We report a 42-year-old man with paraneoplastic pemphigus who developed severe oral mucosal ulceration and pneumonia. Computed tomography of the abdomen demonstrated a mass, and B cell lymphoma was diagnosed by a celiac lymph node biopsy. The patient's serum was positive for anti-desmoglein 1 and 3 antibodies by enzyme-linked immunosorbent assay. Skin biopsies revealed epidermal vacuolization and suprabasal cleft formation. IgG deposition was observed in intercellular spaces of the epidermis and C3 was also positive along the basement membrane zone on direct immunofluorescence.
An indirect immunofluorescence analysis using normal human skin as its substrate showed antiintracellular IgG antibodies at a titre of 1 in 160, which also reacted with transitional epithelia of rat urinary bladder. The patient's serum immunoprecipitated antigens at 210-kDa envoplakin and 190-kDa periplakin. Prednisolone, cyclosporin and topical steroids were used for mucosal lesion without remarkable improvement. Finally, progressive respiratory failure with clinical features of bronchiolitis obliterans was the cause of death in this case. [Skin Cancer (Japan) 2008; 23: 11-16]

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A 48-year-old man presented with a tumor on his left eyelid, which had been noticed as a small papule approximately 10 years ago and progressively enlarged during the past year. Histologically, the tumor, composed of basaloid cells and squamoid cells, was located from the upper dermis to the subcutaneous tissue. We diagnosed the tumor as basosgouamous cell carcinoma (BSCC) . Since the patient refused initial excision, we treated him with systemic chemotherapy with cisplatin (75mg/m²) and doxorubicin (50mg/m²). After 3 courses of the chemotherapy, the tumor mass was reduced by over 90%. We often have difficulties in surgically managing large and deeply invasive basal cell carcinoma (BCC) of the eyelid, if the presentation of the delicate tissues of the eye is desired. In such cases, the current regimen of chemotherapy may provide one of the alternative options for the treatment of BCC of the eyelid. [Skin Cancer (Japan) 2008; 23: 17-21]

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A 45-year-old man visited a local physician with a one-year history of an asymptomatic subcutaneous nodule on his left cheek. A skin punch biopsy was taken, and the findings led to probable diagnosis of myxofibrosarcoma. He was referred to our hospital for evaluation and management. On his initial visit, physical examination revealed a skin-colored, elastic-soft, well-demarcated nodule on his left cheek, 4.5×3.5cm in size. We performed wide local excision and the defect was reconstructed by a cervicofacial flap. The patient was well and remained disease-free at 9 months follow-up.
A histopathological examination revealed a fairly well-defined mass in the subcutaneous tissue. The tumor was characterized by a proliferation of sparsely distributed cells which had slightly atypical, rounded or spindle nuclei, curvilinear, thin-walled blood vessels, and myxoid stroma. Immunohistochemically, these tumor cells were positive for CD68 and negative for alpha-smooth muscle actin, desmin, S-100 protein and cytokeratin. [Skin Cancer (Japan) 2008; 23: 22-26]

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Thirty-four patients with metastatic skin tumor (male: 19, female: 15, an average age of 64.7 years old) in our department from April 1995 to December 2005 were summarized and reviewed. Among the 34 cases, 62% of metastatic skin tumors were from lung cancer (8 cases), breast cancer (7 cases) and gastric cancer (5 cases). Most of the skin lesions were located in the chest and abdomen. The frequent clinical feature of metastatic skin tumors was the presence of nodules. Histopathologically, adenocarcinoma is the most common.The mean duration after the first detection of the primary cancer to the appearance of skin metastasis was about 20 months. The primary internal cancers were discovered in ten cases in which metastatic skin tumors had appeared. [Skin Cancer (Japan) 2008; 23: 27-31]

