Late recurrence of melanoma, 10 years or longer after initial diagnosis, can occur, although not frequently. A 57-year-old woman developed metastasis of cutaneous melanoma 12 years after initial resection of the primary lesion. Surgical resection and chemotherapy were performed, but she died of repeated recurrence and metastasis of the melanoma about half a year after the late recurrence. The patient had kept on receiving regular medical examinations for 7 years after initial treatment, and then she had discontinued receiving the examinations according to her self-judgment. At present, no identifiable risk factors were found for late recurrence of melanoma, because many prognostically favorable melanomas have occurred after prolonged disease free intervals. Therefore, we must keep the possibility of late recurrence and the importance of long-term follow-up in mind in any patient with melanoma. A standard long-term follow-up protocol may be desired, and useful for the cure of cutaneous melanoma. [Skin Cancer (Japan) 2007; 22: 10-15]

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A 68-year-old woman presented to us with a 4-year history of nodule on her left cheek. The tumor was 12.9×9.0cm in size and invaded muscles. Parotid gland and neck lymphnode metastases were also observed. The patient received chemotherapy composed of cisplatin 70mg/m², day 1, and 5-fluorouracil 700mg/m², day 1-4, with concurrent radiotherapy. After one course of chemotherapy with a total dose of 70Gy of radiotherapy, the size of the primary tumor was reduced to 27% of the original size and both the parotid and neck lymphnode metastases were clinically diminished. The residual lesion was surgically removed. After 45 months' follow-up, there was no evidence of recurrence or systemic metastases. [Skin Cancer (Japan) 2007; 22: 16-21]

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A 79-year-old women, who 13 years earlier underwent a typical mastectomy for solid ductal carcinoma of the right breast, 6 months later developed postmastectomy lymphedema in the right arm and experienced repeated remissions and exacerbations. Twelve years after the surgery, erythema associated with suggilations, and dark red papules on the erythema developed on the flexor side of the right upper arm.
Histologically, the lesions appeared to be angiosarcoma and led to the diagnosis of Stewart-Treves syndrome due to chronic postsurgical lymphedema on the affected side. Tests for Factor VIII, CD34, CD31 were positive in the region of the tumor cells. Therapy consisted of IL-2 injection and electron beam irradiation. Five weeks after initiation of the therapy the lesions expanded. Therapy centered on pain relief, but the patient died 115 days after the first visit. This disease is rare and revealed the importance of terminal care. [Skin Cancer (Japan) 2007; 22: 22-26]

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A 64-year-old woman had a slowly increasing tumor in the parietal area, 35×20mm in size, an indistiict border, and elastic hard for four or five years, poor in mobility with a lower bed. We removed it surgically from the periosteum. Histologically, the tumor consisted of three kinds of tumor components as follows: 1. irregular nests which comprise squamoid cells in the upper to middle dermis, 2. substantial nests which comprise clear cells in the middle to lower dermis. 3. small nests which comprise cells having a circular nucleus and poor cytoplasm in the middle dermis to the galea aponeurotica. They have slight nuclear atypia, but no mitosis. Because of perineural infiltration, and infiltration of the galea aponeurotica, we performed an additional excision of the periosteum and the skull shell. One year and 6 months after the operation, no recurrence has occurred. [Skin Cancer (Japan) 2007; 22: 27-31]

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The patient was a 50-year-old male, who felt something was wrong with his dorsolumbar area. CT revealed a tumor at his retroperitoneum. A needle biopsy was performed twice, but no diagnosis of malignancy was made. Lumbago occurred a year later, and an enlargement of the tumor was found by CT. A needle biopsy was performed again, and a malignant tumor was suspected. The tumor was removed with tissues around the tumor. Then, the diaphragm, chest wall, and abdominal wall were reconstructed by muscle flaps. The tumor was diagnosed as myxofibrosarcoma in most areas but myxoid malignant fibrous histiocytoma (myxoid MFH) in some areas.
It is very difficult to diagnose MFH by a small quantity of biopsy, including a needle biopsy, because MFH shows variable structures in the same tumor. So, it is important to get a sufficient amount of tissue for diagnosis when we doubt MFH. [Skin Cancer (Japan) 2007; 22: 32-35]

