The Prognostic and Statistic Investigation Committee of the Japanese Society for Skin Cancer has periodically conducted a nationwide survery of skin malignancies. In this report, we analyzed 535 cases of malignant melanoma in 22 facilities form Jan. 1987 to Dec. 1991. All of the cases were registered in Jun. 1992 and surveyed until the final analysis in Mar. 1999. The 535 cases were consisted of 262 males and 273 females. According to disease types, acral lentiginous melanoma and nodular melanoma were major, and superficial spreading melanoma and lentigo maligna melanoma have been slightly increasing.
10-year survival rate by disease stages was lower than 5-year survival rate except for stage I . Patients with more than 3mm in tumor thickness and more than Clark's level 4 showed poor prognoses. [Skin Cancer (Japan) 2000; 15: 99-107]

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Acantholytic squamous cell carcinoma (ASCC) was first described under title of “adeno-acanthoma of sweat glands” by Lever in 1947. Today it recognizes one type of the squamous cell carcinoma. The tumor commomly occurred in exposed areas, particularly near the head and neck regions in elderly persons. The microscopic feature of ASCC is acantholysis with formation of lumens containing dyskeratotic cells toward the center of the lobule. Johnson et al. reported there was metastasis in 3 patients among 155 patients. But Nappi et al. described cases did metastasize widely and prove fatal were 19%. The tumor size of greater than 1.5 cm correlate with the risk of an adverse outcome. We had experienced a case of 80-year-old male who had raised tumor on the left palm and one year after first operation he was dead to metastasize lymphnode of axilla, liver, kidney and costal bone. Histological finding of palm's tumor showed acantholysis with the lumens containing dyskeratotic cells. But lymphnode's histology showed adenoid carcinoma pattern. Further immunohistochemical examination proved metastatic cells in lymphnode was ASCC. We have discussed the importance of early surgical treatment and lymphnode dissection of ASCC compared with SCC. [Skin Cancer (Japan) 2000; 15: 108-112]

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Although partial spontaneous regression of Bowen's disease has been reported, it is rare that the lesion of Bowen's disease show completely spontaneous regression. We histopathologically investigated lesional skin and revealed that apotosis of epidermal cell is induced before regression and dermal amyloid deposittion after regression. Apotosis related to regression of Bowen's disease and deposition of dermalamyloid is suggested. [Skin Cancer (Japan) 2000; 15:118-120]

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A rare case of extramammary Paget's disease of bilateral axillae with adenocarcinoma was reported. A 82-year-old woman had noticed the erythematous macules on her both axillae three years ago. A subcutaneous mass and a number of swollen lymph nodes were detected under the erythematous macule surrounded by pigmentation or depigmentation on her right axilla. There was no evidence of breast carcinoma on the initial examination. Both lesions were widely excised including the regional lymph nodes of the right axilla. The lesion of the right histopathologically showed a well demarcated nest of adenocacinoma in the dermis through the subcutaneous fat tissue. The overlying epidermis was involved by Paget cells. In the vicinity of the tumor nest, some components of supernumerary mammary glands showing positive immunohistochemical staining for anti-estrogen receptor antibody were found. The left axillary lesion histopathollogically showed Paget's cell infiltration in epidermis and the presence of components of supernumerary mammary glands in the deep dermis. The relationship among the Paget's cell, supernumerary mammary glands and adenocarcinoma was discussed. [Skin Cancer (Japan) 2000; 15:121-125]

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The case of a 74-year-old man with triple extramammary Paget's disease (TEPD) of the bilateral axillae and genital region is reported. Erythematous lesions, pigmentation and depigmentation were seen in the pubic area, scrotum and base of the penile shaft. Faint, poorly defined erythematous lesions and areas of depigmentation were observed on the bilateral axillae.
Histopathological analysis of the axillae and genital lesions revealed Paget cells. No evidence of dermal invasion by the tumor cells was observed.
Finally, the previous 39 cases of TEPD that have been reported in Japan were statistically analyzed. [Skin Cancer (Japan) 2000; 15: 126-130]

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Dendritic cells (DCs) play as a powerful initiator in the development of cytotoxic T-lymphocytes (CTLs) and are capable of invigorating natural killer (NK) cells via their-producing interleukin (IL)-12. Therefore, immunization with melanomaassociated antigen (MAA) peptides in combination with DCs is a widely expected strategy for the treatment of patients with melanoma. In naive mice, administration of MAA peptide-pulsed DCs or application of MAA peptides on corneum barrierdisrupted skin, in which Langerhans cells (LCs) have been maximally activated, effectively develop CTL- and NK cell-mediated anti-melanoma immunity in vivo and the treated mice acquire resistance against transplantation of melanoma cells. However, contrary to this expectation, a considerable number of reports has shown no or weak efficacy of treatment with MAA-pulsed DCs applied to melanoma-bearers, suggesting ineffective generation of cytotoxic cells in a melanoma-bearing state. Our current study has demonstrated that melanoma-infiltrating TGF-β-secreting regulatory T cells take a leading part in this downregulation of antimelanoma immunity. This raises a possibility that elimination of this type of Suppressor cells from melanoma bearers is a successful strategy in DC-MAA-based melanoma immunotherapy. [Skin Cancer (Japan) 2000; 15: 131-137]