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We report a case of squamous cell carcinoma following carcinoma cuniculatum on the left sole of a 75-year-old man. At first the tumor was diagnosed as an epidermoid cyst, but histopathological examination revealed cuniculate-type downgrowth of atypical keratinocytes. Under the diagnosis of carcinoma cuniculatum (cutaneous verrucous carcinoma), the patient was followed up. Because the lesion recurred on the same region after a year, reexcision with disarticulation at the calcaneo-cuboid joint was performed. There had been no evidence of recurrence or metastasis for 8 months.
The final diagnosis was made as anaplastic transformation of carcinoma of the epithelioma cuniculatum. [Skin Cancer (Japan) 2008; 23: 32-35]

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A 62-year-old man presented with a 6-month history of a white warty lesion accompanied by swelling beneath the right thumbnail. As the lesion recurred after partial nail removal and curettage, a malignant tumor was suspected and he was referred to our hospital. On examination, at the proximal side of the partial nail defect, a pale-brown tumor, 6×5mm in size, was seen through the thumbnail. Xray examination showed a demarcated area of erosion of the underlying terminal phalanx. In addition, a hard nodule was recognized at the medial side of the right upper arm. The subungual tumor was excised and an artificial dermis was applied to the skin defect.
Histological examination of the tissue removed at the operation showed proliferating epithelium composed of cells with abundant pale staining cytoplasm. The epithelium formed a cup-shaped structure with a keratin plug protruding the center. We diagnosed him with subungual keratoacanthoma. [Skin Cancer (Japan) 2008; 23: 36-40]

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A 64-year-old man had noticed an erythematous lesion on the genital area 3 years before. Because it gradually enlarged, he visited our department clinic on April 1, 2005. Physical examination revealed an erythematous nodular lesion with partial ulceration on the genital area, and some swollen lymph nodes were palpable in his right inguinal area. A nodule was biopsied and diagnosed histopathologically as extramammry Paget's disease. PET scans suggested metastases to lymph nodes in the right common iliac region. His serum CEA level was high: 7.0 ng/ml. He underwent wTotal tumor excision of the primary lesion, and lymph node dissection from the right inguinal to bifurcation of the abdominal aorta areas were performed. He received 4 courses of adjuvant chemotherapy with EC therapy (EPI, CPA) and his CEA level decreased to less than 3.0ng/ml. But in April 2007, his CEA level increased to 7.6ng/ml. Although no metastasis was found with CT scans, PET scans revealed multiple deposits in the abdominal aorta areas. He received 5 courses of combinational chemotherapy (5-FU, EPI, CDDP, VCR, MMC), and his CEA level decreased to 2.2 ng/ml. PET scans revealed a complete disappearance of the deposits. [Skin Cancer (Japan) 2008; 23: 41-46]

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We presented 6 cases who had undergone excision of skin metastases from lung cancer. The 6 patients, 4 male and 2 female, ranged in age from 57 to 76 years. The pathological findings were adenocarcinoma in four patients, and squamous cell carcinoma and small cell carcinoma in one patient. The median survival time from the diagnosis of lung cancer was 13.0 months and that from the diagnosis of skin metastasis was 6.2 months. We concluded that excision of skin metastases from lung cancer could not improve the vital prognosis. However, symptoms of the patients, including pain, exudate, and bleeding, were improved postoperatively, so we suggest that excision of skin metastases from lung cancer is an important procedure for improving the QOL of the patients. [Skin Cancer (Japan) 2008; 23: 47-52]

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The authors recently experienced eight cases of CD 30 positive lymphoma with cutaneous manifestations recently. Six cases were primary cutaneous anaplastic large cell lymphoma (C-ALCL) with a solitary or several nodules, one was large cell transformation in mycosis fungoides, and one was nodal ALCL involving the skin. Five cases of C-ALCL showed spontaneous remission. One of them had no relapse, and four had minor relapse; these also showed spontaneous remission. One case of C-ALCL died of an other disease after radiotherapy and chemotherapy. One case of large cell transformation in mycosis fungoides died of this disease after radiotherapy and chemotherapy. One case of nodal ALCL involving the skin resulted in complete remission with chemotherapy. As for a solitary or several lesions of C-ALCL, careful observation without any treatment seems to be recommended while these lesions disappear spontaneously. C-ALCL seemed to have excellent prognosis. [Skin Cancer (Japan) 2008; 23: 53-59]

