We report a case with a combined neoplasm arising from a nevus sebaceous. A 58-year-old man was presented with a partially ulcerated giant tumor and a small black tumor on his scalp, on which he had a skin-colored plaque since his childhood. Surgical resection was performed, and the two tumors were pathologically diagnosed as squamous cell carcinoma and basal cell carcinoma, respectively, which developed in a nevus sebaceous. The diagnosis of trichilemmal carcinoma and of trichoblastoma, respectively, were carefully excluded. No recurrence or metastasis was observed during the follow-up of 20 months after the excision. [Skin Cancer (Japan) 2005; 20:116-120]

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e report two cases of basal cell carcinoma (BCC) with lymph nodes metastasis.
Case 1: A 70-year-old man had developed a 60×20mm-sized ulcer on his left inguinal lesion. Histopathology of the ulcer revealed BCC. The wide resection of the tumor and dissection of the regional lymph nodes were performed. In the lymph nodes, no sign of metastasis was seen. Four years later, lymphadenopathy of the right inguinal lesion and lymphoedema of the right leg was found. Biopsy of the right inguinal lymph node presented metastasis of BCC. Metastases of his pelvic lymph nodes were also found. Chemotherapy with cisplatin and adriamycin was performed but the result was ineffective.
Case 2: An 82-year-old man had developed a 70×60mm-sized ulcer with black nodules on his right cheek for 10 years. Histopathology of the nodule revealed BCC. Tumor invasion to his muscular layer and swelling of his right cervical lymph node was found on CT. Radiation therapy was performed and the ulcer healed up. [Skin Cancer (Japan) 2005; 20: 121-126]

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In this study, we evaluated 207 patients (123 males and 84 females) with basal cell carcinoma (BCC) who were registered during the past eighteen years (1985-2002) in the department of dermatology, the hospital of Hyogo college of medicine. The diagnosis of BCC was made, based on histopathology. The incidence of BCC had not changed during the period. In 247 lesions of the cases, BCC was most frequently located on the face (70.4%), especially on the nose, eyelids and cheeks. The nodular type was most common (37.7%), and the mixed type was found unexpectedly more frequently (28.3%) . We propose to establish the histological classification of BCC including the mixed type. [Skin Cancer (Japan) 2005; 20: 127-131]

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We report a case of sebaceoma on the finger. A 55-year-old woman visited us with a reddish nodule on the fourth finger. She was treated with cryotherapy after being diagnosed with granuloma teleangiectaticum. Four years later, she visited us again with an enlarged tumor.
On physical examination, a 10×10 sized reddish or yellowish domed tumor was found on the same region. Histological analysis revealed a well-demarcated oval tumor composed of irregularly shaped cell masses and tubular structures. Although the majority of the cells were undifferentiated basoloid cells, many cells showed differention toward sebaceous cells. We diagnosed her with sebaceoma. [Skin Cancer (Japan) 2005; 20: 132-134]

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Excision of malignant tumor of the eye lid is often inadequate because of the difficulty of repairing, and functional and cosmetic problems. We report a case of meibomian gland carcinoma of the eyelid, whose initial excision was incomplete because tumor infiltration was more severe than our preoperation assessment. Additional wide excision including orbital exenteration was performed. [Skin Cancer (Japan) 2005; 20: 135-137]

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A 71-year-old man had a reddish brown, plaque 70×60mm in size and slightly elevated with a 10×10mm nodule. Histologically the nodule showed tumor cell nests invading into the dermis and connected with the epidermis. It was considered to be eccrine porocarcinoma.
The nodule was seen adjoining a purely intraepidermal eccrine poroma (hidroacanthoma simplex). We diagnosed this tumor as malignant hidroacanthoma simplex. [Skin Cancer (Japan) 2005; 20: 138-141]

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A 67-year-old woman presented with a 10year history of a tumor on the left aspect of the scalp, which had been progressively elevated for the past year. She had a 45×67×45mm firm tumor that was fixed to the underlying skin on the left parietal region. The tumor was removed at a distance of 1cm from the margin. Histologically, the tumor was located from the upper dermis to the subcutaneous tissue, forming sheets or cords of cells and tubular structures. Most of the chondroid matrix was composed of eosinophilic stroma. In some areas, the tumor cells with markedly atypical nuclei diffusely proliferated. Immunohistochemically, the tumor cells were positive for CEA, S-100 and GCDFP-15, but negative for HHF-35 and α-SMA. Based on these findings, we diagnosed the tumor as malignant chondroid syringoma. [Skin Cancer (Japan) 2005; 20: 142-145]

