We report the case of a 59-year-old male with angiosarcoma of the scalp. He noticed a nodule on the right temporal region one month after an injury. There was a dome-shaped red nodule, 40×37×7 mm in size, and which had hemorrhaged easily on the surface. Histopathologically, the nodule was diagnosed as angiosarcoma. Metastases in the lungs and left kidney were detected by computed tomography and scintigraphy. We performed a combination therapy of intravenous docetaxel hydrate and local rIL-2 injection. Although the size of the nodule decreased, relapse occurred two months later. Therefore the patient underwent electron beam therapy of 20 grays. However, he then showed pneumothorax. He died 4 months after his first visit. Postmortem examination revealed multiple metastases in both lungs, liver, left kidney, gallbladder, colon, left adrenal, spleen, mesentery, peritoneum, pleura, epicardium, and greater omentum.[Skin Cancer (Japan) 2010 ; 25 : 119-123]

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A 40-year-old woman visited a dermatological clinic in summer, 2007 because of a red nodule bleeding easily on her left forearm. Granuloma telangiectaticum was susupected, and she was referred to our hospital. On her initial visit, a physical examination revealed a red pedunculated nodular tumor, 8mm in diameter, on her left forearm. It was surgically removed. A histopathological examination revealed spindle or polygonal neoplastic cells with clear nuclei without melanin pigment. Immunohistochemically, the neoplastic cells were positive for MelanA, S-100 but negative for HMB-45 ; they were therefore diagnosed as amelanotic malignant melanoma.
Close inspection of the whole body, including CT and PET-CT, showed no metastasis. Further resection was made and right axillary-lymph-nodes were removed (tumor thickness 6.0mm, pT4bN1M0 : Stage IIIB). The patient received 4 courses of DAV-Feron therapy and no recurrence was found.[Skin Cancer (Japan) 2010 ; 25 : 124-127]

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We report a case of multiple Bowen's disease in a 96-year-old man suspected of chronic arsenic poisoning. At the age of 91 years, he had been diagnosed with multiple Bowen's disease with squamous cell carcinoma (SCC), Bowen's carcinoma, Bowen's disease, and basal cell carcinoma. Five years after the removal of these lesions, he presented at our hospital with a rapidly growing cauliflower-shaped tumor, 7×7 cm in size on the right shoulder. The tumor had been found to have developed from a faint reddish macule on the right shoulder, which had been noticed in a clinical photograph taken at the age of 91 years. In addition, nodules were found on the lower abdomen, side of the navel, and left calf, and were diagnosed histologically as SCC, Bowen's carcinoma and Bowen's disease respectively. Thus, these SCC appeared during a period lacking appropriate follow-up. The present case indicates the importance of periodic follow-up observations following treatment for SCC.[Skin Cancer (Japan) 2010 ; 25 : 128-131]

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A 66-year-old woman was referred to our clinic for further evaluation of lymphangiosarcoma in the right upper limb which was affected by primary, non-hereditary lymphedema at the age of 20 years. The tumor appeared five months before. She was diagnosed as having Stewart-Treves syndrome. The patient did not agree to undergo amputation of the affected arm. Intra-venous chemotherapy with paclitaxel (PTX) was performed, but caused severe bone-marrow suppression. Intra-arterial infusion of PTX was carried out to reduce blood side effects, but induced Grade 3 peripheral neural damage. The chemo drug was changed to docetaxel (DTX), combined with radiotherapy. However necrotic erythema due to DTX occurred in the upper arm. Chemotherapy was switched to oral administration of etoposide and prednisolone. Recently metastasis in the right subaxillary lymph nodes was treated by X-ray radiation. The patient has survived for a period of nineteen months without distal metastasis. This case has survived quite a long time without amputation compared with other reported cases.[Skin Cancer (Japan) 2010 ; 25 : 132-136]

