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Tomomichi ONO
2005 Volume 20 Issue 1 Pages
8-13
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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“Giant” is sometimes used to describe large tumorous lesions of the skin. However, there has been no clear definition of “giant” so far. I circulated a questionnaire of the use of “giant” among members of the Japanese Skin Cancer Society and obtained 501 answers out of 1, 182.
224 members replied that they had an image of “giant” tumors if the tumors were beyond 10cm in diameter, but 118 members wrote that they had different opinions. They wrote that “giant” may differ from tumor to tumor. Some wrote that “giant” has a bad image, and I agree that this should be taken into consideration in describing the diagnosis on charts or in obtaining informed consents from patients. [
Skin Cancer (Japan) 2005; 20: 8-13]
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Taketo HOTTA, Yukiko KOBAYASI, Kinuyo KIDA, Tomoko YAMADA, Satoru MURA ...
2005 Volume 20 Issue 1 Pages
14-18
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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This report presents a 69-year-old female case with giant squamous cell carcinoma over a burn scar in the scalp. She had been burned over her scalp by falling into an irori (a Japanese hearth) at the age of 10 years. She had hidden the scar with a wig, even from her family. She noticed an ulcer of the burn scar 7 years ago. She suffered disturbance of consciousness and convulsive seizures suddenly, and was transported into our hospital. At this time, a huge tumor was found on her scalp. The tumor was 13cm in diameter, crater-like in shape, bled easily, smelled bad, and beat up and down at the center of the tumor. Histopathological diagnosis was squamous cell carcinoma. No lymphatic or distant metastasis was found. However, examination of a scull X-ray film or MRI revealed that the tumor had melted a cephalic bone and invaded the dura. Invasion to the superior sagittal sinus was suspected. Therefore, we diagnosed the tumor as inoperable, and chose palliative radiotherapy. The radiotherapy improved her disturbance of consciousness and convulsive seizures, and decreased the tumor. However, she died 1 year 4 months later. [
Skin Cancer (Japan) 2005; 20: 14-18]
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Tsuyoshi ISHIHARA, Shigeto MATSUSHITA, Atsushi KAGUCHI, Takahisa NAGAT ...
2005 Volume 20 Issue 1 Pages
19-22
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We reported two cases of eyelid reconstruction after surgical excision of large eyelid neoplasms. An 84-year-old woman presented with basal cell carcinoma of the left upper and lower eyelid. An 86-year-old woman presented with squamous cell carcinoma of the left cheek and lower eyelid. It is necessary to choose some flaps and composite grafts on a case by case basis. In particular, the orbicularis muscle flap is a better match when reconstructing the anterior layer. The reasons are as follows: the quality of texture, color, fixation and flexibility of the flap, the stability of the blood supply, the ease of re-establishing the function of the levator muscle and elevating the flap. [
Skin Cancer (Japan) 2005; 20: 19-22]
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Tsuyoshi ISHIHARA, Shigeto MATSUSHITA, Atsushi KAGUCHI, Faith C Muchem ...
2005 Volume 20 Issue 1 Pages
23-26
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We presented a case of popliteal lymph node dissection. The patient was a 43-year-old man who had a history of surgery for melanoma on his right thigh. We recognized the metastatic lymph node on his right popliteus after his first surgery, which was the dissection of the original tumor and groin lymph node dissection. We planned a popliteal lymph node dissection. A popliteal leision is narrow and deep. There are popliteal vessels, a tibial nerve and another motor branch of muscles. It is unique in that it has a three dimensional structure. The point of dissection is to excise en bloc and keep the motor nerves. It is necessary to plan a nerve graft if some motor nerves are cut off. [
Skin Cancer (Japan) 2005; 20: 23-26]
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Akihiro OHSHIMA, Takahiro HORIBE, Yasushi YOSHINARI, Taisuke ITO, Hiro ...
