Case 1: A 67-years-old japanese man who had acral lentiginous melanoma in situ on his right finger, and affected by gastoric adenocarcinoma at the same time.
Case 2: A 72-years-old japanese woman who had acral lentiginous melanoma on her left finger suffered from ovarian adenocarcinoma developed after three years later.
There are ten cases of double cancer of malignant melanoma with gastoric cancer, and no case of ovarian cancer with malignant melanoma in japan. [Skin Cancer (Japan) 2000; 15: 203-207]

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T cells play an important role in rejection of melanoma. We have previously identified human melanoma antigens using cDNA expression cloning with melanoma reactive T cells. These antigens represented 1) tissue specific proteins (gp100, e.g.) 2) cancer-testis antigens (NY-ESO-1, e.g.), 3) mutated peptides (β-catenin, e.g.) and others. Some of these antigens were shown to be also recognized by IgG antibodies in patient's sera, thus, they can be isolated by SEREX. Tissue specific proteins, cancer-testis antigens, proteins over-expressed in cancer cells can be isolated by various cDNA subtraction methods. Using these techniques including SAGE and GeneChip, we have isolated candidate genes for new melanoma antigens. New immunothrapy protocols including immunization with peptides, recombinant viruses, plasmid DNAs, dendritic cells pulsed with peptides as well as adoptive transfer of in vitro generated CTL by stimulation with antigenic peptides, were developed, and Phase I clinical trials have been being performed. The immunization with the gp100_209(210M) peptide that was modified to have a high HLA-A2 binding affinity along with IL2 resulted in 42% response rate in patients with metastatic melanoma in the Surgery branch, National Cancer Institute. These immunotherapies require further improvement based on the isolation of new melanoma antigens with better tumor rejection ability as well as the analysis on tumor escape mechanisms. [Skin Cancer (Japan) 2000; 15: 208-216]

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When you try to take persuative and representative pictures of the patients, you must be aware both of the mechanics of the cameras and how to make use of them. Included are, micro (macro) lenses, flash, magnification, focusing, filters, films, depth, view axis, positioning of the patients, framing and the reason of failure. [Skin Cancer (Japan) 2000; 15: 217-230]

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We compared the plantar melanoma cases from 1990 to 1997 in Kumamoto University and Heinrich-Heine University in a retrospective study. Out of 112 melanoma patients in Kumamoto University, 47 cases (42%) were plantar melanoma, while out of 925 melanoma patients, 68 cases (7%) were plantar melanoma in Heinrich-Heine University. There were no differences in patient's mean age and sex ratio between Kumamoto University and Heinrich-Heine University. However, there were some differences in mean Clark level, mean tumor thickness, patients's delay and the recurrence ratio between these two Universities. Plantar melanoma in Kumamoto University showed those of cases with a thin Clark level, thin tumor thickness, short patients's delay and low recurrence rate. These data suggest that public education on plantar melanoma was more prevailing in Japan and public education will help early detection leading to a good prognosis. [Skin Cancer (Japan) 2000; 15: 231-235]

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We report a case of melanoma on the head of a 48-year-old female. She had noticed a nodule on her head 4 years before her first visit of our hospital. Another rapidly growing pedunculated nodule developed near the first one 2 months before.
The tumor accompanied pigmented macule, 78×48mm in size. Histologically, two large tumor mass were composed with atypical tumor cells with melanin granules. Tumor cells, scattered in the epidermis, showed Pagetoid phenomenon and invaded into many hair follicles. Tumor cells completely ocupied some hair follicules but do not invaded into the dermis around the fibrous root sheath. The diagnosis was superficial spreading malignant melanoma (pT4aN0M0, Breslow's thickness 13mm, Stage III). Wide local exicison with neck dissection and three course of chemotherapy (DTIC, ACNU, VCR, IFN-beta) were performed. The patient showed no evidence of recurence for 10 months after the operation. [Skin Cancer (Japan) 2000; 15: 236-239]

