Stem cells are defined as cells that have the dual capacity to generate mature cells through differentiation and to maintain themselves through self-renewal. It is a widely accepted concept that stem cells are maintained by their specialized microenvironment known as the stem cell niche. However, particularly in most mammalian tissues, the niche has remained elusive, because of the difficulty of identifying individual stem cells and their surrounding components. To overcome these difficulties, we employed the melanocyte system which allows indentification of individual stem cells at the bulge region in the mouse hair follicle. We engineered transgenic mice to label melanocyte stem cells by GFP. We isolated melanocyte stem cells and performed gene expression analysis to obtain the gene expression signature of the stem cells. The data would help to understand the exact molecular mechanisms of the stem cell regulation at the niche and also provide new insight into melanocyte-related dysregulations such as melanoma. [Skin Cancer (Japan) 2006; 21: 10-17]

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A 51-year-old female noticed a red-colored elevated tumor that had first appeared on her left femoral region at the age of 20. Thirty-one years later, the lesion was removed by plastic surgery at our hospital. After the excised tumor was diagnosed as a malignant melanoma, she consulted our department.
After an enlargement operation and lymphadenectomy, DAV-Feron and D-Feron chemotherapy were administered to her. Nine months later after the enlargement operation, we discovered metastatic tumors of the liver and skin. Arterial injection of cisplatin was given to combat the liver metastases, while local INF-gamma therapy was given for the metastatic tumors of the skin. Treatment with 70 mg/m²/M cisplatin by arterial injection remarkably reduced the volumes of the liver and skin tumors. The side effects, however, were severe, requiring a reduction of the cisplatin dose to 7 mg/m²/2W. As a consequence, the metastatic tumors of the skin proliferated. Then, treatment had to be interrupted, due to the secondary infection of an ileus. The patient later died from disseminated intravascular coagulation (DIC) and brain metastases.
In this instance, CDDP arterial injection therapy contributed to a temporary reduction of the metastatic tumor. Therefore, CDDP arterial injection therapy appears to be effective against liver metastases. [Skin Cancer (Japan) 2006; 21: 18-22]

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A 58-year-old man noticed a tumor on his back and visited our hospital the next day, June 25, 2005. The tumor was black, Pedunculated, and 11×12×3 mm in size. The tumor was resected with a 1 mm margin. Histologic examination revealed the tumor was composed of nests of basal cell like cells with peripheral palisading and clefts between the nests and stroma. Some nests contained central foci of keratinization. The patient has survived without any sign of recurrence. Pedunculated basal cell carcinoma is a relatively rare disease, and 38 cases have been recorded, including our case, in Japan. We also reported 84 cases of basal cell carcinomas surgically excised in our hospital between 1993 and 2004. [Skin Cancer (Japan) 2006; 21: 23-26]

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A 51-year-old Japanese man visited our out-patient clinic, complaining of a 12×8 mm black tumor on his right chest. He had lanced this tumor several times by himself. The tumor was diagnosed as SSM on the basis of clinical and pathological findings, and then it was widely resected . No metastasis to the regional lymph nodes or distant internal organs was found. One year and 2 months after this excision, right axillary lymph node metastases were found, and shortly after metastatic tumors were discovered in multiple organs through the body. Their growth was so rapid and aggressive that the tumors continued to enlarge despite 2 courses of combination therapy with DAC-tam (CDDP, DTIC, ACNU and TAM) plus intra-tumoral injections of IFN-β combination chemotherapy. [Skin Cancer (Japan) 2006; 21: 27-30]

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The patient was a 57-year-old woman. She noticed a brown plaque on her left foot two years before the first visit to our department. The size and color of the plaque had not changed. When she was referred to our department, there was a brown plaque measuring 8.9×11.9×1.0mm in size on the inside of her left heel. The histological finding obtained from the specimens of excisional biopsy showed an increased number of melanocytes in the basal layer of the epidermis and clusters of atypical cells in the lower-dermis. Interestingly, however, there observed a thick fibrotic layer between the above two components was observed. The atypical cells in the lower dermis were S 100 and MART-1 positive but HMB45 negative. Our suspected diagnosis was malignant melanoma, and we performed not only wide local resection of the primary lesion but also sentinel lymph node biopsy. Histopathological examination of the sentinel lymph node revealed several cells which were immunohistochemically positive for MART-1 and HMB45 in the peripheral parenchyma of the node. We finally diagnosed this case as malignant melanoma, and the patient received local injections of interferonβ as an adjuvant therapy. [Skin Cancer (Japan) 2006; 21: 31-35]

