Previously in Japan, oncologists did not have sufficient opportunities to perform standard chemotherapy treatment. The Japanese Society of Medical Oncology was established to train oncologists with adequate knowledge and technical capabilities. The “Chemotherapy Specialist” exam was initiated in 2006, and currently 205 oncology specialists in Japan have been authorized under this system. The purpose of this society is not to simply “certify”, but to train talented and capable specialists who can make adequate diagnoses and propose appropriate treatment plans with compassion for each patient. The curriculum is based on that of ASCO/ESMO, with additional evaluation of ethical components and personal character through an extensive interview exam. Oncologists should not only be engaged in clinical research to establish standard treatment, but also must possess the flexibility to allow appropriate treatment for each particular individual. JSMO offers the opportunity for organ specialists to exchange information, and hold seminars so they can obtain the chance to go through the testing/training process smoothly to become chemotherapy specialists. We hope that dermatologists specializing in skin cancer also make the challenge to attain certification though JSMO to become well rounded chemotherapy specialists. [Skin Cancer (Japan) 2008; 23: 258-266]

View full abstract

The Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society conducts a periodic survey of malignant melanoma patients in Japan by sending questionnaires to about 160 selected institutions. The survey in 2006 and 2007 collected 1053 cases, and the details were as follows: male/female ratio: 520/532, age: ranging from 5 to 98 with an average of 62.1, growth pattern: ALM 51.2%/NM 21.2%/SSM 16.2%/LMM 7.9%, and TNM staging: Tis-19.5%/I-24.6%/II-26.7%/III-20.5%/IV-8.8%. We classified the collected cases with several factors and investigated the correlation with prognostic factors such as tumor thickness or lymph node involvement by using a statistical method. This analysis may be useful to ascertain the present status of melanoma and improve the treatment of this disease. [Skin Cancer (Japan) 2008; 23: 267-279]

View full abstract

A better understanding of the diagnosis of cutaneous lymphomas has been made possible by the recent consensus statements including WHO-EORTC classification (Blood, 2005), and new staging classifications for mycosis fungoides/Sézary syndrome (Blood, 2007) and for the other types (Blood, 2007) which may take the place of the previous Ann Arbor classification. As a task force under The Japanese Dermatological Association and The Japanese Skin Cancer Society, we published a tentative guideline for cutaneous lymphomas in 2008, which may represent the current consensus for lymphoma treatments in Japan. In accordance with the guideline, we have established a registry system for cutaneous lymphomas for the purpose of a nation-wide survey and evaluation of outcomes of the patients treated in line with the guideline. [Skin Cancer (Japan) 2008; 23: 280-286]

View full abstract

Clinical practice guidelines for the management of cutaneous lymphomas have been prepared on behalf of the Japanese Dermatological Association and the Japanese Skin Cancer Society. Accurate diagnosis and staging are important, because treatment decisions depend primarily on the diagnosis and extent of the disease. Staging of the patients with mycosis fungoides (MF) and Sézary syndrome (SS) should be performed according to the revised TNMB classification system published in 2007. Treatment recommendations for each stage of MF/SS are summarized as a treatment algorithm. Because there have been few randomized controlled trials, most of the treatment recommendations are not based on high-level evidence. Local (skin-directed) therapies including topical corticosteroids, phototherapy, and radiation therapy are appropriate treatment options for early-stage MF. For refractory or more advanced cutaneous disease, systemic biological response modifiers such as oral retinoid and interferon may be combined with local therapies. Patients with advanced extracutaneous disease are treated with systemic chemotherapy, but long-term remissions are uncommon. [Skin Cancer (Japan) 2008; 23: 287-293]

View full abstract

In this report, the clinical practice guideline for primary cutaneous T/NK-cell lymphomas other than mycosis fungoides and Sezary syndrome is described. These lymphomas can be classified into two clinical subgroups based on clinical features and prognosis. The indolent group consists of cutaneous CD30+ lymphoproliferative disorders, subcutaneous panniculitis-like T-cell lymphoma and cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma. Because these three categories show unique clinical features and slightly different prognosis, clinical questions for these entities were set up separately. The aggressive group consists of cutaneous aggressive epidermotropic CD8+ T-cell lymphoma, cutaneous gamma/delta T-cell lymphoma and cutaneous peripheral T-cell lymphoma, unspecified. Since these lymphomas show similar cutaneous manifestations and very poor prognosis, we made clinical questions for these lymphomas in one group. In the algorithm described in this guideline, we adopted the recently proposed TNM classification system because it is necessary to standardize the clinical descriptions of patients with cutaneous lymphomas for the revision of this guideline in the near future. [Skin Cancer (Japan) 2008; 23: 294-301]