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Epidermotropic metastatic malignant melanoma (EMMM) can simulate a primary malignant melanoma (PMM) . However, since therapeutic management can be dramatically different for these two lesions, care must be taken in evaluating them. We report a man with a history of a PMM on the scalp who has subsequently shown several black papules on the locoregional skin, one of which was diagnosed an EMMM. We found 23 cases of EMMM in the literature and reviewed them. It seemed probable that the recent work with a new immunohistochemical marker, anti-metallothionein antibody, provides some help to differentiate EMMM from PMM. [Skin Cancer (Japan) 2000; 15: 240-245]

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We report a case of advanced melanoma with hypercalcemia due to parathyroid hormone-related protein (PTHrP) secretion. A 40-year-old man had noticed a nodule on his left foot about 20 years previously. The size had increased quickly from January 1998. When he was admitted our hospital on May 1998, the size of lesion was 30×30 mm. We excised the tumor with the diagnosis of malignant melanoma. And inguinal lymph node dissection and chemotherapy were added.
On March 1999, he developed intransit metastasis on his left thigh. From September 1999 the serum calcium were increased. Laboratory data were as follows: serum calcium, 7.1mEq/l; C-terminal PTHrP, 133.8 pmol/l (13.8-55.3 pmol/l); intact PTH, <10 pg/ml (10-64pg/ml). It is very likely that PTHrP production by melanoma caused hypercalcemia in this patient. [Skin Cancer (Japan) 2000; 15: 246-249]

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We reported a case of malignant melanoma with spontaneous regression of the primary lesion. A 50-year-old man noticed a subcutaneous tumor in his left neck 3 months before his visit to us. He was aware of a black macules on his left cheek for the past 5 years, most of which recently disappeared. A histological examination of the tumor showed lymph node metastasis of malignant melanoma. We found no other lesions on his whole body except for the macules on his cheek. Consequently, we diagnosed this case as malignant melanoma, pTxN₁M₀, stage III, which showed the spontaneous regression of the primary lesion. [Skin Cancer (Japan) 2000; 15: 250-253]

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An interesting case of a large tumor which consisted of both a benign trichilemmal cyst and a proliferating trichilemmal cyst, that developed in the buttock of a 57-year-old male, is reported.
Three trichilemmal-derived tumors, that is, trichilemmal cyst, proliferating trichilemmal cyst and malignant proliferating trichilemmal cyst were sequentially consecutive conditions.
It is expected that further accumulation of cases will allow us to draw same conclusions about the time point from which the tumor should be diagnosed as a malignant one. [Skin Cancer (Japan) 2000; 15: 254-257]

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We described a case of Werner's syndrome associated with Bowen disease on the back of the right thigh. A 54-year-old Japanese woman was diagnosed as having Werner's syndrome at 44 years old by the presence of juvenile cataracts, elevation of urophanic hyaluronic acid and glucose tolerance disorder. We considered that prematuer aging characteristic of Werner's syndrome contributed to the development of Bowen disease. [Skin Cancer (Japan) 2000; 15: 258-261]

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We report a case of zosteriform and epidermotropic metastasis of a cutaneous squamous cell carcinoma (SCC) . A 72-year-old woman noticed multiple crustic and red papules with zosteriform distribution on the right L1-L3 dermatomes. She had been excised a SCC on the right knee and been dissected right inguinal lymph nodes two years before.
The histopathological diagnosis of the papules on the right thigh and hip regions was epidermotropic metastasis of SCC. There were no other metastases, with an exception of left inguinal lymph node metastasis. Multiagent-combinationchemotherapy and radiation therapy were performed on the cutaneous metastatic lesions.
Only a few cases of zosteriform and/or epidermotropic metastases of cutaneous SCC have ever been reported. [Skin Cancer (Japan) 2000; 15: 262-265]

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We report a case of primary cutaneous large B-cell lymphoma in a 63-year-old man who exhibited two firm nodules on his right lower leg for about one year.
Histopathological examination revealed a dense infiltrate of atypical, large lymphocytes with mitotic figures from the entire dermis to the subcutaneous tissue. Bottom-heavy pattern was appparent. By immunohistochemical studies, atypical lymphocytes were found to be positive for CD20 and CD79a. A monoclonal immunoglobulin heavy chain gene rearrangement by Southern blot analysis was revealed in the involved tissue. On physical examination, no superficial lymphadenopathy was observed. CT scans and Ga scintigraphy showed no evidence of malignancy. According to the REAL classification, the present case corresponded to the entity, “diffuse large B-cell lymphoma” and EORTC classification classified it as large B-cell lymphoma of the leg. Local excision and local electron beam irradiation (total 40Gy) were administered. The patient has been free of disease for 1-year of follow up. [Skin Cancer (Japan) 2000; 266-270]