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We report two cases who experienced acute myocardial infarction (AMI) related to the chemotherapy they received for melanoma. The first case was a 61-year-old female with hyperlipidemia. She developed AMI on the 9th day of the third chemotherapy course with conventional doses of dacarbazine, nimustine, cisplatin and tamoxifen (DAC-Tam) . Laboratory data showed a rapid increase in hyperlipidemia during the chemotherapy. Cisplatin and tamoxifen can increase serum lipids. The second case was a 69-year-old male who developed AMI on the first day of the second chemotherapy course with conventional doses of dacarbazine, nimustine, vincristine, interferon-beta (DAVFeron) . Enhanced CT, which was taken only 3 hours after the infusion of the dacarbazine and vincristine, revealed a thrombosis in the coronary artery. We suspect that the case of the AMI was closely associated with the chemotherapy, since this type of chemotherapy can induce hypercoagulation. [Skin Cancer (Japan) 2006; 21: 36-40]

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Ray amputation of the left little finger was performed on a 70-year-old woman due to cutaneous malignant melanoma (Stage IA). No recurrence or metastasis was found during a 10-year follow-up after the surgery. Twenty-four years after the surgery, massive subcutaneous and distant lymph node metastases were found. Liver and lung metastases were also progressive. DTIC, ACNU, CDDP, and Tamoxifen (known as DAC-Tam regimen) were used for systemic chemotherapy. The liver metastasis was treated with intra-arterial CDDP and beta-interferon injection combined with TAE. After three courses of the chemotherapy, lymph node and subcutaneous metastases had decreased, but the liver metastasis showed no change. She died of brain metastasis one year after the first detection of the metastases. [Skin Cancer (Japan) 2006; 21: 41-44]

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We reported a case of eyelid reconstruction for full-thickness defects of the lower eyelid after wide resection. A 74-year-old woman presented with Lentigo maligna melanoma of the lower eyelid. Surgical resection of the tumor was carried out along a clinically 12 mm normal skin margin. Fullthickness defects of the lower eyelid were reconstructed with cheek flap and conchal cartilage graft. The raw surface of the perichondrium was epithelialized from surrounding mucosa about 1 month after the operation. Ten months postoperatively, the patient has no sign of recurrence, and the aesthetic result is satisfactory. [Skin Cancer (Japan) 2006; 21: 45-48]

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We obtained the chance to perform a sentinel node biopsy (SNB) using a scintillation survey meter that is used as a measuring instrument for gamma ray inspection instead of as a gamma-probe. Our patient was an 89-year-old woman. Two sentinel nodes (SN) were identified using the dye method with lymphoscintigraphy and the scintillation survey meter for malignant melanoma of the right sole. Because the point of the sensor was large, the following were noted: 1. The SNB operation scar became wider. 2. When two or more lymph nodes were adjacent, it was difficult to distinguish SN from Non-SN. 3. It was difficult to use the survey meter at a location that was complicated three-dimensionally such as an axilla. [Skin Cancer (Japan) 2006; 21: 49-52]

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A strategy for the treatment of patients with cutaneous melanoma, who have regional lymph node swelling, is wide excision of the primary lesion and regional lymph node dissection or sentinel lymph node biopsy. However, occasionally in-transit metastasis occurs after regional lymph node dissection. Subtotal integumentectomy is applied to prevent in-transit metastasis, although the clinical usefulness of subtotal integumentectomy is still controversial. Therefore, we analyzed 19 cases who had subtotal integumentectomy in our departments. The prognosis of the patients who had subtotal integumentectomy is better than those without. Therefore, subtotal integumentectomy is an optional method for treating patients at high risk for in-transit metastasis. [Skin Cancer (Japan) 2006; 21: 53-57]

