The Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society and melanoma study group by the Grant-in-Aid for Cancer Reseach (11-7) from the Ministry of Health, Labour and Welfare have periodically conducted a nationwide survery of skin malignancies.
In this report, we analyzed 701 Japanese patients with malignant melanoma registered by 22 medical institutions from Jan. 1992 to Dec. 1996. The final follow-up data were collected in August 2001. The 701 cases consisted of 335 males and 366 females. The data analyzed included age, sex, anatomical distribution, clinical features of primary lesions, Clark's subtype, tumor thickness (Breslow), Clark's level, disease stage and treatment.
The survival rate was assessed by the Kaplan-Meier method, and the significance of differences was determined with the log-rank test. [Skin Cancer (Japan) 2002; 17: 7-15]

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We report a 29-year-old man with verrucous-keratotic malignant melanoma on the left thigh. The black to dark brown warty plaque, which was clinically compatible with seborrheic keratosis, was observed. Dermoscopic findings showed that the surface of the lesion was covered with a gray-blue area, whitish veil, and black dots/globules. Furthermore, milky-red globules were also recognized. However, pigment network and radial streamings were in conspicuous.
Histopatholigical examination of the nodule was conducted. Hyperkeratosis, acanthosis, and nests, which were composed of round or spindle melanoma cells were observed in the epidermis. Pagetoid cells in the epdermis were also recognized in the surrounding pigment macules. This tumor was diagnosed as verrucous-keratotic malignant melanoma from the above findings. [Skin Cancer (Japan) 2002; 17: 16-20]

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Because of the histopathological similarity, histological differentiation between basal cell carcinoma (BCC) and trichoblastoma (TB) can be difficult. Recent investigations show that constitutive activation of the patched (PTC) -hedgehog signaling pathway plays an central role in the development of BCC. By contrast, TBs do not show either loss of heterozygosity (LOH) at the loci surrounding PTC gene or overexpression of PTC mRNA, suggesting that the deregulation of the PTC-hedgehog signaling pathway is not involved in the molecular pathogenesis of TB. These findings indicate that, although morphologically similar, TB and BCC have different molecular pathogenesis, and that molecular biological methods such as in situ hybridization for PTC mRNA would be useful in the differential diagnosis between TB and BCC. [Skin Cancer (Japan) 2002; 17: 21-25]

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A 73-year-old woman presented with a grayish black nodule on the subungual area of her right thumb. The nail plate had disappeared and central ulceration was observed. She was diagnosed as having an acral lentiginous melanoma with a micrometastasis in the sentinel lymph node. To preserve the function of the right thumb, we recommended to her reconstructive operations such as toe transplantation or pollicization, but she refused any surgical procedure with bone reconstruction and regional lymph node dissection. Consequently, we left the metacarpal bone as long as possible and covered it using an island first dorsal metacarpal artery flap from the dorsum of the index finger. The flap completely survived, and no recurrence was observed for 14 months. She can pinch, manipulate chopsticks and hold a cup, although she feels a slight difficulty in fastening buttons. In this paper, we described the anatomy, surgical technique and usage of this flap. [Skin Cancer (Japan) 2002; 17: 26-30]

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In patients with malignant melanoma, the site for lymph node dessection is now determined by the primary site of the tumor according to the standard of UICC. However, sometimes it is difficult to predict accurate lymph node drainage because the tumor occupies two or three lymph node areas, which Sappey called “Watershed” areas, such as the midline of the trunk. We applied the technique of sentinel node biopsy (SNB) using patent blue dye for the patient with malignant melanoma of the under back. It was possible to detect the lymph node drainage flowing not only to the groin area but also to the axillar area. We consider that SNB is one of the effective methods to determine the lymph node drainage of the tumor in so-called “Watershed” areas. [Skin Cancer (Japan) 2002; 17: 31-37]

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In 2000, the American Joint Committee on Cancer (AJCC) proposed a new TNM classification for malignant melanoma. In this classification, tumor thickness is used in the evaluation of primary lesion and Clark's level is used only in TI subclassification. In addition, ulcers in primary lesions, number of regional lymph node metastases, differentiation of macroscopic metastasis from microscopic metastasis to the lymph node, and serum LDH, are taken into account in the staging and substaging. The International Union Against Cancer (UICC) is going to accept this new staging system. To evaluate the significance of this new classification in Japanese patients, 342 melanoma patients (214 from the National Cancer Center Hospital and 128 from Shinshu University Hospital) were analyzed by the current UICC-TNM classification and this new AJCC-TNM classification.5-year survival rates by the UICC classification were 98% at stage I, 83% at stage II, 54% at stage III, and 14% at stage IV, and those analyzed by the AJCC classification were 95% at stage I, 72% at stage II, 43%at stage III, and 14% at stage IV. As a result, the new AJCC-TNM classification seems to be a useful indicator of prognoses for each stage and substage. The 5-year survival rate at each stage of the AJCC classification was a little lower than that of the current UICC-TNM classification. Further study on many more patients is required to obtain decisive results. [Skin Cancer (Japan) 2002; 17: 38-43]

