日本皮膚悪性腫瘍学会・予後統計調査委員会による定期的な皮膚悪性腫瘍に対する全国アンケートを行った。今回は1997～2001年における年度別・性別発生数について, 179施設に送付し, 97施設から回答が得られた。
対象腫瘍は悪性黒色腫, 有棘細胞癌, 基底細胞癌, 汗腺癌, 菌状息肉症, 成人T細胞白血病・リンパ腫, 血管肉腫, Merkel細胞癌, 日光角化症, Bowen病, 乳房Paget病, 乳房外Paget病などである。集計した腫瘍は21,652例で, 各腫瘍はいずれも漸増の傾向にあり, また腫瘍により性別発生数が異なっている。地域別発生数では悪性黒色腫, 有棘細胞癌, 基底細胞癌, 日光角化症では関東を除いて東海より西南に発生数が多かった。一部の腫瘍では1992～1996年の全国アンケートの発生数と比較した。

抄録全体を表示

症例は74歳女性。打撲後, 左頬部に4×6cmの紫紅色の結節が出現。前医で皮膚生検の結果, 腫瘍は真皮上層から中層に大小種々の管腔構造を認め, 内腔は異型性に富む紡錘形細胞で構成され, 血管肉腫と診断された。本人の希望により切除は行わず, IL-2の全身および局所投与と電子線照射を施行。皮疹は一時平坦化したが, 初診2年後, 同部に紫紅色結節が再び出現し, 当科を受診。治療および経過: 皮膚腫瘍切除術兼分層植皮術を施行。その後IL-2局注および電子線照射を継続したが, 術後1年6ヵ月後, 血尿が出現。膀胱鏡で膀胱内に腫瘤を認めたため, TUR-btを施行。組織学的に原発巣と同様の管腔構造と腫瘍細胞の増殖を認めた。腫瘍細胞はCD31, CD34, Factor VIII陽性で, 血管肉腫の膀胱転移と診断。ほぼ同時期に肺, 皮下, 肝臓および脳に転移巣が出現。エンドセリン-1値は全身転移が認められた時点で高値を示した。病巣内のHHV-8DNAは陰性。

抄録全体を表示

We report a reconstructive case of nasal basal cell carcinoma with reversed submental perforatorbased island flap. An 87-year-old woman had been noticed to have a small tumor on her left nasal alar. Because the tumor began to grow up, she was referred to our office. On initial examination, the tumor size was 15×10mm with broad subcutaneous induration from her left cheek to upper white lip. Histological examination revealed that the tumor was morphea-like basal cell carcinoma. We planned a two-stage operation: a wide tumor resection first, and then reconstruction of the nose in the second operation. The tumor cells had even invaded the bony area of the nasal cavity, after confirmation of a tumor-free margin in the resected tissue, the left nasal alar was reconstructed with a reversed submental perforator-based island flap. Although the reversed flow flap has a risk of flap congestion due to the disturbance of venous return, this flap has a good color match, good flap mobility, and can close the donor primary for facial reconstruction. [Skin Cancer (Japan) 2004; 19: 161-166]

抄録全体を表示

A 66-year-old male noticed erythemas on his thigh 16 years ago and later he noticed generalized erythemas 7 years ago. They were clinically diagnosed as asteatic eczema. He had an axillary subcutaneous tumor sized 10×5cm, which was histologically diagnosed as an acute inflammatory process. Because the tumor had persisted, it was resected and showed a proliferation of large cells, which led to a diagnosis of Hodgkin's disease. Thereafter, generalized erythrodermatous lesions succeeded and an indurated erythema was newly formed in his left shoulder after chemotherapy (ABVD) and irradiation (40Gy). The lesions were biopsied and were diagnosed as mycosis fungoides (MF) showing large cell transformation. Retrospectively, the axillary subcutaneous tumor was reevaluated and the proliferation of large cells noted there was histologically similar to the latter one, thus diagnosed as MF with large cell transformation. [Skin Cancer (Japan) 2004; 19: 167-172]

抄録全体を表示

Primary cutaneous CD30 positive T-cell lymphoproliferative disorders are divided into anaplastic large cell lymphoma, borderline disorder, and lymphomatoid papulosis (LyP) by the rate of CD30 positive cells among the infiltrate. Furthermore, in LyP, B cell infiltration is sometimes observed and self-healing is clinically observed. On the other hand, self-healing is seldom observed in lymphocytoma cutis. Histologically, secondary lymphoid follicles are constantly observed in lymphocytoma cutis, but not in LyP.
In this case, self-healing of the solitary nodule was clinically observed, and a few primary lymphoid follicles and 10% of CD30 positive cells were respectively observed at the deep dermis or subcutaneous layer and among the T-cell dominant area in the dermis on histology and immunohistology. So this case was considered to be LyP rather than lymphocytoma cutis. [Skin Cancer (Japan) 2004; 19: 173-177]