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A seventy-five-year-old man presented with an ulcerated nodule, 12mm in diameter on his lateral canthus. Histologically, the tumor was composed of atypical spindle cells and atypical squamous cells. We diagnosed this tumor as spindle cell squamous cell carcinoma. The local flaps elevating from the cheek were used for reconstruction of the lateral canthus and lower eyelid defects. [Skin Cancer (Japan) 2005; 20: 146-149]

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Sentinel node biopsy is now widely accepted as the most accurate prognostic indicator in the treatment of melanoma. Either the presence of melanoma metastasis in the sentinel node or of the palpable inguinal node indicates the treatment of inguinal lymph node dissection. However, the requirement for iliac node dissection is still controversial when the inguinal node metastasis is recognized. From April 1999 to October 2003, we treated 23 melanoma patients with inguinal lymph node dissection. In addition, we performed iliac node dissection on 8 out of 23 patients who had the palpable inguinal node or the sentinel positive lymph node metastasis with more than 4mm thickness of the primary tumor or with ulcerated primary one. Two out of 8 patients treated with the additional dissection had iliac/obturator node metastasis and died within 2 years after their operation. [Skin Cancer (Japan) 2005; 20: 150-153]

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We report a case of superficial leiomyosarcoma that occurred on the buttocks of a 67 years old Japanese female. The lesion was breitbasig erythematous tumor, 11×10×2.5cm in size, with erosion, ulcer and fur on the surface and pigmentation around the tumor. Histopathologically, tumor cell nests were present in the upper dermis down to the subcutaneous fatty layer, near the fascia in some areas and the spindle cells with large atypical nuclei and eosinophilic cytoplasm were proliferating with a fascicular pattern. Abnormal mitoses were also observed. The diagnosis of superficial leiomyosarcoma was made hstopathologically, immunohistopathlogically and electron microscopically. A wide excision was performed at a margin of 3cm from the lesion. A part of the muscle under the tumor was removed. She has been free from recurrence or metastasis for 14 months after surgery. [Skin Cancer (Japan) 2005; 20: 154-157]

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Dermatofibrosarcoma protuberans (DFSP) is a tumor that often rises in the skin of the trunk and the extremities. Although margins of tumors seem to be clear, tumor cells frequently invade widely into the subcutaneous tissue and the muscle through the fascia. Treatment of DFSP principally requires extended excision. If the tumor is excised incompletely, DFSP frequently recurs. Particularly recurrence rate of DFSP in the scalp is very high. Recently Mohs micrographic surgery (MMS) has been recommended for treatment of DFSP.
We reported a 23-year-old male who presented with a tumor of 4cm in diameter in the scalp, which was removed with a 2cm surgical margin, involving the pericranium. The skin defect was applied with an artificial dermis. After no residual tumor was confirmed by the permanent section, the defect was covered secondarily with a skin graft.
Although MMS is considered to be the best treatment for DFSP, it is not available in our facility yet. In our case we had selected a treatment with confirming non-residual tumor cells by the permanent sections and secondary skin grafting. We discussed the best treatment for DFSP, including MMS. [Skin Cancer (Japan) 2005; 20: 158-161]

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A 16-year-old girl was referred to Toyokawa Municipal Hospital with a red tumor on her left buttock. Because a malignant rhabdoid tumor was suspected by pathological examination of the excisional biopsy, she was referred to our dermatology department. Based on the immunopathological findings, malignant rhabdoid tumor and malignant epithelioid schwannoma with rhabdoid features were excluded. We finally diagnosed her with amelanotic malignant melanoma with rhabdoid features. The appearance of rhabdoid cells is extremely rare in a primary malignant melanoma. [Skin Cancer (Japan)2005; 20: 162-165]