2005 Volume 20 Issue 1 Pages
27-32
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We have treated 40 cases of malignant melanoma during the past 11 years from 1993 to 2003 in our department. The incidence of melanoma patients per year was 3.6, and the average age was 57.3 years. The initial lesion appeared on the lower extremities in the majority of the cases, and the sole represented the most prevalent site (11 of the 40 patients; 27.5%) . Regarding the clinical type, acral lentiginous melanoma was predominant, accounting for 18 patients (45.0%). The 2002 UICC classification of the 40 patients showed 42.5% in stage I, 20.0% in stage II, 30.0% in stage III, and 7.5% in stage IV. Five-year survival rates of stages I, II, III and IV were 92.9%, 66.7%, 60.0%, 0%, respectively. Patients with nodular melanoma, and melanoma located on the trunk or BANS (upper back, posterolateral upper arm, posterior and lateral neck, posterior scalp) area had a poorer prognosis. [
Skin Cancer (Japan) 2005; 20: 27-32]
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Yohei IWATA, Toshikazu USUDA, Kaori TOYA, Kyoko SUGAWARA, Shinsuke IYO ...
2005 Volume 20 Issue 1 Pages
33-38
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We report a case of malignant melanoma with osteocartilaginous differentiation. Osteocartilaginous differentiation of malignant melanoma is rare. Only 21 cases have previously been reported. A 47-year-old woman noticed a phyma of the right little toe. Histologically, spindle-shaped malignant tumor cells with a distinct osteoid and chondroid matrix were observed. Tumor cells showed positive immunoreaction for vimentin, S-100 protein and negative for HMB-45, cytokeratin, NSE, desmin, actin and EMA. After the first operation, she had stopped attending our hospital. Seven years later, it had become impossible for her to walk because of the giant metastatic lesion of the right thigh. She was transported to our hospital by ambulance. We succeeded in resecting the big tumor; the weight of the tumor was about 7kg. Histological and immunohistochemical features of the metastatic lesion were the same as the primary lesion. Melanosomes were identified ultrastructually in every tumor cell, so we were able to diagnose this tumor as malignant melanoma with osteocartilaginous differentiation. [
Skin Cancer (Japan) 2005; 20: 33-38]
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Hideaki NONOMURA, Hiroto TERASHI, Yoriko TSUJI, Makoto OHMORI, Setsuo ...
2005 Volume 20 Issue 1 Pages
39-42
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We report a case of morphea-like basal cell carcinoma arising from an epidermal cyst on the forehead. A 64-year-old man noticed a subcutaneous mass on his forehead 15 years ago. It ruptured spontaneously and then an open drainage treatment was performed after its diagnosis as an epidermal cyst. After one month, he visited our hospital because the wound was slow in healing. It was diagnosed histologically as a morphea-like basal cell carcinoma originating from an epidermal cyst. The cyst wall was partially replaced by the malignant tumor. According to the literature, basal cell carcinoma is apparently less common in association with an epidermal cyst than is squamous cell carcinoma. And as far as we know, the morphea-like type BCC has not been reported to date. [
Skin Cancer (Japan) 2005 ; 20: 39-42]
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Satomi ITOH, Eriko NOMURA, Yoshiki TANIGUCHI, Yoshiharu NARA
2005 Volume 20 Issue 1 Pages
43-46
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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A 59-year-old woman had noticed a tumor on the nape a year ago but had ignored it.
