We reported a case of spindle cell squamous cell carcinoma (SCSCC), which is well known for often being difficult to diagnose. The patient was a 35-year-old female who had a perianal eruption over a period of 6 years, at the center of which an ulcer had been developing rapidly for several months before her visiting our hospital. A biopsy specimen suggested scar tissue of fibroblastic cell proliferation with dense neutrophilic infiltration probably due to bacterial infection. After 2-months of treatment for the ulcer with no result of complete epithelization, an excisional biopsy of the ulcer was carried out and it was finally diagnosed as SCSCC because proliferating spindle cells were cytokeratin-, bimentin- and EMA positive immunohistochemically. The tumor resting around the anus was widely excised, and no recurrence or metastasis of the tumor has been recognized for these 5 years. [Skin Cancer (Japan) 2009 ; 24 : 12-15]

View full abstract

The patient was a 68-year-old woman. She noticed a cutaneous nodule on her lower limb. The diagnosis of an NK-like T-cell lymphoma with cytotoxic T-cell phenotype was made. Lymphoid tumor cells were positive for UCHL-1, cCD3, TIA-1, CD56 and negative for CD4, CD8, CD30, CD79a. TCR gene analysis using Southern blotting disclosed that these cells were derived from TCR cβ1 T-cells. Radiation followed by DeVIC chemotherapy (×3) was performed.[Skin Cancer (Japan) 2009 ; 24 : 16-20]

View full abstract

We report the case of a 43-year-old female who presented with primary cutaneous CD30+ anaplastic large cell lymphoma (PCALCL) with generalized skin involvement accompanied with one peripheral draining lymph node region involvement. Histological findings of the nodule of her right lower leg revealed a dermal infiltrate of markedly atypical, large lymphocytes without evidence of epidermotropism. Immunohistochemical study revealed that the atypical lymphocytes were positive for CD30, CD43 and bcl-2, but not for CD3, CD10, CD20, CD56, epithelial membrane antigen (EMA), and anaplastic lymphoma kinase (ALK). Although the disease relapsed after multiagent chemotherapy regimens, the disease was successfully treated with low dose etoposide. We reviewed the previously reported cases of PCALCL treated with low dose etposide. We suggest that oral etoposide might be useful, effective therapy for treatment of relapsed multifocal PCALCL.[Skin Cancer (Japan) 2009 ; 24 : 21-24]

View full abstract

A 59-year-old man visited a local physician with a rapidly enlarging nodule on his scrotum. He was referred to our hospital for management. Physical examination revealed a brown-black, polypoid, spherical nodule measuring 2.5×1.5cm in diameter, covered with a friable hemorrhagic crust. Lymph nodes were palpable in the left groin. We performed a subtotal integumentectomy, and a diagnosis of malignant melanoma (MM) stage IIIC was established. Dacarbazine, nimustine, vincristine, interferon-beta (DAV-feron) were used for his adjuvant chemotherapy. The patient tolerated well and remained disease-free at 15 months follow up. A majority of polypoid malignant melanomas (PMM) have extreme tumor thickness and are often ulcerated at the time of diagnosis. Patients with PMM frequently exhibit lymph node metastases at the time of presentation. Clinical recognition of the characteristic features of PMM should alert physicians to consider them as a high risk group for MM.[Skin Cancer (Japan) 2009 ; 24 : 25-29]

View full abstract

One hundred patients with extramammary Paget's disease between 1976 and 2007 are reviewed. The incidence has increased recently, and the average age was 72.1 years old ; the male/female ratio was 2.1 : 1. The prognosis was good for 67 in situ cases, whereas 11 out of 13 lymph node metastasis cases died. The surgical margin of skin resection has been reduced recently, but no local recurrence was found. Also limited application of lymph node dissection was not related to the survival rate. It was suggested that even reduction surgery was adequate for most cases of extramammary Paget's disease. However, further study of the surgical margin and refined technique for sentinel lymph node biopsy would be required.[Skin Cancer (Japan) 2009 ; 24 : 30-34]

View full abstract

We report a case of extramammary Paget's disease treated with radiotherapy. The patient was a 71-year-old Japanese female with dementia. She had refractory eczema of the external genitalia for two years. Skin biopsy at a previous clinic showed extramammary Paget's disease. Judging from her Activities of Daily Living (ADL) status, she would likely have had a difficult post-operative course. Irradiation with X-rays (4 MV) at a dose of 2.5 Gy was delivered 16 times, 40 Gy in total. The skin became eroded and was epithelialized in two weeks. Six months later, the only skin abnormality was pigmentation, and histopathological examination showed that no cancer cells remained. While the standard therapy for extramammary Paget's disease is surgery, we often encounter cases for which surgery is contraindicated. Current guidelines do not recommend definitive radiotherapy for a primary tumor. We are monitoring the patient carefully for local recurrence and metastasis, and long-term follow-up will be necessary.[Skin Cancer (Japan) 2009 ; 24 : 35-39]