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Basal cell carcinoma (BCC) usually grows slowly, increasing in size and depth of invasion over months to years. It is important prior to surgery to predict aggressive behavior of BCC, especially its deeper extension. In 216 primary BCCs treated with surgical excision, maximum vertical diameter, designated as “invasion index, ” from the surrounding skin surface to the bottom of the tumor was measured. As predictive factors, age, sex, duration, anatomical location, tumor horizontal diameter, histologic subtypes, and ulceration were listed. Multiple linear regression analysis, which was performed on the seven factors related to the invasion index, showed significant strength of influence of male sex, larger tumor horizontal diameter, and aggressive histologic subtypes (infiltrative, morpheic, and micronodular). When treating BCC having the three predictive factors, clinicians should keep in mind its potential for deeper invasion. [Skin Cancer (Japan) 2000; 15: 138-142]

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Seventeen cases of coetaneous malignant melanoma which admitted to Juntendo University Urayasu Hospital during the last 16 years (1984-1999) were statistically analyzed. A gradual increase in the number of new cases of this tumor was observed, probably due to the increasing ratio of older population in Urayasu City and surrounding areas. They involved 35.3% the trunk, 23.5% the sole, 17.6% the lower extremities, 5.9% the head and 5.9% the genitals. Two cases (11.7%) were in stage I, 7 cases (41.7%) in stage II and 8 cases (47.1%) in stage III. No patients had reached stage IV. Five-year survival ratio were 0% on stage I, 70% on stage II and 25% on stage III, which were poorer than the previously reported Japanese cases. Further improvement of lymphnode dissection and extended chemotherapies were expected. [Skin Cancer (Japan) 2000; 15: 143-146]

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We report a rare case of giant metastatic malignant melanoma (GMMM). A 52-year-old man had noticed a small nodule on the top of his head about one year previously. When he visited our hospital on March 18, 1998, the dome-shape nodule measured 30×30mm and was accompanied with satellite lesions. Excisional biopsy of satellite lesion yielded a histopathological diagnosis of malignant melanoma (MM). There were no findings of systemic metastasis. We classified this as MM (pT4bN0M0, Clark level V, Stage III) . After we injected IFN β into the lesion, we perfomed wide local excision. However, in this case, cutaneous metastasis appeared on the left neck 5 months lates MM. He had received DAV-IFN β therapy for the lesion. However, after three courses of adjuvant therapy, the neck metastasis did not decrease. He died of the disease one year and 9 months after the operation. Very few cases of GMMM have been reported to gradually enlarge reaching a size of 330×220×115mm. [Skin Cancer (Japan) 2000; 15: 147-151]

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Seborrheic keratosis (SK) is common benign skin tumor. But some authors reported malignant transformation of SK.
The patient is a 72-year-old man who had noticed a small black nodule on right lower abdomen for 30 years. The nodule was getting larger slowly, but it becomes ulcerative and elevates recently.
Histopathologically, this tumor was revieled a deeply invasive squamous cell carcinoma that had developed from the base of a SK. [Skin Cancer (Japan) 2000; 15: 152-154]

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A-66-year old worman had noticed a pigmented lesion on the lateral side of the right lower leg for several years. The part of the lesion began to elevate 1 year previously. The physical examination revealed a coin size brown, keratotic plaque which had a reddish nodule at the upper portion of the lesion. Histopathology revealed an apparent picture of Bowen's disease in the pigmented lesion, while there was continuously adnexal carcinoma in the nodule. Immunohistochemically, this Bowen's disease and the adnexal carcinoma showed respective different antigenecities.
Whereas Bowen's disease is generally regarded as a premalignant dermatosis, 3% to 5% of patients may develope invasive carcinomas if untreated. The case like the patient case of Bowen's disease combined with other adnexal carcinoma is very rare. For the present case, Bowen's disease with invasive adnexal carcinoma was diagnosed. [Skin Cancer (Japan) 2000; 15 :155-158]

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Wound necrosis is a major complication after groin dissection. We reviewed all the cases of radical groin dissection which were performed at the Department of Plastic and Reconstructive Surgery in Tokyo Medical and Dental University between 1992 and 1999. Twenty-six patients underwent groin dissection, and wound necrosis was seen in fifteen patients (58%), but four of the five patients who underwent groin dissection with the modified technique which preserve the perforators, did not develop postoperative flap necrosis. Accordingly, the technique which preserve the perforators near the sartorius muscle is considered to reduce the incidence of skin flap necrosis. [Skin Cancer (Japan) 2000; 15: 159-163]