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A 39-year-old woman visited our hospital, complaining of a painful tumor in her right foot. A tumor biopsy and magnetic resonance imaging (MRI) were performed, and we recommended an amputation of her right leg. The patient and her family refused the surgical treatment, and the patient was discharged from our hospital. About 5 months later, she revisited our hospital, and complained that the tumor had become larger and she could no longer walk because of the pain. The patient decided to undergo the amputation and was admitted to our hospital. The amputation was performed, and the pathological findings revealed a synovial sarcoma. Using reverse transcriptase polymerase chain reaction, the tumor was shown to express the SYT-SSX type 1 gene complex. [Skin Cancer (Japan) 2007; 22: 36-38]

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A 72-year-old woman was aware of a subcutaneous nodule with no swelling on the inner side of her right lower leg about 3 weeks before visiting our clinic. The tumor was hard and 8×8mm in size, and the skin surface was light red. A histopathological examination revealed that a nest of tumor cells with round nuclei and poor cytoplasm was localized in the deep dermis to subcutaneous fatty tissue, and did not extend into the epidermis. Electron microscopy demonstrated dense core granules in the intracellular space of the tumor cells. The primary lesion and right inguinal lymph nodes were irradiated after excision of the tumor. No recurrence or metastases were observed postoperatively for 19 months. As most Merkel cell carcinoma appears to be a nodule raised on the face, the clinical features of our case were unusual. [Skin Cancer (Japan) 2007; 22: 39-43]

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Angiosarcoma of the scalp is known as a rare sarcoma arising in the elderly, and for its desperately poor prognosis. However, recent treatment modalities have improved the prognosis of the patients. We herein report the clinical features and follow-up data of 12 patients (8 men and 4 women, average age 76) with angiosarcoma of the scalp treated at Kanazawa University Hospital between 1995 and 2005.
A total of 9 patients underwent surgical excision in combination with chemotherapy, recombinant interleukin 2 (r-IL2) and/or radiotherapy. Two patients received only r-IL 2 or radiotherapy and one received radiotherapy and r-IL2. Six of the 12 patients received radiotherapy for post-surgical adjuvant and two for recurrent disease. Weekly docetaxel chemotherapy was performed in 3 patients to treat pulmonary metastasis and in 5 patients as an adjuvant therapy after surgical excision.
Local recurrence was observed in 5 of 8 patients after a disease free interval. Six of the 12 patients died of pulmonary metastasis of angiosarcoma, and one died of disseminated intravascular coagulation at an average of 7.6 months after initial therapy. A group of patients who underwent adjuvant weekly docetaxel chemotherapy showed significantly longer survival rates than the others. [Skin Cancer (Japan) 2007; 22: 44-48]

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Case 1: A 71-year-old female felt a sense of discomfort, and bled on her left fifth finger nail for several months. Under her nail, a reddish macule was observed. A biopsy suggested Bowen's disease. A second biopsy revealed squamous cell carcinoma. We separated the tumor from the periosteum and removed it, including her whole nail.
Case 2: A 65-year-old male who had been hospitalized with dementia nipped his right fourth finger with a door, then found bleeding and swelling. Under the nail, an elastic soft tumor measuring about 1 cm was observed. A biopsy revealed squamous cell carcinoma. We amputated the finger at the DIP joint.
Cases of squamous cell carcinoma under the nail are rare. Moreover, it is difficult for patients to consent to a biopsy, because it needs a removal of the nail. These circumstances often cause a delay of diagnosis. It is sometimes difficult to make a correct diagnosis from small pieces of a biopsy specimen. Therefore, it is important to repeat biopsies as necessary. [Skin Cancer (Japan) 2007; 22: 49-52]

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Basal cell carcinoma (BCC) is a tumor that often arises from the skin on the face. When it occurs on the trunk, however, it is often difficult to diagnose it as BCC because of various clinical appearances.
We reported an 83-year-old Japanese female, who noticed a skin tumor in the right groin since 1999. It had gradually grown and showed intermittent bleeding and discharge, so she visited our hospital in July 2005. She had a pedunculated tumor of 53×45 mm in size in the right groin, and it looked blackbrown and was easy-bleeding. And swelled lymph nodes were palpated in the right groin. Clinically we suspected it as malignant melanoma, eccrine porocarcinoma, or basal cell carcinoma, and an incisional biopsy was carried out. Pathological examination revealed it as basal cell carcinoma. A pedunculated BCC in the groin region is relatively rare. The pathological process of pedunculated tumor formation has not yet been evaluated. We should take BCC into consideration when observing a pedunculated tumor on the trunk. [Skin Cancer (Japan) 2007; 22: 53-56]