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A 66-year-old man consulted our clinic with cervical lymph node swelling due to metastasis of malignant melanoma. A few black nodules and patches were found at the nasal cavity, which was the primary site of his melanoma. We tried total nose resection, cervical lymph node dissection and reconstruction of the nose. Five cycles of adjuvant chemotherapy using dacarbazine, nimustine, vincristine and interferon-beta, and monthly injection of interferon beta which successfully treated the melanoma. He has remained disease-free for 5 years. We experienced 234 cases of malignant melanoma from 1999 to 2008 at the Department of Dermatology, Shinshu University. This included 197 cases of primary cutaneous melanoma, 25 (10.7%) primary mucosal, 2 ocular, and 9 cases of unknown origin. As for mucosal melanoma, we treated 12 genital, 6 lip and oral cavity, 4 anorectal, 2 nasal cavity, and 1 accessory sinus case. Mucosal melanoma, especially arising from the accessory sinus, anorectal and female genital showed a poor prognosis.[Skin Cancer (Japan) 2010 ; 25 : 137-140]

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Vitiligo-like hypopigmentation occasionally occurring in patients with malignant melanoma (MM) is an unfully elucidated and important phenomenon, but exploration of its mechanism may be helpful for further development of melanoma treatment. Here, we present a case of metastatic MM showing complete remission following the development of systemic vitiligo. In our case, as a considerable number of lymphocytes infiltrated both the primary and metastatic lesions, an autoimmune response appears to have taken place. In addition, he developed vertebral osteomyelitis persisting for more than a year during the course of treatment. The two extraordinary conditions might contribute to achieving a complete eradication of the metastatic melanoma.[Skin Cancer (Japan) 2010 ; 25 : 141-144]

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A 72-year-old man presented with erythematous plaques on his head and back, which had not responded to topical corticosteroids. Erythematous plaques were found on the parietal and occipital lesions of the head and on the back. A biopsy specimen from the occipital lesion showed extensive perifollicular and intrafollicular infiltrates of atypical lymphocytes and showed follicular mucinosis. Immunohistochemical stains of the atypical lymphocytes showed positive reaction for CD3 and CD4, and negative reaction for CD8 and CD20. Southern blotting demonstrated a clonal rearrangement of the T-cell receptor J-gamma chain. There was no abnormal lymph node swelling or visceral metastasis under positron-emission tomography and computed tomography. The patient was diagnosed with folliculotropic mycosis fungoides, stage IA. He was treated with topical PUVA and interferon gamma, which had little effect. Electron beam irradiation and oral etretinate were administered, and then the eruption regressed.[Skin Cancer (Japan) 2010 ; 25 : 145-149]

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A 72-year-old man presented with erythema on his abdomen with pustules and fever up to 38°C. He was given glucosidase inhibitors for diabetes ; thus, we diagnosed him as having acute generalized exanthematous pustulosis, and he was started on oral steroids. After tapering of the steroid treatment, the eruptions became worse. Computed tomography showed multiple lymph node swelling. Histopathologic analysis of the lymph nodes revealed a disappearance of lymphatic follicles, proliferation of medium sized neoplastic clear cells and high endothelial venule. Immunostaining of lymph nodes demonstrated that tumor cells expressed CD3 and perivascular cells expressed CD21. Southern blot analysis was not able to detect rearrangement of the β chain gene of the T-cell receptor and the H chain gene of the immunoglobulin. EBER in B cells was detected by in situ hybridization analysis. Therefore we diagnosed the patient as having Angioimmunoblastic T-cell lymphoma with clinical and histopathological findings. Although he received steroid pulse therapy and the eruptions disappeared, he died due to MRSA pneumonia.[Skin Cancer (Japan) 2010 ; 25 : 150-156]

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A 28-year-old Japanese female noticed a slowly enlarging, red nodule on her right thigh about 2 weeks before her initial visit to our department. Clinical examination revealed a 1×2-cm-sized red nodule on her right medial thigh. Histologically, a dense and diffuse infiltration of CD30 and ALK-positive atypical cells was observed from the upper dermis to the subcutaneous tissue. We resected the entire tumor and her swollen right inguinal lymph node. The histology revealed tumor cells in the lymph sinuses and afferent lymphatics. FDG-PET disclosed a right intrailiac lesion, which prompted us to diagnose her condition as primary cutaneous ALCL with metastasis to the right inguinal lymph node and intrailiac area. Following this diagnosis, the patient was administered 8 courses of CHOP regimen although the right intrailiac lesion was no longer visible in the PET imaging after the initial 3 courses. The patient has remained in complete remission for 12 months.[Skin Cancer (Japan) 2010 ; 25 : 157-161]