抄録全体を表示

Stewart-Treves syndrome is a relatively rare malignant tumor. It develops in chronic lymphedema of the upper extremities after treatment for breast cancer. We report here an additional case of a 55-year-old female.
Twenty-two years ago, she was treated with mastectomy and axillary lymph node dissection and radiotherapy for a left breast cancer. After that she had chronic lymphedema of the left upper extremity. One month before admission, she noticed a subcutaneous nodule on left cubital region. A biopsied specimen from the lesion showed angiosarcoma and the cells were positive for CD31 and CD34 immunohistochemically. The patient received a forequarter amputation. But, the tumor cells were found to have invaded to the stump, and she received radiotherapy. She is under careful follow up now. [Skin Cancer (Japan) 2004; 19: 178-180]

抄録全体を表示

(Case 1) A 62-year-old man suffered from psoriasis for several decades and was treated with ultraviolet A. He noticed a tumor on the right side of his scrotum 10 months ago. A biopsy specimen of the tumor led us to the diagnosis of squamous cell carcinoma (SCC) . Wide excision and right inguinal lymph node dissection were performed. Inspite of the treatment, paraaortic lymph node and lung metastases developed 18 months later. Combination chemotherapy (carboplatin, 5-FU, and peplomycin) could not inhibit the tumor progression and he died 3 years after the first visit.
(Case 2) A 42-year-old man presented with a tumor on the left side of his scrotum. He had worked at an ironworks and used machine oil. After wide excision and left inguinal lymph node dissection, he was treated with 3 courses of peplomycin chemotherapy. The tumor recurred locally 4 years later and was surgically removed again. He has been tumor-free for more than 6 years.
(Case 3) A 77-year-old man, who also worked at an ironworks before, had a tumor on the left side of his scrotum and had it resected at another hospital 4 years ago. Local recurrence occurred and was widely excised. He has been tumor-free for more than 4 years.
During the past 11 years, we experience 251 cases of SCC in our institutions. Among them, 3 cases developed on the scrotum. It is often indicated that SCC occurs on the scrotum soaked with machine oil or exposed to ultraviolet rays. [Skin Cancer (Japan) 2004; 19: 181-185]

抄録全体を表示

The patient was a 73-year-old female. A whitish, flat, protruding tumor of 5×30mm in size was seen in the right corner of her mouth, contiguous with a whitish verrucous tumor of 20×30mm in size in the right buccal mucous membrane. This was diagnosed from biopsy as squamous cell carcinoma. No metastasis to other organs was found with diagnostic imaging. With consideration of the cosmetic and functional prognosis, anticancer agents were injected locally. An anticancer agent sensitivity test (CD-DST) was used in selection of the anticancer agent. A high sensitivity was shown to peplomycin sulfate only. When this agent was used in local injection the tumor shrank and there was a clear clinical effect. Degeneration of the tumor cells was also seen histopathologically, and necrosis was confirmed. Afterward, radiation therapy was also given, but a biopsy revealed remaining tumor cells. Finally the tumor was resected, although the area of the resection was small. The above indicates that CD-DST, which has the capacity to screen in advance the anticancer agents expected to have a clinical effect, will be a useful test in the future. [Skin Cancer (Japan) 2004; 19: 186-189]

抄録全体を表示

Sebaceous carcinomas are divided into an ocular sebaceous carcinoma and extraocular sebaceous carcinoma. Ocular sebaceous carcinoma is derived from the meibomian glands, Zeis' glands, or caruncula lacrimalis. It is misdiagnosed as a chalazion so that it often recurs after excision. It can be diagnosed only by pathological examination. Prognosis of sebaceous carcinoma is poor, when it is more than T3 in size. Early diagnosis and treatment are required.
We experienced 2 patients with sebaceous carcinoma in the upper eyelid. Operation is the first choice in treatment against ocular sebaceous carcinoma, although ocular sebaceous carcinoma rising in the eyelid is often difficult to remove completely. We excise these tumors in full thickness of the eyelid with a safety margin of 5mm or 10mm, which is different in accordance with the tumor's size. A defect of the upper eyelid was reconstructed with a switch flap of the lower eyelid. This method is useful in reconstructing the function and appearance of eyelid. [Skin Cancer (Japan) 2004; 19: 190-194]