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We report the case of a 77-year-old Japanese woman who presented with an ulcerated erythematous nodule with extensive induration on her left arm. She presented fewer than 10 similar subcutaneous nodules during the following 8 years without any internal organ metastasis. Some nodules spontaneously regressed. Histological examination of an excised nodule revealed dense infiltration of markedly atypical medium to large lymphoid cells throughout the entire dermis to subcutaneous tissue, as well as dense eosinophil infiltration and necrotic areas. Immunohistochemical studies of paraffin sections revealed that most of the infiltrated atypical lymphoid cells were positively stained by CD3, CD8, CD 45 RO, Granzyme B and TIA-1, whereas CD 4, CD 20, and CD 56 showed no immunoreactivity. Less than 30% of the large atypical lymphoid cells were stained with CD 30. EVB was negative as determined by in situ hybridization. Polymerase chain reaction analysis revealed a distinct band representing the TCR gene, which confirmed the T-cell clonality of infiltrating lymphocytes. The patient was treated with a topical steroid ointment or by simple surgical excision resulting in good clinical course. [Skin Cancer (Japan) 2008; 23: 60-65]

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A 74-year-old male recognized an erythema on his right thigh in December 2004, and it became an erythematous nodule in 6 months. A biopsy was performed in June 2005. Histopathologic analysis revealed diffuse proliferation of lymphoblastic cells in the dermis. By immunophenotyping, CD4, CD56, CD123, and TdT were positive, while cCD3, CD45RO, CD20, CD79a, TIA, and LFA-1 were negative. In genetic analysis, no T cell or B cell gene rearrangement was observed. Further, in situ hybridization showed no relationship with EB virus. We diagnosed the patient as having ‘CD4+/CD56+hematodermic neoplasm’. Although combination chemotherapy was undertaken and complete remission was noted once, recurrence in the skin and in the regional lymph node was observed 5 months after the therapy. Simple resection and local radiation therapy were performed, respectively, but the disease invaded the bone marrow, and eventually lapsed into the peripheral blood stream, developing to the leukemic stage. Finally, the patient died of multiple organ failure and brainstem hemorrhage. [Skin Cancer (Japan) 2008; 23: 66-71]

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We report a case of an 84-year-old Japanese man who noticed cutaneous erythematous plaque with some nodules on his umbilicus over a period of 2.5years. Histlogical findings from the skin lesion revealed proliferation of centrocyte-like cells shown CD20+, CD5-, CD 10- and CD23- immunohistochemicaly. He had no abnormality in Ga-scintigraphy, bone scintigraphy nor chest-abdominal computed tomography. He was diagnosed with primary cutaneous extranodal marginal zone B-cell lymphoma of MALT type. He underwent total gastrectomy for gastric cancer 30 years ago and hormone therapy for prostate adenocarcinoma 2 years ago. There is no report of primary cutaneous MALT lymphoma accompanying the two another cancers. [Skin Cancer (Japan) 2008; 23: 72-75]

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We report a case of a calcifying basal cell carcinoma on the cheek. A 66-year-old man presented with a black nodule on the cheek. He had been undergoing dialysis for chronic renal failure. Histopathologic study revealed a solid type of BCC and calcium deposition observed in the tumor nests and cysts, and its surrounding stroma. Because the calcium and inorganic phosphate concentration in his serum were within normal limits and calcification of his tumor occurred in association with local tissue abnormality, our case was classified as dystrophic calcification. The mechanism of calcification in BCC remains elusive; we discuss the hypothesis according to the English literature. [Skin Cancer (Japan)2008; 23: 76-79]

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Giant condyloma acuminatum is a rare variant of condyloma acuminatum that commonly affects the genitalia and perianal region. It was originally described in 1896 by Buschke, and was further elaborated as a separate entity in 1925 by Buschke and Löwenstein. Histological analysis shows classically benign papillomatous proliferation, with occasional malignant transformations. For this reason many cases are treated by radical excision. We report a case of perianal giant condyloma acuminatum successfully treated by surgical electrocautery excision alone. [Skin Cancer (Japan) 2008; 23: 80-86]