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A 62-year-old woman had had coccygodynia since May 1998, and noticed a swelling around coccygeal bone on May, 1999. She was referred to our hospital on August 25, 1999. Pelvic computed tomography and magnetic resonance imaging showed a tumor, 6cm×6cm wide and 4.5cm high, over the coccygeal bone. The tumor was excised together with the periosteum of coccygeal bone. The histological diagnosis of this tumor was chordoma. Subsequently local recurrence and metastases to liver, lung, and lymph node developed in February, 2000. The patient died on July 17, 2000. Chordoma is a low-grade malignant tumor originating from remnants of the notochord. We, dermatologists, should consider chordoma as a differential diagnosis when we encounter a tumor or subcutaneous nodule on the sacrococcygeal region. [Skin Cancer (Japan) 2000; 15 : 271-275]

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Angiosarcoma of the scalp is a relatively rare skin malignant disorder. We experienced a case of angiosarcoma. A 74-year-old woman admitted our hospital with a tumor which had appeared 1 month before on her right frontal scalp. Three months ago she got injures for two times on the scalp where exact same place the tumor appeared. She was diagnosed as angiosarcoma by typical clinical and histopathological features. She was intensively treated with rIL-2 and surgical operation. Intra-arterial infusion of rIL-2 was carried out before the operation. After the operation she was treated with intra-venous infusion of rIL-2. At the time of beginning the treatment, diameter of the tumor was 5cm and decreased to 3cm just before the operation. We estimated the IL-2 therapy benefitable for decreasing the tumor-size. No recurence is observed until now. [Skin Cancer (Japan) 2000; 15 : 276-279]

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se of drug eruption after long term rIL-2 therapy is reported.
A 67-year-old man had a tumor on his right temporal scalp on June 1995. On April 1996, the lesion was excised and the raw surface was covered with grafted skin at another hospital. Histopathological findings were similar to malignant hemangioendothelioma. On May 1996, so he visited to our department to begin the combination therapy of rIL-2, operation, radiation.
The rIL-2 therapy with celmoleukin had been started by local injection, one shot arterial injection since May 1996. But on June 1998, edematous, irregular, erythema was observed on the medial aspects of his upper arms and thighs. We suspected drug eruptions which were caused by celmoleukin. So we continued rIL-2 therapy with teceleukin by one shot arterial injection. On May 1999, the similar eruptions were observed again. We suspected drug eruptions which were caused by teceleukin.
Erythema is well known as one of the side effects of rIL-2. But this is conc eivable as a rare case of drug eruption after long term rIL-2 therapy. [Skin Cancer (Japan) 2000; 15 : 280-283]

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A 77-year-old female patient, who was diagnosed with bladder cancer and was operated on for it 7 years before, had noticed erythema with itching on her vulvar lesion 4 months berore. She had visited a near clinic and was reffered to our hospital. Physical examination revealed an erythematous plaque with an regular margin from the bilateral labia majus to labia minus. There were two erosions, which was on the right side of the labium minus (diameter 2.5×2.5cm) and was the left side of the labium minus (diameter 1.0×1.0cm). A skin biopsy from the erythema plaque showed large round cells with ample cytoplasm, which formed nests or glandular structures within the irregularly acanthotic epidermis. The tumor cells in the epidermis were histochemically positive for CK7 and CK20, but negative for CEA, PAS and GCDFP15.
MRI examination found the mass formation of the reccurence bladder cancer near the vagina. A skin biopsy from the vagina was the same histological and histochemical findings of the epidermis and was connected with the above mass formation.
Therefore, this case was suspected of the intraepidermal invasion, so called pagetoid spread, followed by reccurence bladder cancer. [Skin Cancer (Japan) 2000; 15 : 284-288]