View full abstract

Because the classification of ATLL is mainly based on hematological and serological features, the existence of skin lesions has not been considered as one of the important prognostic factors. However, several studies have revealed that the prognosis of the smoldering type ATLL with skin lesions is significantly worse than that without skin lesions. Thus, the smoldering type ATLL with skin lesions should be divided into a different category, such as “cutaneous ATLL”. Patients with cutaneous ATLL show neither leukemic involvement (low percentages of abnormal lymphocytes in the peripheral blood) nor invasion of tumor cells into the lymph nodes. A detailed diagnostic criterion for cutaneous ATLL is a matter being discussed. The skin-direct therapy including topical steroids, PUVA and electron beamirradiation, and the systemic therapy including interferon-g and retinoids are reviewed. Although these therapies improve the patients' symptoms, there is no apparent evidence that they improve the prognosis for the disease. [Skin Cancer (Japan) 2008; 23: 302-307]

View full abstract

Recently, representatives of WHO (World Health Organization) -EORTC (European Organization for Research and Treatment of Cancer) published a consensus proposal for the classification of cutaneous lymphomas. According to this classification, a tentative Japanese guideline for the diagnosis and treatment of cutaneous lymphomas was proposed. [Skin Cancer (Japan) 2008; 23: 308-314]

View full abstract

A statistical survey of extramammary Paget's disease (EMPD) has been conducted in cooperation with the Japanese Association of Dermatologic Surgery. We investigated 2284 cases of EMPD from 79 fascilities from 1999 to the present. The aims of this survey are as follows: i) Statistical analysis based on a proposal for a clinicopathological TNM classification and staging, ii) Examination in surgical margin of the excision and indication of lymph node dissection, iii) Examination of treatments for advanced cases including local recurrence and distant metastasis. The results of the epidemiological survey and prognosis assessment were evaluated in detail, and the cumulative survival rate was calculated by a proposal for a clinicopathological TNM classification and staging. However with regard to TNM staging, we were not able to give a conclusion whether this classification reflects its prognosis. Additionally, we also cannot show useful data according to the indication of lymph node dissection. The therapeutic strategy for advanced cases requires further investigation. [Skin Cancer (Japan) 2008; 23: 315-319]

View full abstract

Pathological findings of extramammary Paget's disease will be discussed. Extramammary Paget's disease is a usually non-invasive adenocarcinoma of the skin outside of the mammary gland, and is characterized by 1) glandular formation, 2) intracytoplasmic mucin production, 3) hyperchromatic nuclei and 4) conspicuous nucleoli. Melanin pigmentation is rarely seen in the cytoplasm of Paget's cells. To detect Paget's cells, application of CAM 5.2 and CEA is useful. In evaluating the invasion one should be very careful not to over diagnose the tangential section or the in situ spread along the adnexal tissues. Finally we mention Toker cells as a precursor of extramammary Paget's disease. [Skin Cancer (Japan) 2008; 23: 320-331]

View full abstract

The microinvasive stage of Paget's disease is defined as proliferation of solitary or a small group of cancer cells in the subepidermal layer of the dermis. It is important to recognize this stage of the disease in order to anticipate the prognosis of the patients and to select the most suitable treatment. Key features to differentiate microinvasion of the disease with oblique cut pathology preparations are the absence of basal layer around the tumor nests, dense staining of the tumor cells, focally grouped or band like proliferation of tumor cells devoid of spiral or linear configuration and smaller size of the tumor cells compared with those in the epidermis. [Skin Cancer (Japan) 2008; 23: 332-337]

View full abstract

The status of regional lymph nodes is an important predictor of the prognosis in patients with extramammary Paget s disease (EMPD) . We previously reported that the invasion level of the primary lesion is correlated with the extent of lymph node metastases and prognosis. Further multi-centre studies should be conducted to investigate the prognostic factors and to establish an optimal therapeutic strategy for progressive EMPD. [Skin Cancer (Japan) 2008; 23: 338-340]

View full abstract

Extramammary Paget s disease is considered to be a malignant tumor originating from the sweat glands. It is fatal once the tumor invades the dermis and metastasizes to the visceral organs. As no standard treatment has been established, it is still extremely difficult to treat patients in the advanced stages of this disease. Very few studies of systemic chemotherapy have been reported; based on them, combination chemotherapies were conducted that consisted of 5-fluorouracil and cisplatin. Recently some cases of extramammary Paget's disease were also treated with docetaxel. These therapeutic regimens should be considered as options in managing advanced extramammary Paget's disease. [Skin Cancer (Japan) 2008; 23: 341-346]