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A 58-year-old woman had an episode of pain on her right upper arm nine months before her first consultation. After then, as the erythematous swelling progressively enlarged on the area, she was admitted to a nearby hospital on suspicion of cellulitis in May, 2008. Because some peripheral nerves in the area had become paralyzed, a diagnosis of acute compartment syndrome was established and a fasciotomy was performed. After that, her right lower arm also became swollen with gradually worsening symptoms. In June 2008, she was referred to our hospital for admission. Since histologically, infiltration of large atypical lymphoid cells from dermis to fascia was observed, we diagnosed this case as diffuse large B cell lymphoma (DLBCL). Systemic analysis revealed slight swelling of a right axillary lymph node and a right perineal subcutaneous mass. We performed eight courses of R-CHOP chemotherapy and a partial remission was achieved. Herein, we report this rare case showing cellulitis-like manifestation.[Skin Cancer (Japan) 2010 ; 25 : 162-167]

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A 46-year-old Japanese man with a solitary cutanous nodule on the nose came to our attention. The lesion had first appeared 3 years before. The cutaneous lesion was an erythematous nodule, approximately 13×12mm in diameter. Histologically, there was a grenz zone in the upper dermis, and nodular and sheet-like proliferation of lymphoid cells with dense infiltration of large eosinophilic cells (- 30mμ in diameter) at the periphery. The lymphoid cells were positive for CD20, CD79a, bcl-2 and CD43. As the cytoplasms of the large cells were PAS-positive, diastase resistant, they were Mott cells having many Russell bodies in the cytoplasm with displaced nuclei to the periphery. The large cells were negative for CD20, and positive for IgA and κ-chain. The polymerase chain reaction method using DNA extracted from a paraffin section showed a rearranged band of the IgH gene. As further investigations did not demonstrate any visceral manifestations, he has been diagnosed as having primary cutaneous marginal zone B-cell lymphoma.[Skin Cancer (Japan) 2010 ; 25 : 168-172]

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Verrucous carcinoma is an uncommon well-differentiated squamous cell carcinoma with slow, progressive local invasion and low potential for metastasis. A definitive diagnosis is often difficult to obtain if only superficial portions of the lesion are submitted for pathological evaluation. We present a case report of an 84-year-old man with a verrucous carcinoma on the fourth interdigital fold of his right foot which had not been recognized as a carcinoma for several years. It was refractory to cryotherapy at another institution ; he subsequently visited our hospital. Despite the initial benign pathological diagnosis, the lesion continued to grow. He underwent resection of the lesion with clear margins, and the final pathological findings were consistent with verrucous carcinoma. We treated the condition successfully with amputation of the fourth and little toes. Fifteen months after the operation, he is well with no signs of recurrence.[Skin Cancer (Japan) 2010 ; 25 : 173-176]

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We report a case of mucinous carcinoma of the skin. A 29-year-old Japanese woman with a tumor on the left upper eyelid, which had been growing for two years, consulted a dermatologist, and the tumor was excised. Histological diagnosis disclosed mucinous carcinoma. The patient consulted our hospital because the tumor was suspected of being metastatic skin cancer. On gastro-intestinal fiberscopy, abdominal, mammary gland, and endovaginal ultrasonography and mammography, and gallium scintigraphy, no neoplasm was detected. Consequently, the tumor was diagnosed as mucinous carcinoma of the skin. The excision scar on the orbital septum was excided at a distance of 10mm from the scar, and a skin graft from the back of the auricle was transplanted to the skinless upper eyelid. Nine months after surgery, the patient is able to open and close the upper eyelid, and there has been no evidence of tumor recurrence or metastasis.[Skin Cancer (Japan) 2010 ; 25 : 177-180]