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We reported a case of extramedullary plasmacytoma of the testis, with a subsequent development of cutaneous tumor lesions. A 78-year-old man presented with a swelling of the scrotum, cutaneous tumors on his chest and abdomen. In addition, bilateral blepharoptosis and left oculomotor nerve palsy were seen. Head CT revealed a lesion, localized from pituitary fossa to sphenoid sinus. Histopathological findings showed that both testicular and cutaneous tumors were composed of many plasma cells, which were immunohistochemically positive to CD38 and CD79 α, but negative to CD20. Bone marrow biopsy disclosed normal findings and no neoplastic cell. We diagnosed this case as an extramedullary plasmacytoma of the testis origin, which developed subsequently cutaneous tumors. Therapy with radiotherapy and chemotherapy was performed, and the cutaneous tumors disappeared. However, local recurrence with disseminated cutaneous tumors occurred after 9 months. Then, a combined therapy with surgical excision, radiotherapy, and chemotherapy was performed, which resulted in a disappearance of the disseminated, cutaneous tumors. [Skin Cancer (Japan) 2005; 20: 166-170]

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We describe a case of multicentric Castleman's disease of a 48-year-old woman, which was initially manifested in the skin. She had been followed up for 17 years and 10 months. She had multiple, slowly enlarging erythematous plaques on her chest, back, abdomen and face. An initial cutaneous biopsy specimen was diagnosed as plasma cell type of Castleman's disease. Immunohistochemically, the tumor cells showed no light chain restriction. Only oral and topical steroids were administered. After 5 years and 6 months from initial diagnosis, she had similar cutaneous lesions on her chest and face with lymphadenopathy. Lymph node biopsy showed a plasma cell type of Castleman's disease and bone marrow aspiration showed plasma cell proliferation. As the serum IL-6 was elevated (17.7pg/ml), she was dignosed as having multicentric Castleman's disease. By only steroid therapy again her cutaneous lesions and lymphadenopathy have disappeared. As the serum immunoglobulin is still elevated (IgG, 7114mg/dl; IgA, 735mg/dl), anti-human interleukin-6 receptor antibody is going to be administrated if she develops new cutaneous lesions. [Skin Cancer (Japan) 2005; 20: 171-175]

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It is a doubtful of whether physicians accomplish adequate diagnosis and prompt treatment to those with SCC of the lip (L-SCC), even though it has a high potential for metastasis. Herein two cases with highly malignant L-SCC are reported. As they were suspected to be malignancy, so skin biopsies were done as usual. Unfortunately the pathological diagnoses were benign epithelial hyperplasia, and the patients lost the chance to undergo early treatment. As a result, the prognosis was poor, such as one had deep infiltration of tumor cells into the muscle layer, and in the other one's specimen, tumor cells attached to dermal vessels and eventually metastasized to the lung. We emphasize that the early stage of L-SCC often shows mild features clinically and pathologically. The important hints of diagnosis of L-SCC are elevated appearance and verrucous histopathology, which is often diagnosed as verrucous carcinoma. Such cases could become more malignant with time. [Skin Cancer (Japan) 2005; 20: 176-182]

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Distribution and color of dots on dermoscopy are important for discrimination of melanoma from nevus. We analyzed differences of dots distribution and numbers on dermoscopic images of melanoma and Clark nevus. A total of 188 cases of Clark nevus and 75 cases of melanoma have been analyzed for dots using a closing operation filter to detect small areas on a computer. It was found that there were characteristic differences regarding peripheral dots between melanomas and Clark nevi. [Skin Cancer (Japan) 2005; 20: 183-189]

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We have analyzed color information from dermoscopy images of melanomas, Spitz nevi and Clark nevi. All the colors were divided into 4096 colors by RGB components. The area ratio of each color to the total lesional area was calculated and compared between Clark nevi and melanoma or Spitz nevi. Twenty-one colors were detected as melanoma specific colors and 9 were detected as Spitz nevus specific colors. These specific colors seemed to contain colors of blue-white structures and colors of amelanotic melanoma. 7 of 9 Spitz specific colors were also included in the melanoma specific colors. This could explain why Spitz nevi are sometimes misdiagnosed as melanoma. Using melanoma specific colors, 28 cases (37.3%) of melanoma were extracted without detecting a Clark nevus. [Skin Cancer (Japan) 2005; 20: 190-196]