抄録全体を表示

A 61-year-old man had noticed a nodule on his right thigh a few years ago. As the nodule gradually became larger, he visited our hospital. He had a black nodule on his right thigh which had a smooth surface and subucutaneous induration. Wide resection of the nodule was performed. Histologically, the nodule and the wall of the subcutaneous cystic structure consisted of basaloid cells. Our case was a peculiar cystic type of BCC and we discussed the pathogenesis of large cystic structures. [Skin Cancer (Japan) 2004; 19:195-197]

抄録全体を表示

A hemangioma simplex (HS) or a port-wine stain has a tendency to darken in color and to become thickened gradually in its natural history. But it is uncommon for a skin cancer to develop inside an HS.
We report a case of a 64-year-old female, who had a large HS on her face from birth, in which a basal cell carcinoma (BCC) developed. At first an excisional biopsy was done to define the histological diagnosis of the nodule which developed on her lower lip, and the diagnosis was BCC. Then a wide local excision of the nodule with 5mm surgical margin and plasty of the enlarged lip and tongue were performed under general anesthesia. At 11 months after the final operation, no sign of loco-regional recurrence was observed.
There have been reported 19 cases of BCC developing inside HS in the literature. Eleven of these cases had some previous treatments for HS, such as thorium-X irradiation or cryotherapy. The etiological significance of the therapy is still unknown but is discussed in this article. [Skin Cancer (Japan) 2004; 19: 198-202]

抄録全体を表示

We report a case of a 79-year-old female who had multiple Bowen's disease accompanied by sigmoid colon cancer. The patient underwent an operation for left breast cancer at the age of 42. Her oldest brother had colon and lung cancer; in addition, the older brother had gastric cancer and the older sister had colon cancer. She presented with erythematous plaques on her right third finger, right lower leg and left dorsal hand in August 2002. A histopathological examination of all the plaques showed Bowen's disease. Her sigmoid colon cancer by occult blood in her feces after admission was revealed. Subsequently, she underwent a resection of her sigmoid colon. Histopathological diagnosis was adenocarcinoma. This case was considered in association with Multiple Bowen's disease and internal malignancy. [Skin Cancer (Japan) 2004; 19: 203-207]

抄録全体を表示

The patient was a 77-year-old male with an asymptomatic subcutaneous nodule on the lateral right thigh. Starting in June 2002, the nodule began to grow larger. After performing a skin biopsy, a local doctor suspected it to be Merkel cell carcinoma and referred the patient to our hospital. Upon examination, the nodule was found to be a dark-red colored, dome-shaped tumor 10.5×8.0cm in size. A histopathological examination showed the tumor to consist of a solid nest of cells formed of small, atypical cells with scanty cytoplasm and circular nuclei. Moreover, immunostaining showed the tumor to be positive for cytokeratin 20 and NSE. The tumor was diagnosed as Merkel cell carcinoma. We excised the tumor together with fascia within a radius of 3cm from the tumor margin, and then covered the excised area with a mesh skin graft. During the operation, metastases were found in the sentinel and 3 other lymph nodes among the 13 lymph nodes, and these 3 were then resected. [Skin Cancer (Japan) 2004; 19: 208-211]

抄録全体を表示

We report a case of dermatofibrosarcoma protuberans (DFSP) which developed on the left lower abdomen of a 54-year-old male. Recently, the tumor with a ten-year history rapidly grew larger. Then, the patient was admitted to our hospital for surgical treatment. The tumor was excised, and was histologically diagnosed as a DFSP based on the characteristic histopathological findings with storiform pattern and intensive CD34 expression on the tumor cells. Then, the peri-lesional tissue was excised with a 5cm of marginal tumor free skin. No obvious sign of recurrence has been identified during 9 months follow-up. [Skin Cancer (Japan) 2004; 19: 212-214]

抄録全体を表示

We report a case of aneurysmal fibrous histiocytoma of the skin on the lower leg of a 32-year-old man. The patient noticed the rapidly increased nodule on his right lower leg about 3 months ago. The tumor was 2×2cm in size, and a firm erythematous nodule. Microscopically, the tumor was composed of fibroblastic and histiocytic cells showing slight atypicality. There were collections of capillaries, foci of hemorrhage and foamy macrophages surrounding a blood-filled space in the tumor. Immunohistochemically the tumor cells were positive for vimentin and focally positive for actin, CD34 and CD68, but gave negative results for desmin, EMA, and S-100. From these findings, this case was diagnosed as aneurysmal fibrous histiocytoma of the skin, a variant form of dermatofibroma. [Skin Cancer (Japan) 2004; 19: 215-218]