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We report 3 cases of basal cell epithelioma (BCE) on the forearm. Case 1 was a 70-year-old woman who had a brown-black nodule, measuring 12×8mm on the dorsal surface of her left forearm. Histological examination revealed a nodular type of BCE. Case 2 was a 86-year-old woman. Her chief complaint was a 12×12mm in size erosion with crust on the dorsal surface of her forearm. Histological examination revealed superficial type of the BCE. The dermis around the BCE showed remarkable basophilic degeneration. Case 3 was an 84-year-old woman. She had a 8×8mm in size erythema with crust on the flexural side of her forearm. Histological examination showed nodular nests of BCE on the upper dermis. We discuss the relationship between ultraviolet light and these BCEs. [Skin Cancer (Japan) 2002; 17: 44-47]

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The number of patients with basal cell carcinoma (BCC) treated at our department has been increasing in recent years. We statistically studied seventy-six specimens from seventy-three cases diagnosed as BCC from 1991 to 2000.
There were fewer than ten cases of BCC per year from 1991 to 1996, while there were more than ten cases per year in 1997, 1998 and 2000. The patients consisted of forty-two men and thirty-one women. Sixty-one patients were more than sixty years old. The locus of the BCC in forty-four cases (57%) was the face, in fifteen it was the trunk, in six it was the lower extremities, in four each it was the upper extremities and the pubic region, in two it was the scalp, and in one it was the neck.
The clinical classification of noduloulcerative type was observed in fifty-seven cases (75%), superficial type was observed in twelve, epithelioma-planum-cicatricans type and morphea-like type were observed in three cases each, and epitheliomaterebrans type was observed in one. The histopathological classification of solid type was observed in fifty cases (66%), superficial type was noted in ten, adenoid type was noted in seven, keratotic type was observed in five, morphea-like type was noted in three, and cystic type was observed in one. [Skin Cancer (Japan) 2002; 17: 48-50]

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Dermatofibrosarcoma protuberans (DFSP) are uncommon skin tumors that have a high incidence of local recurrence even with wide surgical margin, but DFSP rarely metastasize. We report a case of DFSP that showed accelerated growth during pregnancy.
Immunohistochemical stains for CD34, S-100 protein, factor XIIIa, and estrogen and progesterone receptors were performed on biopsy specimens. Previous reports showed expression of progesterone and PDGF receptor which may be factors that accounts for their accelerated growth during pregnancy. [Skin Cancer (Japan) 2002; 17: 51-53]

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We report a case of 42-year-old man with dermatofibrosarcoma protuberans (DFSP) arising on his right cheek. Histopathological findings of an excised specimen revealed typical striform appearances and atypism of neoplastic cells. They were also positive for vimentin and CD34. The wound was reconstructed using a free forearm flap, and no tumor recurrence has been observed 9 months after tumor resection. The face is a relatively rare location of DFSP. [Skin Cancer (Japan) 2002; 17: 54-56]

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A 43-year-old Japanese woman visited our hospital with a large tumor on her back. The tumor size was 20×15×4cm. She first noted the tumor on her back 5 years ago. Wide excision of the tumor including fascia and skin grafting were performed. Histologically, the tumor consisted of areas of ordinary dermato-fibrosarcoma protuberans composed of spindle-shaped tumor cells with storiform patterns. In other areas, a dense proliferation of atypical spindle cells arranged in fascicular and herring-bone patterns was obserbed. Immunohistochemical staining of CD34 showed strongly positive in DFSP and showed decreased CD34 reactivity in fibrosarcoma.
No local recurrence and metastasis was seen under the follow-up period of 7 months. [Skin Cancer (Japan) 2002; 17: 57-60]