When she was referred to our clinic, there was a red-elastic demarcated papule, 5mm in diameter, on the Unna's nevus on the back of the neck. Beneath the papule there was a relatively hard subcutaneous tumor measuring 15×20mm in size, which moved freely from the tissue under the tumor. There were no lymph nodes swelling around the neck. Skin biopsy showed the typical findings of sebaceous carcinoma. After wide excision of the tumor including normal skin, she hasn't had local recurrence or experienced distant metastasis. As sebaceous carcinoma usually shows a yellow nodule around the eyes, subcutaneous sebaceous carcinoma is extremely rare even in extraorbital ones. Since this tumor is highly malignant, early detection and early treatment are essential. [
Skin Cancer (Japan) 2005; 20: 43-46]
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Manabu HASHIMOTO, Masahito TAGUCHI, Akira KURAMOCHI, Tetsuya TSUCHIDA
2005 Volume 20 Issue 1 Pages
47-50
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We reported a case of eccrine porocarcinoma in a 67-year-old woman. She noticed erosion of the lateral malleous in July, 2002. It gradually increased and started to bleed. On October 30, 2003 she received her first medical examination at our department. A fingertip-sized, broad-based red tumor which had necrotic tissues was found in the left lateral malleous. Lymh nodes were not palpable in the left inguinal region and left popliteal fossa. A biopsied specimen showed atypical tumor cells and ductal formation, so diagnosis of eccrine porocarcinoma was made. We performed sentinel lymph node (SN) biopsy using blue dye and RI and a wide local excision and applied skin grafting. Two SNs each were identified in the left inguinal region and left popliteal fossa. SN on the central side of the popliteal fossa was positive for metastasis. As postoperative therapy, the area of left popliteal fossa and primary lesion were irradiated. Neither recurrence nor metastasis was found 5 months after surgery. [
Skin Cancer (Japan) 2005; 20: 47-50]
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Hideki KAMIYA, Yasuo KITAJIMA
2005 Volume 20 Issue 1 Pages
51-57
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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Eighteen patients with eccrine porocarcinoma (EPC) who had been treated at our hospital between 1988 and 2003 were reviewed. Five cases had regional lymph node and/or distant metastasis. Since advanced cases are rare, no standard treatment has been established, and very few studies of chemotherapy and radiation for EPC have been reported. Metastatic EPC has generally been refractory to multiple treatment regimens, including radiation and chemotherapy. Because of this and the tendency to develop local recurrence, a wide excision of the primary tumor, with histologically clear margin, is indicated. A current standard treatment course for EPC in our department is as follows:
i) Surgery with wide local excision is the first choice of treatment. ii) Radiation is indicated for the cases of local recurrence and inoperative lymph node metastasis. iii) Low dose FP (5-FU+low dose cisplatin) and FECOM (CBDCA, EPIR, MMC, 5-FU, VCR) therapy are performed for EPC patients with distant metastasis.
Future clinical trials are required to establish any ideal treatment course in the management of advanced EPC patients. [
Skin Cancer (Japan) 2005; 20: 51-57]
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Masaki HORIE, Tsutomu OHTSUKA, Toshihiro SUZUKI, Soji YAMAZAKI
2005 Volume 20 Issue 1 Pages
58-61
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We report a case of an 89-year-old Japanese woman who presented with a subcutaneous tumor on the extensor aspect of her left upper arm. A histological examination of the biopsy specimen showed that the tumor suggested adenosquamous carcinoma or metastatic skin cancer. The tumor was surgically resected. A histological examination led to the diagnosis of adenosquamous carcinoma. No other tumor was found despite intensive examination including computed tomography and scintigraphy. The tumor was concluded to be a very rare tumor of skin origin. After 4 months, recurrence near the original tumor was found.
The patient is now being treated with radiotherapy. [
Skin Cancer (Japan) 2005; 20: 58-61]
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Yasuhiro ITO, Yuuichi IKEDA, Emi SATO, Masaki IBE, Hajime IIZUKA
2005 Volume 20 Issue 1 Pages
62-65
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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A 73-year-old man with cutaneous metastases from leiomyosarcoma is reported. The primary lesion on the upper back had been excised 13 years ago in 1988. In March 1991 local recurrence was noted and he received wide resection followed by CYVADIC chemotherapy and 50Gy irradiation. In March 2002 he noticed an asymptomatic 3.5 cm-sized nodule on his left elbow. Histologically, the tumor was composed of spindle cells with blunted nuclei in fascicular pattern. Immunohistological analysis showed that the tumor cells were positive for vimentin and α-smooth muscle actin. Following wide resection of the metastatic skin lesion, no recurrence or distant metastases were noted after 22 months' follow-up. [
Skin Cancer (Japan) 2005; 20: 62-65]
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Miho HIGUCHI, Hideki KAMIYA, Yasuo KITAJIMA
2005 Volume 20 Issue 1 Pages
66-69
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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Sclerosing epithelioid fibrosarcoma is a rare tumor of deep soft tissues, originally described in 1995 by Meis-Kindblom JM, Enzinger FM et al. It is characterised histologically by a predominant population of epithelioid cells arranged in strands and nests, embedded in a fibrotic and hyalinised stroma. Vimentin immunostains are consistently positive. We reported a case of Sclerosing epithelioid fibrosarcoma in a 53-year-old man. The patient had noticed a subcutaneous nodule in the left upper limb girdle for the past 3 years. Histologically, it consisted of epithelioid cells arranged in strands and nests, embedded in a fibrotic and hyalinised stroma. Only vimentin immunostains were consistently positive. [
Skin Cancer (Japan) 2005; 20: 66-69]
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Yasuhiro FUJISAWA, Yasuhiro NAKAMURA, Masashi ISHIKAWA, Yoshihiro UMEB ...