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An 83-year-old man presented with a 5-year history of an erythematous lesion on his head, which had been diagnosed as eczema and treated with topical corticosteroids. Physical examination revealed infiltrative erythemas and plaques on the parietal, right temporal, and occipital lesion of the head. Pigmented macules were also observed on his back and chest. A biopsy specimen from the parietal lesion exhibited infiltration of large-sized, atypical lymphoid cells along with a basal layer of epidermis and around the hair follicles in the upper dermis with mucinosis. Part of the infiltration formed a microabscess. These observations led to the diagnosis of follicular mycosis fungoides (FMF) stage Ia. In spite of internal PUVA therapy (100 J/cm² of total dose), the tumor cells remained in the plaque lesion. Electron irradiation was performed on the remaining lesion, and the eruption became flat. [Skin Cancer (Japan) 2006; 21: 58-61]

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We report a case of Myxofibrosarcoma. A 40-year-old female patient visited our department complaining of a dark red tumor on her upper abdomen which had grown in size to 2cm during the two years prior to her visit. An excisional specimen revealed spindle cells with storiform pattern, pleomorphism and atypia which had penetrated the dermis and the subcutaneous layer. They tended to arrange themselves around a curvilinear vasculature. The amount of myxoid change was 10%. The immunohistochemistry of the specimen indicated that it was S-100, CD-34, SMA negative. The tumor was diagnosed as a Myxofibrosarcoma, intermediate grade. An additional wide local excisional specimen revealed two satellite nodules around the area of the original excision. No recurrence or distant metastases were noted after 18 months' follow-up. [Skin Cancer (Japan) 2006; 21: 62-66]

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Leiomyosarcomas, occurring in middle age and most commonly on the extremities, develop as solitary, painful or tender intra-or subcutaneous nodules showing a relatively benign biologic course. We reported a 39-year-old male with a subcutaneous tumor seen in the left arm region. Histological appearance of the tumor corresponded to cutaneous leiomyosarcoma, showing spindle-shaped atypical myomatous cells. Immunohistochemical studies demonstrated positivity of the tumor cells for α-smooth muscle actin and desmin. The leision was completely excised with wide margins. He has been free from recurrence or metastasis for thirteen months. [Skin Cancer (Japan) 2006; 21: 67-70]

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Spindle cell lipoma (SCL) is a rare tumor of soft tissues, originally described in 1975 by Enzinger FM and Harvey DA. It is characterized by a mixture of mature adipocytes and undifferentiated spindle cells. This report presents a 39-year-old male case with spindle cell lipoma on his right posterior thigh. He noticed the tumor four years ago. He visited our hospital because the size of the tumor had gradually increased and was accompanied with inflammation. A histological examination of the biopsy specimen showed that the tumor suggested lipoma. The tumor was surgically resected. A histological examination led to the diagnosis of well differentiated liposarcoma, and a wide local excision was performed. We reconfirmed the specimen because there was no typical lipoblast. From the histological and the immunohistological findings, we made a diagnosis of SCL. It is difficult to ascertain a diagnosis of SCL at time. SCL tends to be misdiagnosed as liposarcoma and treated as such. Therefore, it is very important to take a differential diagnosis of SCL into consideration, if the tumor is diagnosed as liposarcoma. [Skin Cancer (Japan) 2006; 21: 71-76]

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We reported a 74-year-old woman with angiosarcoma on the lower abdomen. Ten years before, she had undergone a radical hysterectomy and postoperative radiotherapy, 50 Gy in total, for squamous cell carcinoma of the uterine cervix. After the therapy, she suffered from long lasting lymphedema on her lower abdomen and lower extremities. Nine years later, a purplish macule appeared on her lower abdomen and soon after, reddish nodules developed and enlarged quickly.
The biopsy specimen from the skin lesion revealed the features of angiosarcoma. Since the tumor was widely spread over the abdomen and extended to the genital regions, docetaxcel was firstly injected weekly, and then cyclophosphamide was administered. However, these drugs produced no observable no clinical effect. Thereafter, interleukin-2 (IL-2) was locally injected, which showed effect on several tumor nodules for 6 months. After that, the angiosarcoma relapsed and she died of cachexia one year later. [Skin Cancer (Japan) 2006; 21: 77-80]