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A case of a 79-year-old female patient with multiple Bowen's disease was reported. The patient, who had undergone operations for right breast cancer and squamous cell carcinoma at the right ear, 8 years and 1 year before, respectively, had presented several erythematous scaly plaques at the chest. Biopsy showed that all were characteristic of Bowen's disease. Further examinations such as CT scan and cytology revealed lung cancer (adenocarcinoma) . In this issue, 251 cases of multiple Bowen's disease reported from 1969 to 2007 in Japan were also summarized and discussed. [Skin Cancer (Japan)2008; 23: 87-92]

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We report a case of a 39-year-old Japanese man who was operated on for malignant melanoma (NM, stage IIc) on his right leg. After its operation, adjuvant chemotherapy with dacarbazine, nimustine hydrochloride and vincristine sulfate was performed 8 times over a period of 2 years. Seven years after the initiation of the therapy, he developed purpurae on his legs, accompanied by pancytopenia. Skin biopsy was performed on the purpurae and a histopathological examination showed infiltration of leukemic cells in the dermis. Bone marrow biopsy was performed and the patient was diagnosed with acute myelocytic leukemia (megakaryocytic leukemia) . This case was thought to be a case of therapyrelated leukemia. [Skin Cancer (Japan)2008; 23: 93-97]

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A 63-year-old woman presented with a 5-month history of multiple nodules on the forehead, the parietal and occipital areas of the scalp, and the posterior aspects of the auricles. Histological examination disclosed metastatic lesions of adenocarcinoma. A CT scan showed multiple nodules in her left lung and other organs. A bronchoscopic biopsy specimen revealed lung adenocarcinoma. The patient was treated with chemotherapy and radiotherapy, which successfully reduced the size of the metastatic skin nodules as well as the primary lung lesion. [Skin Cancer (Japan)2008; 23: 98-101]

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In an 84-year-old woman, multiple papillomatous lesions had arisen from a grafted skin at the right frontal area. Four years prior to this episode, the skin had been transplanted from the left groin after excision of squamous cell carcinoma. Papillomatous lesions which had formed nearby, and which were pathologically diagnosed as seborrheic keratosis, had rapidly increased in size and number. As a result of detailed study, we determined that if the original specimen was diagnosed as squamous cell carcinoma, it was found that this cancer had possibly arisen from clonal type seborrheic keratosis. There was no development of papillomatous lesions at the left groin from where the skin had been transplanted. Based on this evidence, we conclude that the unique clinical manifestation of multiple seborrheic keratoses arising from a skin graft developed from factors at the recipient site. [Skin Cancer (Japan) 2008; 23: 102-106]

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An 80-year-old Japanese male presented with tumors of the left forearm and forehead. A biopsy specimen from the skin lesion showed dense infiltrates of medium-sized lymphoid-appearing cells in the dermis with a Grenz zone. These cells were stained positively by LCA, CD4, CD56, bcl-2 and negatively by CD3, CD5, CD8, CD10, CD20, CD30, CD79a, TIA-1, granzyme B, TdT, MPO on immunohisto-chemical examination. There was no evidence of abnormal lymph node swelling or visceral involvement under image diagnosis. The patient was diagnosed with CD4+/CD56+hematodermic neoplasm. [Skin Cancer (Japan)2008; 23: 107-110]

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We report a 68-year-old female who presented with a red pedunculated tumor, measuring 30mm in diameter, on her left thigh. Histological examination showed that the tumor was composed of two parts: atypical squamous cells that had a distinct tendency of keratinization and glandular structures composed of atypical cells producing mucinous materials in its duct-like structures. From the pathological findings we diagnosed this neoplasm as adenosquamous carcinoma. Eleven months after resection, there has been no evidence of recurrence or metastasis. [Skin Cancer (Japan) 2008; 23: 111-116]

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