View full abstract

There is no standard chemotherapy for advanced extramammary Paget's disease. Therefore, to establish a standard guideline for the treatment of extramammary Paget's disease, we have researched this disease in the Society of Extramammary Paget's Disease starting from 2006. At present, we treat it with docetaxel and study the effect. In this report, we mention the process by which we chose docetaxel, usage, side effects and the cost of treatment. However, docetaxel is not authorized as a treatment for extramammary Paget's disease and the effect is not clear. In several years, we will bring this research to a conclusion. [Skin Cancer (Japan)2008; 23: 347-354]

View full abstract

A 71-year old male had received radiofrequency ablation therapy for hepatocellular carcinoma, 5cm in diameter, about 16 months before visiting our department. He noticed a painful subcutaneous induration at the site of the needle puncture from the radiofrequency ablation therapy. The pathological findings revealed invasion of hepatocellular carcinoma (Edmondson II type) in the deep dermis and subcutaneous tissue with invasion into the vessels. We diagnosed this case as hepatocellular carcinoma implantation to the skin by radiofrequency ablation therapy. Since radiofrequency ablation therapy or ethanol injection therapy of hepatocellular carcinoma is performed widely, we think that such a potential complication caused by needle tract implantation should be kept in mind. [Skin Cancer (Japan) 2008; 23: 355-358]

View full abstract

A 54-year-old woman presented with a smooth nodule within a medium-sized congenital nevus on her right dorsal foot. A histopathological examination revealed this nodule to be benign, leading to the diagnosis of proliferative nodule arising within a congenital nevus. Recognition of proliferative nodules arising within a congenital nevus is important, in order to avoid confusion and misdiagnosis of malignant melanoma arising within a congenital nevus. [Skin Cancer (Japan) 2008; 23: 359-363]

View full abstract

A 62-year-old man with false phimosis recognized that there were several spotted eruptions on his glans penis in spring, 2005. Over about a half-year period, the sizes of those eruptions gradually enlarged. The lesion was pathologically diagnosed as erythroplasia of Queyrat (EQ) by skin biopsy taken in another hospital; subsequently, he was reffered to our hospital on December 6. We performed wide local excision and the defect area was reconstructed with a skin graft. EQ is generally recognized as the same entity as Bowen's disease which just appears on mucous membrane. But this concept still remains questionable whether EQ is true Bowen's disease or not. The relations to continuous local irritation or human papilloma virus, as a possible cause of EQ, have been reported. Although conservative therapies such as topical application of anti-cancer ointment or cryosurgery have also been reported, curative surgical excision is recommended for EQ. [Skin Cancer (Japan)2008; 23: 364-366]

View full abstract

A 68-year-old Japanese man noticed erosive scaly erythemas in his genital area 4 years ago. As the lesion gradually extended, he consulted our department. Physical examination revealed that multiple erythemas and depigmentations had intermingled in the genital area and right axilla, but clinically, there was no obvious lesion in the left axilla. Histological examination with HE staining revealed typical Paget's cells in the epidermis in the genital area and right axilla; however, only a limited number of Paget s cells were scattered in the left axilla. On immunohistochemical study, sparsely distributed Paget's cells in the left axilla were stained clearly by using a monoclonal antibody against CK 18 rather than CEA. We finally diagnosed triple Paget's disease. The skin lesion in the left axilla was so-called occult Paget's disease. Our case clearly suggests that immunostaining with CK 18 antibody is suitable for easy detection of the presence of Paget's cells in the lesional skin. [Skin Cancer (Japan)2008; 23: 367-370]

View full abstract

Here, we report a rare case of extramammary Paget's disease of the axilla. An 80-year-old man had noticed an erythematous lesion on his right axilla a few weeks before visiting our hospital on August 30, 2007 with complaint of the lesion. Physical examination revealed an unclearly demarcated eggsized erythema without infiltration on his right axilla. The erythematous lesion was biopsied and diagnosed histopathologically as extramammary Paget's disease. An erythematous lesion was also seen in his genital area, but no tumor cells were found on biopsy specimens. No erythematous lesion was seen on his left axilla. He underwent surgical excision of the erythematous lesion on his right axilla and no metastatic lesion was found. [Skin Cancer (Japan)2008; 23: 371-374]