View full abstract

A 95-year-old woman had a tumor on her left cheek about 8 years ago. It had gradually grown. She visited our hospital in 2003. Pathological examination revealed squamous cell carcinoma. She received radiotherapy with a total dose of 60gry in 2004, which resulted in remission. The tumor had shown recurrence in 2006, was growing, bleeding, and was difficult to control. Since she refused to undergo an operation, she was treated with Mohs paste in 2007. The tumor was successfully treated, and the bleeding stopped. Mohs paste is a good treatment for a bleeding lesion of an inoperative malignant tumor.[Skin Cancer (Japan) 2009 ; 24 : 40-43]

View full abstract

A 58-year-old woman presented with a tumorous hemangioma in association with a facial ulcer. Since birth, she had a simple hemangioma from the right eyelid to the right upper lip. Over the course of about three years, a nodule formed on top of the hemangioma and gradually increased in size in a tumorous manner. For about the past three months, she had an ulcer accompanied by a foul smell. She received neither laser therapy nor radiotherapy. At the initial visit, she had no vision in the right eye. The right facial hemangioma was first excised, and a split-thickness skin graft was used. Histopathological analysis showed atypical squamous epithelial proliferation accompanied by keratinization, and a highly differentiated squamous cell carcinoma had formed on top of the hemangioma. Therefore, extensive resection was performed, and the defect was reconstructed using a free rectus abdominis muscle flap.
Systemic tests have not shown any clear sign of recurrence. At present (one year after surgery), the patient is free of local recurrence or distal metastasis.[Skin Cancer (Japan) 2009 ; 24 : 44-48]

View full abstract

An 88-year-old woman had noticed a perianal tumor over a period of 7 or 8 years. She visited our hospital because of tumor ulceration and bleeding. There was a 15×21mm sized blackish brown crater like tumor with ulcerated center, located on the right side of her anus. Histopathological examination revealed typical features of solid basal cell carcinoma. The clinical type indicated nodulo-ulcerative basal cell carcinoma. The tumor was resected with a 5mm safety margin without injuring the sphincter.
There is no evidence of local recurrence or metastasis at present.
It is known that most basal cell carcinoma is seen in sunexposed areas, particularly on the face. However, basal cell carcinoma arising in the perianal region seemed very rare, and was found in only 26 case reports from 1984 to 2007 in Japanese literature. [Skin Cancer (Japan) 2009 ; 24 : 49-52]

View full abstract

In January 2008, a 68-year-old man visited our department because of a 30-year history of a slowly growing nodule on his neck. Clinical examination revealed a skin-colored, 34×18×7 mm-sized firm nodule on the anterior part of his neck. The clinical diagnosis was pilomatrixoma. The tumor was excised. Histological examination revealed a well-circumscribed lesion located in the dermis. Epithelial components were embedded in a myxoid stroma. The epithelium showed solid cords, epithelial islands, and small non-branching tubules, containing eosinophilic cuticles detected in some areas. Decapitation secretion was not found in the tubules. Neither follicular differentiation nor plasmacytoid cells were found. Epithelial components, solid cords and islands, showed S-100 protein-positive. The inner layer of tubules was stained by anti-pan-keratin antibody, AE1/AE3. Therefore, the patient was diagnosed as having mixed tumor of the skin.[Skin Cancer (Japan) 2009 ; 24 : 53-56]

View full abstract

A 59-year-old woman noted a nodule on her back in 2002. The nodule was untreated ; it gradually increased in size, so she visited our hospital in March 2007. The tumor size was 4×4×2cm and dome-shape. It was excised with a 1cm surgical margin. Histologically, the central part of the tumor appeared to be compatible with fibrosarcoma, because it contained a dense proliferation of atypical spindle cells arranged in herring-bone-patterns, and the edge of the tumor consisted of dermatofibrosarcoma protuberans (DFSP) composed of uniform spindle-shaped tumor cells in storiform patterns. Immunohistochemical staining of CD34 showed strongly positive in the fibrosarcomatous area and showed positive in the DFSP area. It was diagnosed as fibrosarcomatous variant of DFSP, and wide excision of the tumor including muscle was performed with a 3cm margin from the first operating wound. No local recurrence or metastasis was seen during the follow-up period of 1 year.[Skin Cancer (Japan) 2009 ; 24 : 57-61]