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Cancer of the accessory brest tissue is rare. We report a 73-year-old women with a tumor on the right axillary area. There was no other primary malignant lesion by general examination. Physical and histopathological findings offered a suspection of accessory brest cancer.
A wide local resection with lymph node dissection was performed. Postoperativery, she was treated with 6 courses of chemotherapy. She is alive with no evidence of local recurrence and metastasis for 19 months after the operation. This paper presents a rare case of accessory brest cancer with a review of 66 cases in the literature. [Skin Cancer (Japan) 2000; 15 :164-167]

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We report a case of an 88 year-old man with Merkel cell carcinoma. He noticed a subcutaneous induration on his left antebrachium about three months before visiting Tokoname municipal hospital. The tumor was firm, light red, dome-shaped with the size of 25×25mm in diameter. The biopsy specimen revealed nests of tumor cells with round nuclei and poor cytoplasm localized in the middle dermis to subcutaneous fatty tissue and did not extend into the epidermis. Electron microscopy demonstrated dense core granules in the intracellular spaces of the tumor cells. From the features mentioned above, we diagnosed his nodule as Merkel cell carcinoma. We chose the treatment of electron beam therapy (6MeV) alone to the primary lesion and left axillary lymph nodes in place of surgical treatment because of his age and past history of myocardial infarction. The tumor completely disappeared when the total amount of irradiation had been 51 Gy. We reviewed 46 reported cases of Merkel cell carcinoma located in the extremity and discussed the effectiveness of radiotherapy alone carried out in 12 reported cases with the tumor in Japan. [Skin Cancer (Japan) 2000; 15: 168-174]

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A 29-year-old man visited our hospital because of indurated erythemas with papillomatous nodules on the entire body skin. Histological finding revealed atypical lymphoid cell infiltration to the upper dermis and papillomatous proliferation of the epidermis. Immunohistochemically, atypical cells showed CD3 (+), CD4 (+), CD45RO (+), and CD19 (-) . Diagnosis of cutaneous T cell lymphoma was made. PUVA and BRM had been given. But these therapies were not effective. Three months after admission, suddenly atypical lymphocyte appeared in his peripheral blood. [Skin Cancer (Japan) 2000; 15: 175-178]

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We report 5 cases of metastatic lung carcinoma to the skin. The 5 patients, 4 male and one female, ranged in age from 35 to 80 years. Clinical manifestations were intracutaneous or subcutaneous nodules, which were located on various sites: the head, trunk, and inguinal region and finger. Histologic examination revealed 3 cases of adenocarcinoma and 2 cases of small cell carcinoma. Duration between occurrence of skin metastasis and death was from 4 to 14 months. No expression of cytokeratin 20 (CK20) was observed in any cases. The results suggested that CK20 is a useful marker in the differentiation between merkel cell carcinoma and skin metastasis of small cell carcinoma, or between metastasis from the lung and that from the gastrointenstinal (GI) tract because merkel cell carcinoma and adenocarcinoma of GI tract express CK20 in general. [Skin Cancer (Japan) 2000; 15: 179-184]

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A 40-year-old woman visited our hospital because of a dome-shaped light red eroded-surfaced tumor measured 1.5×1.9×1.0cm on her right heel. On closer examination, a small dark brown pigmented macule was observed in its peripherary. Excision of the tumor disclosed the tumor to be amelanotic melanoma. The tumor was composed of anaplastic epithelioid cell nests with junctional activity. No melanin granules were appreciated. The tumor cells were positive for S100 and HMB45. Two weeks later wide local excision, sentinel node biopsy and ilio-inguinal lymph node dissection were performed. Although her right inguinal nodes were clinically palpable, no evidence for lymph node metastasis was obtained. The patient was diagnosed as amelanotic melanoma stage III_A (pT_4aN₀M₀ tumor thickness 4.4mm) and is currently followed without evidance for metastasis. This is the 3rd amelanotic melanoma patient among 91 cases malignant melanoma (3.3%) in our department. [Skin Cancer (Japan) 2000; 15: 185-188]

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A survey of the prognosis of the patients used in a late phase II clinical trial was conducted in order to determine the clinical usefulness of OH-6000 in patients with adult T-cell leukemia (ATL) whose lesions were confined to the skin. In terms of patients with or without an anti-tumor effect, symptoms that progressed to leukemia or lymphoma were observed in 2 of 10 patients who showed response to OH-6000 (CR+PR) and in 8 of 9 patients who showed no response (MR+NC+PD). The 50% survival time was 1170 days for all patients eligible for analysis, 802 days for the no response patients, and not yet achieved for the response patients.
From the above findings, OH-6000 is considered to be clinically useful in the treatment of patients with ATL whose lesions are confined to the skin. [Skin Cancer (Japan) 2000; 15: 189-195]

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