View full abstract

A 64-year-old man presented with a four or five-year history of erythema on the genital area. On the first consultation, erythema and depigmentation, partially with induration, were observed on the genital area. Histological findings of the erythema showed Paget's cells in the epidermis and dermis. A computed tomography scan revealed multiple lymph node swellings in the left inguinal, para-aorta and left subclavicle areas. Based on these findings, a diagnosis of extramammary Paget's disease, stage IV was made. The patient was treated with palliative resection of the genitals and left inguinal lesions, followed by low dose FP (a combination of 5-FU and CDDP) therapy. After 3 courses of this therapy, partial response (a 60% reduction in the para-aorta lymph node swelling) was obtained in the lymph node metastases without any side effects. Low dose FP therapy might be one of the effective therapies for advanced extramammary Paget's disease. [Skin Cancer (Japan) 2008; 23: 375-378]

View full abstract

We reported a case of giant squamous cell carcinoma arising in a traumatic scar on the left thigh of a 57-year-old man. The large traumatic scar on his left thigh was due to a traffic accident he experienced at the age of 10 years. He had noticed an intractable ulcer on the scar about 1 year ago. When he visited our hospital, he had a 20×13cm crater-like ulcerated tumor on his left thigh. A biopsy of two inguinal lymph nodes revealed no metastasis and no distant metastasis was detected. We treated the giant tumor with intra-arterial chemotherapy (cisplatin and doxorubicin) and radiotherapy. After the tumor's size had decreased, it was possible for the subject to undergo a curative excision of the tumor with sufficient margin. [Skin Cancer (Japan) 2008; 23: 379-383]

View full abstract

The most frequent malignancy of the auricle is squamous cell carcinoma. Resection of auricular squamous cell carcinoma results in over one-third or one-fourth of auricular skin and cartilage defects. We experienced a case in which one half of the auricular skin and cartilage defects were due to auricular squamous cell carcinoma resection (T2N0M0 stage II) . We performed staged reconstruction of the auricle with the aim of auricular appearance and the functional purpose of wearing eyeglasses. We carried out auricular reduction in the affected side and cartilaginous graft transplantation from the unaffected side. Auricular wedge-shaped closure, chondrocutaneous advancement flap, temporoparietal fascial flap and split-thickness skin graft techniques were also employed.
One year after the auricular reconstruction, tumor recurrence and distal metastasis has not been observed. The reconstructed auricle is smaller than the unaffected auricle and has some deformity. However, the patient can wear eyeglasses. [Skin Cancer (Japan) 2008; 23: 384-389]

View full abstract

We reported a rare case of basal cell carcinoma (BCC) which developed on the labium majus. A 58-year-old woman was referred to our hospital by a practicing gynecologist for her skin lesion of a black nodule with the size of 4×15mm on the right side of the labium majus. The lesion was totally excised, and the histopathology revealed a solid type of BCC. As we have experienced 3 patients with genital BCC out of 58 patients with BCC in our clinic during the past 10 years, we discussed the incidence of genital BCC reported in Japan. [Skin Cancer (Japan) 2008; 23: 390-393]

View full abstract

We report a case of clear-cell eccrine carcinoma. A 51-year-old man visited our department on September 18, 2007, with a red nodule in the medial heel area of the right foot that he had first noticed in January of the same year, and that had since rapidly enlarged. He had developed a nodule in the same area seven years previously, which had been resected by a nearby doctor. At this visit, examination revealed a red pedunculated mass measuring 40×35×15mm in size in the medial heel area of the right foot. The surface of the mass showed ulceration and necrosis. Thoracoabdominal CT and Ga scintigraphy revealed no evidence of metastasis. On October 1, resection of the tumor along with a part of the fascia was performed, with a margin of 1cm around the tumor. Biopsy of a palpable lymph node in the right inguinal region revealed no metastasis. Histopathological examination revealed nests of proliferating tumor cells with clear cytoplasm within the dermis, that showed dyskaryosis. Formation of vacuoles was observed within the cytoplasm and in the intercellular spaces, and differentiation into cuticular border cells was recognized. Immunostaining of the tumor cells revealed positive staining for broad-spectrum keratin, CEA and EMA, and negative staining for GCDFP 15, a staining pattern suggestive of eccrine carcinoma. At present, one year after the surgery, the patient remains well, with no evidence of tumor recurrence or metastasis. [Skin Cancer (Japan) 2008; 23: 394-399]

