, the improvement rate was considered lower in this group than others. More effective combination therapies must therefore be explored for patients in more advanced stages of CTCL.

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