抄録全体を表示

A 61-year-old male was admitted to our hospital in February 2002, because of a recurrent tumor on his chest wall. The patient was operated on six times in another hospital after a diagnosis of desmoid tumor since 1998. We reexamined the pathological specimens of all of the excised tumor and we diagnosed it as malignant fibrous histiocytoma (MFH) . Before the operation, 100mg of doxorubicin was administered into the left internal thoracic artery, which entered into the tumor. We performed extensive resection of the tumor with the 4th-6th ribs and left half of the sternum. The defect of the chest wall was reconstructed with polypropylene mesh, latissimus dorsi and rectus abdominis musculocutaneous flap. One month after the operation, a total of 50Gy of radiotherapy was performed. There is no recurrence one year after the treatment. [Skin Cancer (Japan) 2004; 19: 219-223]

抄録全体を表示

64歳, 男性。左前腕伸側の7×6×6cmの易出血性の有茎性腫瘤と基部の皮下に9×10×3cmの腫瘍を認めた。画像診断, 細胞診より軟部悪性腫瘍を強く疑い, 左上腕切断術を施行した。病理組織学所見より悪性線維性組織球腫 (Storiform pleomorphic type) , T2b, NO, MOでstage IIIと診断した。術後3ヵ月半後に, 肺転移を認め, ifosfarnide単独投与による化学療法を3クール施行したが, 肺転移巣に著変ないためCA療法に変更し, 2クール施行し, 一部転移巣の縮小を認めた。術後11ヵ月, 他臓器への転移は認めず, 部分寛解である。

抄録全体を表示

We report a case of malignant peripheral nerve sheath tumor (MPNST) of the nape. A 52-year-old woman suffering from neurofibromatosis type I since her childhood noticed a tumor on the nape six years ago. The tumor gradually became enlarged and elevated. On her visit to our hospital on July 25th, 2002, physical examination revealed an elastic soft, 15×13×6cm sized tumor on the left side of her nape. The tumor grew rapidly and ruptured with bleeding on August 23rd. Immediate excision of the tumor was performed. Histologically, the tumor mainly consisted of spindle cells showing palisading arrangement.
A part of the specimen showed nuclear atypia and mitoses. Immunohistochemically, the spindle cells were positive for S-100 protein and NSE. The tumor was diagnosed as MPNST. Multiple lung and liver metastases developed and the patient died of respiratory failure caused by lung metastases in 5 months after her first visit to our institution. [Skin Cancer (Japan) 2004; 19: 229-232]

抄録全体を表示

A 73-year-old woman was referred to our hospital with a complaint of a black nodule on her vulva. Bilateral inguinal lymph nodes were palpable. The diagnosis of malignant melanoma of the vulva was made on clinical features. We performed a wide local excision immediately circumferentially to a distance of 2cm from the nodule and a bilateral ilio-inguinal lymph node dissection, including subcutaneous tissue between the nodule and the inguinal lymph nodes. We reconstructed the urethral orifice and vaginal orifice with the residual skin flaps. At present, 9 months after surgery, no recurrence has been noted, and no distant metastases have been observed. She has no difficulty in urination. We consider this method is effective for a moderate vulvar defect. [Skin Cancer (Japan) 2004; 19: 233-237]

抄録全体を表示

We reported 2 cases of granulomatous slack skin, one is a 39-year-old woman and the other is a 75-year-old man.
In both cases, the biopsy specimens showed massive infiltration of small to medium sized lymphocytes and the loss of elastic fibers. Monoclonal rearrangement of the TCRβ gene was detected in both cases by southern blot analysis.
In case 1, 33Gy X-ray irradiation for the skin lesion and subcutaneous nodules on the right upper arm and the lymphonodes in the axilla and PUVA therapy for the whole body induced almost completely regression of the lesions. In case 2, we performed 36Gy-electron beam therapy to irradiate the tumorous lesions of the right upper arm, axilla, and chest. Both patients responded to the treatment and have been almost free of disease up to the time of writing, August 2003. [Skin Cancer (Japan) 2004; 19: 238-242]

抄録全体を表示

We report a case of primary penile malignant melanoma. The patient was an 80-year-old male, who developed a blackish macule and nodule on his penis during the past 10 years. Physical examination revealed he had a subcutaneous metastatic skin lesion near his left axilla; no other metastatic lesion could be identified. Total resection of the penis and bladder and inguinal and intrapelvic dissection of lymphnodes were performed with 8/42 positive nodes. The metastatic skin lesion was also dissected. These surgical procedures were followed by DAV combination chemotherapy (DTIC, ACNU and Vincristine ) with local injection of interferon-β. During the post-operative DAV-feron treatments, however, multiple metastatic lesions were discovered in his brain and lung. Stereotactic radiosurgery was performed for his brain metastases, which resulted in no benefit in our case. Primary malignant melanoma of the penis is a very aggressive and uncommon tumor and less than 30 cases have been reported in the Japanese literature. [Skin Cancer (Japan) 2004; 19: 243-246]

抄録全体を表示