2005 Volume 20 Issue 1 Pages
70-74
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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Three patients with cutaneous malignant melanoma metastatic to the liver were treated in our institute, two with hepatic chemoembolization using cisplatin and gelatin sponge, and one with hepatic trans-arterial infusion using cisplatin only. Complete response was observed in one patient who survived without recurrence for 62 months. The patient with stable disease survived for 22 months ; the patient with progressive disease survived for 9 months but both died with tumor progression. In general, melanoma is fatal for patients with liver metastasis. The median survival time was estimated at only 4-7 months. We considered this therapy adequate therapy for melanoma patients with liver metastasis, for a prolonged survival time with less treatment related morbidity. [
Skin Cancer (Japan) 2005; 20: 70-74]
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Toshio YOSHIDA, Yuki NARITA, Nobuaki MORISHITA, Yoshihiro SEI, Yoshino ...
2005 Volume 20 Issue 1 Pages
75-78
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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The patient was a 64-year-old man. He had had erythema in the vulva for about 10 years. It spread gradually while nodes accompanied by ulcers developed. Surgery for skin tumor removal, skin grafting, and reconstruction of the urinary tract was performed.
Histopathological examination revealed Paget's cells in the epidermis, a papillary tumor focus that had proliferated from the superficial layer to the deep layer of the dermis, and a tumor focus comprised of squamous cells and signet-ring cells in the deep layer of the dermis. The tumor cells in the site of the papillary proliferation were positive for CAM5.2 and CEA staining and negative for GCDFP15. There was no decapitation secretion. Signet-ring cells were positive for PAS and CAM5.2 staining and squamous cells were negative for Ki-67 staining, which represents cell proliferation capacity. These findings suggest that Paget disease of the vulva progressed to papillary proliferation and squamous metaplasia in this patient. [
Skin Cancer (Japan) 2005; 20: 75-78]
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Rinko OSAWA, Satoru AOYAGI, Daisuke SAWAMURA, Satoshi MATINO, Sintarou ...
2005 Volume 20 Issue 1 Pages
79-83
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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A 61-year-old Japanese man presented with a five-year history of erosive lesions in the genitals. Histological findings of the skin lesions confirmed the diagnosis of subcutaneous invasion of extramammary Paget's carcinoma, and computed tomography revealed metastases of bilateral inguinal and left external iliac lymph nodes. The patient was treated with palliative resection of the genitals and left inguinal lesion, followed by low dose FP (5-FU, CDDP) therapy and simultaneous radiation therapy with 89 Gy to the lymph nodes and 59 Gy to the skin lesion. After 3 courses of the combination therapy, partial response was obtained in the lymph node metastases. After 6 courses, however external iliac lymph nodes enlarged in size and the local recurrence of skin lesion was observed. Low dose FP therapy combined with radiotherapy might be one of the armamentaria for assisting prolonged survival in the patients with advanced extramammary Paget's carcinoma. [
Skin Cancer (Japan) 2005; 20: 79-83]
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Atsushi OTSUKA, Makiko OKUNAKA, Naotomo KAMBE, Satoshi KOREEDA, Takao ...