View full abstract

Case 1 : An 80-year-old woman presented with a nodule with purpura on the top of the left side of the head. Case 2 : A 79-year-old man presented with a nodule with purpura on the top of the head after bruising. In both cases, there was no evidence of metastasis. Although they were treated by recombinant-IL2 therapy, the therapy was not effective. In addition to radiation therapy, weekly Docetaxel therapy was initiated at 25-30mg/m²/day/week for three weeks followed by a one-week intermission. Case 1 achieved complete remission. There were adverse effects such as a small amount of pleural and cardiac effusion during therapy. Case 2 achieved partial response. During therapy, leg edema caused a reduction in the dose. Weekly Docetaxel therapy may provide a highly effective treatment for scalp angiosarcoma in the elderly.[Skin Cancer (Japan) 2009 ; 24 : 62-66]

View full abstract

An 82-year-old woman complained of a blackish patch with ulcer on her right sole. One sentinel node was identified on her right inguinal region by computed tomography-lymphography, which was taken after injection of a contrast medium. Four additional lymph nodes were positive by dye sentinel node mapping. Histopathology revealed malignant melanoma with metastasis to the former inguinal lymph node, Stage IIIB (T3b N1a M0). She was treated with local IFN-β injection.[Skin Cancer (Japan) 2009 ; 24 : 67-70]

View full abstract

A 59-year-old Japanese woman visited us with multiple subcutaneous erythematous nodules on the trunk, and with high fever. Histological findings revealed dense infiltrates of atypical lymphocytes in the subcutaneous tissue, and moderate infiltrates of those cells in the dermis. These cells were stained positively for CD3 and CD56, and negatively for CD4, CD8 and CD20. The patient was diagnosed with cutaneous gamma/delta T-cell lymphoma. At first, she was treated successfully with CHOP-E therapy. However, after 3 months, the nodules had reappeared, and the patient had a high fever. Bone marrow examination showed hemophagocytosis. Finally, the patient died of multiple organ failure after 7 months.[Skin Cancer (Japan) 2009 ; 24 : 71-75]

View full abstract

A 28-year-old male presented with a 2-week history of a rapidly growing nodule on his left lower mandible. The nodule was 21×24 mm in size, dome-shaped, and dark reddish with thin crusts. Soluble IL-2 receptor was not elevated, and HTLV-1 antibody was negative. Image examination of PET, CT and MRI revealed that no other lesions were detected except the one on the left mandible. Histlogically, a dense and diffuse infiltration of the tumor cells was observed from the upper dermis to the subcutaneous tissue. The infiltrate consisted of small to medium-sized pleomorphic lymphocytes expressing a CD3+, CD4+, CD8- and CD30- phenotype. A clonal TCR gene rearrangement was detected by Southern blot. We diagnosed him as having primary cutaneous CD4+ small/medium sized pleomorphic T-cell lymphoma, and treated it with local radiation (total 50 Gy). A CR was achieved and no relapse occurred at 20 months follow up.[Skin Cancer (Japan) 2009 ; 24 : 76-79]

View full abstract

A 70-year-old Japanese man with a past history of rheumatic arthritis noticed a subcutaneous mass on his left thigh three months before his first consultation. After then, his left leg was swollen accompanied with pain and fever. He was diagnosed with cellulitis, and antibiotics were administered. Beside the treatment, which relieved the swelling of the leg, extensive firm nodules and cord-like induration were noticed on his left leg. Histologically, dense dermal infiltration of CD20, CD79a, bcl-2 positive lymphoma cells was seen. Systemic analysis revealed lymph node swelling and bone marrow infiltration of lymphoma cells. From the characteristic feature of the eruption, and the clinical course of his first complaint, the occurrence of a subucutaneous mass, we consider this case to be primary cutaneous diffuse large B cell lymphoma, leg type. Though we performed two courses of chemotherapy, they were not effective.[Skin Cancer (Japan) 2009 ; 24 : 80-84]

View full abstract

Malignant melanoma in the right thumb of a 45-year-old man was operated on by IP joint amputation with right axillary lymph node dissection. Micrometastasis in one of 26 lymph nodes was present, leading to Stage IIIA (pT2aN1aM0). He was followed by a total of five courses of adjuvant chemotherapy with DAV-feron. A right humeral subcutaneous tumor appeared 39 months postoperatively. A lymphoscintigraphy labeled ^99mTc-stannous phytate disclosed only a palpable humeral tumor. We resected it, and diagnosed it as an interval lymph node metastasis of melanoma by histological examination. The cubital lymph node is known to be common as an interval node, while the humeral interval lymph node is very rare.[Skin Cancer (Japan) 2009 ; 24 : 85-90]

View full abstract

We report a 53-year-old male who presented with a brown macule on the back. Because Bowen's disease was initially suspected, excision with a 5mm margin was performed. However, the lesion was diagnosed as thin melanoma (Tumor thickness : 0.95mm). The lesion had spontaneously regressed, and was carefully observed. So reexcision and sentinel node (SLN) biopsy under the guide of a local injection of 2% patent blue around the previously open scar were performed after pre-operative lymph scintigraphy. The SLN showed metastatic tumor cells. Further lymph node dissection and general examination revealed no metastasis (pT1aN1aM0, Stage IIIA). Some reports suggest SLN biopsy for thin melanoma. We also recommend this procedure, selecting thin melanoma on certain conditions.[Skin Cancer (Japan) 2009 ; 24 : 91-95]