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A 45-year-old woman had noticed a tumor on her right thigh for ten years. Since the tumor had increased in size during the past several months, she visited a doctor and complete surgical excision was performed. On histological examination, this tumor consisted of basaloid cells with eosinophilic cytoplasm and closer examination revealed numerous ductular structures. These ducts were highlighted by CEA and EMA immuno-staining suggesting that this tumor had a feature of eccrine differentiation. We performed a wide resection and right inguinal lymph node dissection. There were no distant metastases other than right inguinal lymph node metastasis. After the surgical treatment, three courses of low-dose FP therapy and two courses of FECOM therapy were performed. Two years after the excision, multiple small nodules and erythema developed on her right leg. The diagnosis of EPC with retrograde extension of wide-spread cutaneous metastasis was made. Palliative radiotherapy was employed without significant results, she died of DIC. [Skin Cancer (Japan) 2006; 21: 81-84]

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We report a case of a 43-year-old Japanese man who presented with a red tumor on the left side of the back of his head. The histological examination of a biopsy specimen initially suggested a metastatic lesion of adenocarcinoma. The tumor was surgically resected. No other tumor was found despite intensive examinations including positron emission computed tomography. Together with the histological and immunochemical examinations, he was diagnosed with classic type of eccrine adenocarcinoma. Multiple metastases were found in the lymph nodes and lungs. Although chemotherapy was not effective for the lung lesions, the local radiation reduced the size of the lymph nodes and the pain from bone metastasis. In this case, the radiotherapy was useful for quality of life. [Skin Cancer (Japan) 2006; 21: 85-90]

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A 78-year-old woman began to develop a reddish and pedunculated tumor on her scalp half year ago. The tumor was excised with a 5 mm margin, and the defect was covered by skin grafting. No recurrence of the tumor was recognized up to a year after the operation. Histological findings showed sarcomatous features at almost all parts of the tumor and an adenomatous lesion at the bottom. These two lesions had transition and the same findings revealed by immunostain. Then we considered this tumor was consistent with a sarcomatous type of spiradenocarcinoma described by Ackerman (1998). [Skin Cancer (Japan) 2006; 21: 91-95]

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The patient was a 62-year-old male who had noticed a folliculitis-like rash on his right shoulder which had gradually enlarged. The first medical examination revealed a hard cystic-like tumor which was 2.5cm in diameter on the lateral side of the right shoulder and its surface revealed teleangiectasia. We excised this tumor with about 5mm of marginal tumor free skin and diagnosed it histologically as angiosarcoma. Then the patient was injected with IL-2 (total dose of eight million units). One month later after finishing IL-2 injection therapy, local recurrence of angiosarcoma emerged. It was excised again. Then he was treated by electron beam therapy (total of 60 grays). As of July 2005, we observed neither new local recurrence nor metastasis. Few cases of angiosarcoma on the shoulder have been reported and this case was thought to be very rare. [Skin Cancer (Japan) 2006; 21: 96-100]

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A 70-year-old woman had multiple subcutaneous tumors on the left thigh for ten years. The tumors were excised at our hospital and the diagnosis was neurofibroma. Since the tumor cells showed slight atypia, she was under our observation. One year and a half later, a subcutaneous tumor which was 3 cm in diameter appeared on the left groin. Incisional biopsy revealed tumor cells with nuclear atypia, a lot of mitoses and high cellular density. Immunohistochemically the tumor cells were positive for S-100 protein and vimentin. The tumor was diagnosed as malignant peripheral nerve sheath tumor (MPNST) . Wide excision of the tumor and dissection of the left inguinal lymph nodes were performed and lymph node metastasis was found. Therefore 4MeV X-ray was used postoperatively. Since then, her course has been uneventful for one year. Lymph node metastasis of MPNST is quite rare, and possibly her neurofibromatosis is type V. [Skin Cancer (Japan) 2006; 21: 101-104]

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We report a case of basal cell carcinoma (BCC) that developed after radiation therapy. A 63-year-old woman, who had received an unknown amount of radiation therapy for the treatment of nevus spilus on the right breast, shoulder and arm at the age of 20, presented with an erythema with crust within the area of chronic radiation dermatitis. A biopsy of the lesion showed a BCC.
We discuss the occurrence of cutaneous carcinoma after radiation therapy. [Skin Cancer (Japan) 2006; 21: 105-108]

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