View full abstract

A 58-year-old man, who had noticed a subcutaneous mass on his right shoulder over a period of one year previously, was referred to our institution, complaining of an increase in the mass. Clinical examination revealed a giant red tumor with erosion on his right shoulder, measured 6.5×7×5cm. The histological diagnosis was dermatofibrosarcoma protuberans (DFSP). A wide excision was performed. Histological examination of all the resected specimens revealed DFSP and a partly fibrosarcomatous area with increased cellularity and mitotic activity. Interlacing bundles and a herringbone pattern were evident. Immunohistological examination showed that the DFSP lesion was strongly positive for CD34, but the fibrosarcomatous area showed only weakly positive staining. Reported cases of DFSP with fibrosarcomatous change were reviewed for comparison. [Skin Cancer (Japan) 2008; 23: 400-404]

View full abstract

A 75-year-old Japanese man who had noticed a mass on his forehead for some years came to the Department of Plastic and Reconstructive Surgery, Saiseikai Nakatsu Hospital in July 2007 because the mass had enlarged rapidly before his visit. An initial examination revealed a dark-red colored movable mass with uneven surface on his forehead. The size of the mass was 3×4cm. And an elastic-hard and movable 2×2cm subcutaneous nodule was recognized on the right anterior section of the mass. The tumor was excised above the pericranium with a 1.5 cm surgical margin, and it was diagnosed as dermatofibrosarcoma protuberans based on the characteristic histopathological findings of a storiform pattern and intensive CD34 expression by the tumor cells. Seven months after the operation, local recurrence was noted and a wide excision, including the pericranium under the tumor, with a 3cm surgical margin was carried out. There has been no evidence of recurrence for six months. [Skin Cancer (Japan) 2008; 23: 405-409]

View full abstract

A 63-year-old man had noticed a nodule on the lower back about 4 months before consultation. He visited a clinic nearby his house and malignant lymphoma was suspected. He was subsequently referred to our department. Histopathologic analysis revealed proliferation of small to medium-sized atypical lymphocytes. The tumor cells had a CD3 (+), CD4 (+), CD20 (+) phenotype, thereby diagnosed as “peripheral T-cell lymphoma, unspecified”. He received 6 courses of CHOP regimen, leading to a complete remission (CR) . However, about 11 months after the therapy, recurrence of lymphoma on the trunk and extremities was confirmed histopathologically by skin biopsy of the erythematous lesions. The biopsy specimen showed infiltration of monotonous atypical lymphocytes with a phenotype of CD4 (+), CD79a (-), CD56 (+), CD123 (+), TdT (-), MPO (-), and EBV-ISH (-), establishing the diagnosis of “CD4+/CD56+ hematodermic neoplasm (blastic NK cell lymphoma)”. He received 2 courses of CHOP regimen and then 1 course of hyper-CVAD regimen; thereafter he underwent allogenic peripheral blood stem cell transplantation, leading to a CR. He has remained in CR without any symptoms for about 6 months. [Skin Cancer (Japan)2008; 23: 410-415]

View full abstract

We report a rare case of granular cell tumor in an infant. A six-year-old girl presented with a tumor on her trunk for over a period of 2 years. The tumor gradually enlarged and finally developed ulceration. At the first visit, there was a dome-shaped red tumor, 18mm in diameter with ulceration at the top. Histological examination revealed a well-circumscribed tumor nest composed of large round cells with abundant eosinophilic granular cytoplasm. The tumor cells were positive for vimentin, S-100, and cytoplasmic granules were PAS positive. Together, a diagnosis of granular cell tumor was made. However, the tumor cells intermingled with some spindle-shaped cells and formed a small satellite lesion apart from the encapsulated main tumor mass, suggestive of a malignant phenotype. We therefore performed an additional resection with a 1 cm width from the previous margin. She has not experienced recurrence or metastasis for a year after the operation. [Skin Cancer (Japan) 2008; 23: 416-419]

View full abstract

A 75-year-old man was treated with several regimens as the adjuvant chemotherapy after tumorectomy and lymphodenectomy of a malignant melanoma in 1995. However, in-transit metastasis had been present in the left thigh in 1999, and combined modality therapy was started. The internal metastasis was not recognized although the metastatic melanoma of the left thigh tended to have increased. But, the tumor of the left thigh increased rapidly, and a transfusion was required because of a remarkable hemorrhage from the site of the tumor (Hb: 13.0→6.3g/dl) in September 2006. Therefore, Mohs ointment, a hospital preparation, was applied, resulting in a remarkable cessation of bleeding and the leakage of effusion, reduction of the metastatic melanoma size, control of odor and the improvement of the patients quality of life. [Skin Cancer (Japan) 2008; 23: 420-423]

View full abstract