2005 Volume 20 Issue 1 Pages
84-88
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We report a case of recurring Merkel cell carcinoma on the nose of a 90-year-old man. A radical operation was performed on the red nodule on his nose. However, 1 month later a red nodule 30×30mm in diameter was found on his nose and another red nodule 6×7mm in diameter appeared on his right cheek. The biopsy specimen revealed cytokeratin20-positive tumor cells localized in the dermis to subcutaneous fatty tissue. We chose radiotherapy treatment of (5MeV) for both lesions. When the total amount of irradiation reached 66 Gy, the tumor completely disappeared. We reviewed 21 reported cases of radiotherapy treated Merkel cell carcinoma and found a 24% rate of local recurrence. The recurrence cases with prophylactic lymph node radiation were observed only in 10%, whereas the recurrence rate without radiotherapy revealed 45.5%. Local recurrence and lymph node involvement are important prognostic factors. We suggest that adjuvant radiotherapy is very effective for Merkel cell carcinoma. [
Skin Cancer (Japan) 2005; 20: 84-88]
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Takashi INOZUME, Yuumi NAKAMURA, Rui AOKI, Tatsuyoshi KAWAMURA, Hiroyu ...
2005 Volume 20 Issue 1 Pages
89-92
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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Recently, MIA has been reported to be a useful marker in monitoring melanoma patients after primary surgery. We report a case of a melanoma patient accompanied by Von Recklinghausen disease (NF1) with high levels of serum MIA. This patient shows continuously shows a high level of serum MIA, despite no evidence of recurrence or metastasis. We analyzed the serum MIA level of 4 NF1 patients without melanoma, and in two cases the serum MIA level had clearly increased. These results suggest that we have to use MIA more carefully in its specificity, for melanoma patients accompanied by NFI. [
Skin Cancer (Japan) 2005; 20: 89-92]
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Takashi INOZUME, Yuumi NAKAMURA, Rui AOKI, Hiroyuki MATSUE, Naotaka SH ...
2005 Volume 20 Issue 1 Pages
93-98
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We administered DAC-Tam therapy as a treatment of the progressive stage of melanoma in a patient on maintenance hemodialysis. The patient received an infusion of CDDP (50mg/m
2) as the key drug in this treatment. We measured the plasma concentration of total platinum, and non-protein bound platinum of the patient. Measuring the pharmacokinetics of CDDP in serum, safe and sufficient concentration of CDDP ( 0.25μg/m
l<free platinum) in this patient's serum was determined. As the size of the lung's metastatic tumors had not changed for one month after CDDP administration, we concluded that this treatment was effective. There has been no report of DAC-Tam therapy in melanoma patients on maintenance hemodialysis. Our experience suggests that DAC-Tam therapy can be applied as a treatment of melanoma patients on maintenance hemodialysis, with careful dose adjustment and monitoring of CDDP. [
Skin Cancer (Japan) 2005; 20: 93-98]
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Kaori TSUJI, Yasuyuki NAKAJIMA, Rui MATSUOKA, Makiko ICHIKAWA, Naoki Y ...
2005 Volume 20 Issue 1 Pages
99-103
Published: May 13, 2005
Released on J-STAGE: August 05, 2010
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We reported a case of Merkel cell carcinoma which regressed spontaneously following an incisional biopsy. A 68-year-old female patient visited our department complaining of a reddish nodule on her left cheek that had grown in size in the three months prior to her visit. The biopsy specimen revealed large tumor cells with scanty cytoplasm and round nuclei tightly packed in sheet and trabecular patterns. The immunohistochemistry of the specimen indicated that it was S-100protein-, synaptophysin-, chromogranin A-, and cytokeratin-positive. The patient was diagnosed as having Merkel cell carcinoma. The biopsy revealed a dense, inflammatory cellular mass consisting of lymphocytes and histiocytes surrounding apoptotic tumor cells. The tumor regressed spontaneously within the month following the biopsy. [
Skin Cancer (Japan) 2005; 20: 99-103]
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