View full abstract

Angiosarcoma is a malignant tumor that commonly occurs on the head of the elderly. It seems that angiosarcomas are derived from endothelial cells in the vascular and/or lymphatic vessels. We examined the expression of endothelial markers CD31, CD34 and D2-40, using the immunohistochemistry for 11 cases of angiosarcomas. As a result, CD31 was positive in all cases. CD34 was positive in 7 cases. D2-40 was positive in 10 cases. CD31 was a specific vascular endothelial marker. D2-40 was a specific lymphatic endothelial marker. Ten cases of 11 angiosarcomas showed mixed expression of both vascular and lymphatic endothelial phenotypes. Thus, it suggested that the majority of angiosarcomas in our cases differentiate vascular and lymphatic endothelia.[Skin Cancer (Japan) 2009 ; 24 : 96-98]

View full abstract

A 62-year-old man visited our clinic in October, 2000 with a three-year history of erythema of the genital area. We diagnosed his condition as extramammary Paget's disease (EMPD), and a wide excision with a resection margin of 3cm was performed. Dermal invasion of the tumor cells was observed so that he followed up as EMPD stage 2. He noticed swelling of the left leg in July, 2007 and there was a subcutaneous nodule, 8×4 cm in diameter on his left inguinal area. We diagnosed it as metastasis of EMPD by needle biopsy. Metastasis to the left iliac, para-aortic, left supraclavicular and hilar lymph nodes was confirmed by CT scan. He received 12 courses of weekly PET therapy. The edema of the left leg improved, the left inguinal lymph node decreased in size, and other lymph node metastasis disappeared from the image. This regimen is hopeful as therapy for metastatic EMPD.[Skin Cancer (Japan) 2009 ; 24 : 99-103]

View full abstract

Basal cell carcinoma (BCC) is the most common cutaneous malignancy on the sun-exposed face of the elderly. The size of BCC is usually small. Eighty-five percent of BCC in Japanese individuals is pigmented, and large BCC is said to have a risk of metastasis.
We report a case of pigmented giant BCC raised on the right buttock of a 61-year-old male.[Skin Cancer (Japan) 2009 ; 24 : 104-107]

View full abstract

Nine cases of extramammary Paget's disease on whom sentinel node biopsy was performed at the Department of Dermatology, Shimane University Faculty of Medicine between July 2004 and December 2008 were investigated. Sentinel nodes were identified in the inguinal region of the same side if the primary lesion took over one side of the external genitals. They were identified on both sides if the primary lesion took over both sides of the external genitals. Five cases of pT1 and 3 cases of pT2 were negative for lymph node metastasis. One case of pT3 was positive for lymph node metastasis. None of the cases has relapsed over the period of observation (6months-45months). We considered that we could avoid unnecessary lymph node dissection and omission of lymph node metastasis.[Skin Cancer (Japan) 2009 ; 24 : 108-111]

View full abstract

A 45-year-old woman had noticed a mass in the right upper lip over a period of several years, which measured 5×20mm in size with an irregular border, elastically hard, and showing poor mobility. The diagnosis was microcystic adnexal carcinoma. Histopathological examination of a biopsy specimen showed invasion to the muscularis mucosae. We performed wide local resection with a 1cm margin at all layers. An extensive deficit in the area from the cheek to the upper lip was reconstructed with Burget's method.
There has been no evidence of recurrence for one year after the surgical treatment. Her mouth showed a symmetrical appearance and movement. As a result, esthetic and functional satisfaction was obtained by the use of Burget's method.[Skin Cancer (Japan) 2009 ; 24 : 112-116]

View full abstract

A 63-year-old Japanese male presented with a painful subcutaneous nodule on the left buttock. The nodule was diagnosed as a keloid and removed in 2000, and again in 2003. The patient noticed a further local recurrence and consulted us in July 2004. At his first visit, we found a 5.0×1.5 cm pink cutaneous nodule with an associated scar, overlying a 6.5×3.5 cm subcutaneous nodule. Histologically, nests of tumor cells were present in the upper dermis, down to the subcutaneous fatty layer. Within the nests of tumor cells were proliferating spindle cells in a fascicular pattern, with large atypical nuclei. Immunohistochemical studies of the tumor cells were positive for α-smooth muscle actin, vimentin and desmin. We diagnosed the tumor as a leiomyosarcoma, both histologically and immunohistochemically. The lesion was completely excised, with wide margins. The patient has now been free from recurrence and metastasis for about four years.[Skin Cancer (Japan) 2009 ; 24 : 117-121]

View full abstract