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A 54-year-old woman had noticed a nodule on her thigh 6 years ago. The nodule was excised three times because of reccurrence. In April 2000, 4th reccurence occurred. At this time, she consulted a dermatologist who suspected the lesion to be a malignant tumor; subsequently, she was referred to us. The nodule was excised completely. Histopathologically, the tumor was composed of spindle-shaped cells mixed with bizarre giant cells. In some areas of the lesion, the tumor cells were arranged in a storiform pattern, and in other areas chondroid tissue had formed. Immunohistochemically, the tumor cells revealed a variety of findings. Electron microscopy did not show that the tumor cells had characteristic ultrastructural features. Thus we diagnosed this tumor as malignant fibrous histiocytoma, pleomorphic type. [Skin Cancer (Japan) 2002; 17: 61-64]

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We reported a 74-year-old women of lipoma-like liposarcoma. She has had a subcutaneous mass in the left buttock for about 10 years and received operations twice for the lipoma at a previous hospital, but she had repeated recurrence of the tumor. Clinical findings showed a subcutaneous mass about 21cm in the left buttock. CT examination showed a lipoma-like shadow with septums. Pathological findings showed the tumor was composed of mature adipose tissue and contained atypical cells within dense fibrous bands. We diagnosed this tumor as lipoma-like liposarcoma. The recurrence of the tumor was found by MRI examination 2 years and 8 months after the operation. We performed wide local excision with a margin of surrounding normal muscle for the recurrent tumor. There have been no recurrences and distance metastases of the tumor for 8 months.
The characteristic of the lipoma-like liposarcoma, shown by CT and MRI scans, a giant lipoma-like tumor with dense fibrous structures, present among the muscles of the limbs. Because of the marked tendency of local recurrence of the tumor, we carefully discussed the condition and decided that the tumor margin should be excised. After the operation, no recurrence has been seen for 8 months. [Skin Cancer (Japan)2002; 17: 65-69]

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We report a case of a 75-year-old man with synovial sarcoma.
There was a painful mass, 3.5×3×2cm in size, on the dorsum of the DIP joint of his left thumb. The mass was smooth on the surface, relatively well-demarcated, elastic soft, weak and hemorrhagic. There was osteolytic change in the phalanx of the thumb on X-ray.
Histological examination revealed the tumor mainly consisted of hypercellular sheets of small round cells with dark-stained nuclei. Another portion of the specimen showed presence of a typical biphasic pattern, which was composed of epitheloid cells and spindle cells. Immunohistochemically, the small round cells and spindle cells were positive for vimentin, and the epitheloid cells were positive for CAM 5.2. These cells were negative for CEA, S-100 protein, HMB-45 and CD34. The tumor was diagnosed as poorly differentiated synovial sarcoma. Chest X-ray and CT showed a giant mass in the upper lobe of the right lung. We couldn't obtain a biopsy specimen of the mass because of severe hemoptysis during the bronchoscopic examination. We assumed that the tumor was lung metastasis of synovial sarcoma.
The patient's left thumb was amputated. Radiotherapy for the lung mass was not effective. He died of respiratory failure 6 months after the tumor of the left thumb appeared. [Skin Cancer (Japan) 2002; 17: 70-74]

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In June 2000, a 66-year-old Japanese man was admitted to our hospital because of an ulcerative tumor on the back of his left middle finger, and two subcutaneous tumors on the left arm, which showed remarkable edema. A large amount of serous exudate flowed out of the subcutaneous tumor on the upper arm after incision.
Histopathologically, a diagnosis of squamous cell carcinoma (SCC) was made for the tumor on the finger, and metastatic SCC for the two subcutaneous tumors.
His left arm was amputated below his shoulder, and his left axillary and subclavian lymph nodes were dissected. He was treated with combination chemotherapy including cisplatin and 5-fluorouracil 4 times. The histological examination confirmed that the tumor cells had grown in the deep dermis of a part of the dissected skin with normal appearance, representing the presence of intransit metastasis. At present there is no evidence of recurrence, or metastasis to the other organs.
To our knowledge, there are few reported cases in which SCC originating from the skin developed intransit metastasis. The present case strongly suggests that the remarkable lymphedema of his left arm caused local immunodeficiency, and resulted in the rapid induction of the intransit metastasis. [Skin Cancer (Japan) 2002; 17: 75-78]

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We reported a rare case of malignant melanoma and multiple squamous cell carcinoma, occurring simultaneously on a burn scar. A 49-year-old woman had been burned on her scalp in childhood, resulting in a scar. At the age of 48, she was diagnosed breast cancer, and received a breast resection. After two or three months, she found an enlarged multiple tumor on the burn scar. Histologically, one was nodular melanoma, the other was squamous cell carcinoma. The cause is likely to be a reduction of tumor immunity. [Skin Cancer (Japan) 2002; 17: 79-82]