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We have constructed an automatic server for discrimination of melanoma and Clark nevus using a neural network. We have used a combination of Java language and C language to compensate for respective shortcomings, namely that Java is slow and C is not user-friendly. Our new program works parallel and efficiently analyzes the image and returns a result without delay. The program, after reconstruction, turned to run without a break. We also used a neural network system, instead of a linear discriminant analysis. The neural network has enabled more compound discrimination. Moreover, we have elaborated a new specific algorithm to analyze acral lesions. This program enabled us to distinguish among parallel furrow, parallel ridge and fibrillar patterns. There have been no reports to discriminate acral lesions in the literature so far. [Skin Cancer (Japan) 2005; 20: 197-202]

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Between April 2001 and August 2004, 33 melanoma patients underwent sentinel lymph node (sLN) biopsy. We used a technique which included the blue dye method, lymphscintigraphy, and a gamma probe. sLN resection succeeded in 31 (93.9%) of 33 patients and the total number was 60 sLNs (average 1.94) . The gamma probe was very useful in detecting sLN. Melanoma metastases were detected in 7 patients (21.2%) . 6 patients underwent regional LN resection and were still tumor-free, but in-transit metastasis was found in the patients who had not undergone regional LN resection. Two patients developed postoperative metastases among the sentinel-negative patients. We evaluated the sLN metastasis by HE staining, immunohistochemical staining with several specific antibodies, and RTPCR. In order to improve the precision of the diagnosis, we thought it useful to use two or more methods. [Skin Cancer (Japan) 2005; 20: 203-209]

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A trial of Moh's method and moxibition for two terminal patients with malignant melanoma (MM) and squamous cell carcinoma (SCC) was reported.
A 77-year-old man noticed pigmentation on his left toenail, for which excision was performed in a nearby hospital. He visited our department's hospital on Aug. 18th, 1998, because of a complaint of inguinal lymph node swelling, and was diagnosed with MM with metastasis of the lymph node, so that amputation of the left toe was performed with anti-cancer chemotherapy: DAV-feron. However, multiple metastatic tumors were noticed in the left inguinal portion around the skin-graft lesion, and the tumor grew rapidly although local excision was carried out several times. Finally, Moh's method was begun, however, the tumor became rapidly elevated, so that moxibiton was tried for the tumor, and necrosis change was seen after several trials. Histopathological examination biopsied from the necrotic mass revealed no positive cells of MM in the dermis. He died March 15th, 2000, due to cardiac failure with candidiasis on the black of his tongue.
A 63-year-old man noticed an elevated tumor near his nose, and was diagnosed with inflammatory reaction histopathologically in a nearby otolaringological clinic. He visited our department's hospital on June 13th, 2000, with the complaint that the tumor was gradually growing, and a biopsy was carried out, which was diagnosed as SCC. Wide resection of the tumor was performed with radiation therapy (totally 60 gray) ; however, a metastatic tumor was seen in the neck which gradually grew and invaded the parotid gland and tongue cartilage. It was impossible to remove this lesion surgically. Subsequently, combination therapy with Moh's method and moxibition was started and effective for inhibition of the tumor growth. Histopathological examination biopsied from the necrotic mass after the moxibiton revealed few SCC tumor cells with necrotic change in the dermis. The patient was in hospitalization, Nov. 3rd, 2001, again, and he died Feb. 23rd, 2002, due to multi-organ failure.
Moh's method was useful and effective for terminal or inoperative patients with metastatic tumors, for which, additionally, moxibition revealed some evidence of inhibitory function as well as improvement for various kinds of complaints as reported previously. [Skin Cancer (Japan) 2005; 20: 210-218]

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A 56-year-old man presented a hard, painless palpable mass in his left axilla. Resected tumor cells showed an epithelioid appearance with eosinophilic cytoplasm, forming a sheet-like or a nodular arrangement with central necrosis. Immunohistochemical staining showed positive for Keratin, EMA, Vimentin, CD34, and SMA. Recent reports have shown that CA125 is expressed in epithelioid sarcoma and its serum values correlate with the progress of the disease. Although serum CA125 was within reference value, membranous staining of CA125 was also confirmed in our case. We will carefully monitor the serum CA125 value to see if it would be useful as a tumor marker to follow up the course of the disease. [Skin Cancer (Japan) 2005; 20: 219-222]

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