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The first choice of treatment for squamous cell carcinoma is surgical excision, then other choices are radiation therapy and chemotherapy. Recently, it is chosen for treatment of squamous cell carcinoma that biological response modifier (-for example- Interferon, Interleukin-1, Interleukin-2, tumor necrotizing factor), cryosurgery, chemical surgery, electrosurgery, local chemotherapy and thermal therapy is go on. But progressive case has various problems for treatment -for example- high ages, informed consent and quality of life. We experienced a case of progressive squamous cell carcinoma which had recurrence and metastasis for 5 years. This case was finally treated with Retinoid and got complete remission. It is reported that Retinoid is effective drug to inhibit tumor growth, and we recognized that Retinoid inhibited tumor growth in this case. We think that Retinoid has a possibility of one of treatment for squamous cell carcinoma. [Skin Cancer(Japan) 2000; 15: 289-294]

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A case of metastatic squamous cell carcinoma successfully treated with CDDP and 5-FU is reported. A 70-year-old man noticed a dark-reddish ulcerated nodule of 15×8mm in size on the left lower abdomen in October, 1993. Although the lesion was surgically excised, the left inguinal lymph node swelling appeared in December, 1995. The inguinal lymph nodes were widely resected following 2 courses of PM chemotherapy (5 mg/day of peplomycin sulfate from day 1 to day 6 and 10 mg/day of mitomycin C on day 7). However, the metastatic lesion with 35×42mm in size in the pelvis and bone invasion to left coxa were detected by CT scan in October, 1997.
Since radiation therapy (40 Gy) was not effective, CF chemotherapy (80mg/m²/day of cisplatin on day 1 and 500 mg/m²/day of fluorouracil from day 1 to day 5) was performed. The findings of the metastatic lesion in the pelvis and the bone invasion were not shown in CT scan after 6 courses of CF chemotherapy, respectively. These findings suggest that CF chemotherapy may be one of the effective treatments for metastatic squamous cell carcinoma. [Skin Cancer (Japan) 2000; 15: 295-298]

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Purse-string suture technique has been described in many papers for the circular defect closure after skin tumor removal. We have modified this technique to pull an intradermal continuous stitch which is placed around the wound margin. We applied this technique in six facial skin cancer cases (seven lesions) and obtained satisfactory results. This technique seem to be simple, rapid and useful for skin defect closure, especially in cases of facial skin cancers which are usually seen in older indivisuals.
In this paper, clinical experiences of this technique in facial skin cancer cases are presented. In addition, we refer to the advantage of excisional biopsy using this. [Skin Cancer (Japan) 20; 15: 299-304]

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Male Breast Cancer is a comparatively rare disease, and it accounts for about 1.0 % of all breast cancers. We report a 75-year-old man with breast cancer. He had noticed a breast mass just under the right nipple in September 1999. Because the mass had gradually enlarged, he came to our hospital on November 5th. The tumor was 3.0cm in diameter. Skin biopsy from the mammary areola showed carcinoma. Since there were no findings of malignancy in the rest of his body by examination and the mass appeared just under the male nipple, we diagnosed this case as Male Breast Cancer. Auchincloss' operation and lymphadenectomy were performed by surgeons. From histological findings this case was confirmed to be medullary carcinoma. [Skin Cancer (Japan) 2000; 15: 305-308]

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We evaluated efficacy and toxicity of the combination of cisplatin, interleulin-2 (IL-2) and interferon (IFN) α or β in patients with metastatic melanoma. Ten patients received cisplatin, 50 or 80 mg/m² intravenously on day 1, IL-2, 70×10⁴ IU intravenously on days 4-7, 18-22 and IFN β, 300×10⁴ IU subcutaneously or intravenously on every second days (regimen A). Six patients received cisplatin 80 mg/m² intravenously on day 1, IL-2, 140×10⁴ IU subcutaneously on days 2-8 and IFNα, 500×10⁴ IU subcutaneously on days 2, 4, 6, 8 (regimen B). The induction cycle was repeated on day 29 in both regimens. There was no responder in 6 patients (A) and 4 patients (B) assessed for clinical response. Main toxisities were thrombocytopenia, neutropenia, anemia and nausea. Vitiligo-like depigmentation was seen in one patient, whose disease progressed during the therapy. There were no treatment-related death. These regimens had low activities in the treatment of advanced malignant melanoma. [Skin Cancer (Japan) 2000; 15: 309-314]

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