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It has been known that there are individual differences in terms of effectiveness of anticancer agents for advanced skin cancers even in cases when patients had the same type of cancer. The chemosensitivity test for advanced stomach cancers has been covered by insurance since 2000 in Japan and it is now widely used in anticancer chemotherapy to determine the maximum effect with minimum side effects.
It would be possible to generalize the tests in skin cancers because of their superficial location on the skin and the facility of their repeated excision. A three-dimensional cellular growth assay using a collagen gel matrix with an MTT assay, one of the chemosensitivity tests, has been applied to four cases of advanced skin cancers (malignant clear cell adenoma, malignant eccrine poroma, squamous cell carcinoma and malignant melanoma) and to two cases of lymphoma from 1999 to 2000. The anticancer agents tested are 5-Fu, adriamycin, cisplatin, bleomycin, actinomycin D, dacarbazine, etoposide and vincristine. Furthermore, the appearance of multidrug resistance (MDR) agents, which include p-glycoprotein, MDR-related protein, lung resistance protein, glutathion-s-transferase π and topoisomerase, was studied immunohistochemically in six cases.
A chemosensitivity test is useful to determine regimens of chemotherapy. Each case showed sensitivity to some anticancer agents and some MDR agents. There is, however, no considerable relationship between drug resistance and MDR agents. [Skin Cancer (Japan) 2002; 17: 83-88]

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Angiosarcoma of the scalp and face is a rare malignant endothelial tumor arising mainly in elderly people, and the prognosis is usually poor. Here we report a case of angiosarcoma treated by excision followed by interleukin-2 injection. A 91-year-old Japanese woman presented a 10×8cm irregularly shaped purpuric plaque with a central necrotic nodule. A biopsy specimen showed tumor cells with a pattern of sheets of large atypical cells composed dilated, irregular, blood filled channels. Despite explicit information concerning the extremely malignant potential of the tumor, the patient refused any treatment. However, six months later, she developed a large blacky cystic nodule and a pigeon egg sized macule which was 8cm apart from the primary lesion and thought to be skin metastasis. A wide resection of the primary tumor was performed and interleukin-2 was administrated intrarterially. Skin metastasis initially disappeared, but two months later, the tumor recurred. During the subsequent 12 months with interleukin-2 therapy locally and intrarterially, the tumor size decreased and she has not developed other metastatic spread. [Skin Cancer (Japan) 2002; 17: 89-93]

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We reported an 81-year-old man with primary cutaneous T-cell lymphoma with a gastrointestinal stromal tumor (GIST) . He manifestated a solitary reddish tumor on the left hip that grew rapidly to a size of 4 ×4×1cm during a period of two months. A skin biopsy of the tumor showed dense infiltration of abnormal lymphocytes in the dermis and subcutaneous tissue. The immunophenotype was positive for LCA and UCHL-1, and negative for L-26. An abdominal CT revealed a lesion of a large nodule on the outside of the stomach wall, that was diagnosed as a GIST with immunohistochemically CD-117⁺. 3 couses of combined chemotherapy (THP-COP; pirarubicin, cyclophosphamid, vincristin and prednizorone) were effective for cutaneous T-cell lymphoma.
A local excision of the GIST was performed, and he had no recurrence. There were no reports of cutaneous T-cell lymphoma with GIST. [Skin Cancer (Japan) 2002; 17: 94-97]

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A 43-year-old Japanese woman was admitted for excision of a subcutaneous tumor on the forehead. A subcutaneous nodule was first noticed on the left side of the forehead half a year previously, and it grew slowly to become a tumor about 2 cm in diameter. After the excision, this tumor has histopathologically examined. The features showed apocrine carcinoma with eccrine spiradenoma. [Skin Cancer (Japan) 2002; 170: 98-100]

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We report 75-year-old man with extramammary Paget's disease restricted to the left axilla. He had an egg-sized erythematous plaque with scale and erosion. Histopathologically, Paget's cells were found in the epidermis and neither dermal invasion or intradermal carcinoma was found. Immunohistochemical examination revealed that the Paget's cells were positive for CEA and EMA, and negative for GCDFP-15 and HMFG-1. We compared this case immunohistochemically with five cases of extramammary Paget's disease which were treated in our department, but there was no specific pattern of reactivity to the above mentioned antibodies. [Skin Cancer (Japan) 2002; 17: 101-103]

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