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We reported a case of multiple metastases of basal cell carcinoma (BCC) to the lung and liver. A 61-year-old man had noticed a giant ulcer with circumscribed nodules on his right eyelid for 2 years, and visited our hospital in 2001. The tumor had enlarged gradually and directly infiltrated into the zygomatic bone. Histological findings showed typical solid type BCC; we diagnosed clinically destructive BCC.
Resection of the primary tumor as wide as possible and cryosurgery were performed to reduce the volume of the tumor. Additionally he was treated with radiation (total 45 Gy) .
One year later, the ulcer recurred around the operated scar; we re-excised the tumor. Two years later, CT examination revealed abnormal nodular shadows in his liver and lung. The histlogical finding of needle biopsy from the liver indicated metastases of BCC. [Skin Cancer (Japan) 2007; 22: 57-61]

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An 87-year-old woman had noticed a small nodule on her right index finger about 8 years before being admitted for treatment. The nodule grew gradually in size; however, at first, she had sought no treatment. The nodule had become painful over the previous few months, and the patient was referred to our department from a hospital that she was admitted to for the treatment of cardiac failure.
A dark-red irregularly-shaped nodule measuring 5×3 cm in size was observed on her right hand, extending from the dorsal PIP joint to the pulp of the index finger. The surface of the nodule had a fine granular appearance with irregular asperities showing erosion and hemorrhage. Histological examination revealed proliferation of tumor cells from the epithelium in an irregularly club-shaped to a cordlike arrangement with the formation of tubular structures, with some tumor cells invading the deeper layers of the dermis. The tumor cells consisted of quasispherical cells with irregular-sized heteromorphic nuclei showing mitotic figures. At the periphery of the tumor, the epidermis formed cord-like branches which were fused together to form tubular structures (eccrine syringofibroadenoma-like histology). The index finger was amputated at the MP joint with a 5mm margin around the tumor. However, the patient died about a month later of cardiac failure. [Skin Cancer (Japan) 2007; 22: 62-67]

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A 79-year-old man noticed an asymptomatic eruption on the right axilla 13 years ago. The lesion had rapidly enlarged irrespective of the treatment with topical corticosteroids and UVB-irradiation for 2 years. On examination, a poikilodermatous lesion was present on the right axilla. A biopsy specimen showed a band-like infiltrate of atypical medium-to-large lymphocytes in the upper dermis. More than 70% of these cells were positive for CD3, CD4, CD7 and CD45RO. A Southern blotting analysis of DNA from the lesional skin revealed rearrangement of the T cell receptor gene. No lymphoma involvement was apparent in internal organs other the skin. On the basis of these findings, the present case was diagnosed as unilesional mycosis fungoides, stage IA. A complete remission of the disease was achieved after local (total 30 Gy) and additional total skin electron beam irradiation (total 30 Gy). [Skin Cancer (Japan) 2007; 22: 68-71]

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Case 1 A 64-year-old man noticed an asymptomatic gradually-enlarging blackish macule on his right sole. Preoperative lymphoscintigraphy disclosed two sentinel nodes on the right groin and popliteal region, which were confirmed by blue dye and gamma probe during surgical operation.
Case 2 A 74-year-old woman noticed a gradually-enlarging irregular shaped blackish macule on her right palm expanding to the 3rd and 4th fingers. Preoperative lymphoscintigraphy disclosed the presence of two sentinel nodes in the right axillary and epitrochlear region, which were confirmed by sentinel node biopsy during surgery: one sentinel node on her right axillary region and two nodes on the epitrochlear region. [Skin Cancer (Japan) 2007; 22: 72-76]

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A 66-year-old male with a black macule on his right sole was admitted to our clinic. The clinical features of the black macule were asymmetrical, irregular contour, dark diffuse palpable without elevation or ulcer formation. He was palpated; no inguinal or popleteal lymph nodes were noticed. No biopsies were performed, and pre-operative lymph-scintigraphy with ^99mTc was performed to detect sentinel lymph nodes. Immediately before the resection of the tumor, a sentinel lymph node was excised under a guide of local injection of 2% patent blue around the tumor. Though the primary lesion was only 0.8 mm in thickness, equivalent to Clark's level II, the sentinel lymph node showed metastatic tumor cells. Further lymph node dissection and general CT examination did not reveal any other metastasis. Because such a thin melanoma, less than 1 mm, caused local lymphatic metastasis, invasive melanoma in any thickness should undergo a sentinel lymph node biopsy. [Skin Cancer (Japan) 2007; 22: 77-80]

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