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A 62-year-old male patient had noticed red eczema on the sole of his left foot about 10 years ago. Since 2 years ago, erosion and bleeding have repeatedly occurred at that site due to the patient's own scratching due to itching. He was diagnosed at another hospital with eczema and treated with steroid ointment without any remarkable effect. Then he was referred to our hospital. Physical examination revealed a red scratched erythema with erosion 11×12mm in size at that site. A diagnosis of eccrine poroma was diagnosed by skin biopsy, followed by total resection. The final pathological report resulted in eccrine poroma associated with Bowen disease, which were identified separately. Immunohistochemically, poroid cells had a positive reaction to anti-CEA antibody. Because coincidental occurrence of both disease entities is very rare, we thought there might be an interrelated immunological or biochemical correlation.[Skin Cancer (Japan) 2010 ; 25 : 181-184]

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We report a case of undifferentiated adenocarcinoma on an axillary region of a 65-year-old male, the presence of which suggested the possibility that it was of apocrine origin. The lesion was first noticed as a small subcutaneous nodule some ten years ago, and it had grown rapidly during the last 6 months. Physical examination revealed a 6×5cm in size, elastic hard, subcutaneous nodule with a wrinkled surface, and regional lymph node adenopathy under the nodule. Histopathological examination revealed numerous trabecular strands with lumina, which were composed of atypical cells with abundant eosinophilic cytoplasm. A few lumina showed decapitation secretion. Immunohistochemical findings were as follows : GCDFP-15 (+), CAM5.2 (+), vimentin (-), SMA (-), S-100 (-), HMB-45 (-), LCA (-), CEA (-), AFP (-), TTF-1 (-), estrogen-receptor (-), progesterone-receptor (-). Further precise examination, including various imaging tests, denied the possibility of either visceral malignancies or distant metastases. At the time of writing, during the 18-month follow-up there have been no signs of either any local recurrence or of metastasis.[Skin Cancer (Japan) 2010 ; 25 : 185-188]

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Thick melanoma (Breslow thickness>4mm) is characterized by a high recurrence rate and distant metastasis. Although DAVFeron (DAVF) is used as a standard adjuvant therapy in Japan, the clinical evidence for its efficacy is limited. A retrospective analysis of 55 thick melanoma patients was performed at Asahikawa Medical College hospital from 1978 to 2009. Overall survival (OS) and disease-free survival (DFS) curves were analyzed by Kaplan-Meier estimates and by Cox proportional hazards methods. The estimated 5-year OS was 47.6% for all 55 patients. The 5-year OS rate was significantly higher in patients after the introduction of DAVF therapy than that of patients before the DAVF ; the DFS rate, however, was not significantly altered. By multivariate analysis, the treatment era before or after the DAVF therapy, and the lymph node metastasis were the statistically significant factors for the OS. The prognosis of thick melanoma patients at our hospital has shown improvement in recent years. Because this study is a retrospective case series report, we cannot conclude the efficacy of the DAVF or IFN-beta for thick melanoma. To establish high-risk melanoma treatment, evidence-based clinical studies regarding the prognosis by IFN-beta treatment should be performed.[Skin Cancer (Japan) 2010 ; 25 : 189-194]

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Problems of vulvar reconstruction are wound contamination due to secretion, and delayed wound healing caused by lymphorrhea. An aesthetically and functionally satisfying reconstruction of the vulva is also required. There are some reports concerning the gluteal fold flap for vulvar reconstruction. The gluteal fold flap has a reliable blood supply based on the internal pudendal artery. The internal pudendal artery is not compromised by groin dissection. The gluteal fold flap can be safely elevated in the case of longhorn resection of vulvar cancer and groin lymph nodes. Another advantage of the flap is the inconspicuous postoperative donor site scar. We performed vulvar reconstruction based on our using the gluteal fold V-Y advancement flap. We elevated the flap retaining the continuity between a part of the flap and the skin of the medial thigh. It can easily be elevated and advanced to reconstruct an aesthetically and functionally satisfying vulva.[Skin Cancer (Japan) 2010 ; 25 : 195-199]

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We report the treatment experience of a burn scar carcinoma of the lower lip. A 39-year-old man suffered a burn on his face and upper body caused by a gas explosion. The wound healed with conservative treatment, but a lesion occurred on the lower lip 25 years after primary wound healing. Incisional biopsy was performed on the tumor in the department of dermatology, and the biopsy suggested squamous cell carcinoma in situ. We excised this tumor with about 5 mm of marginal tumor-free skin and diagnosed it histologically as highly differentiated squamous cell carcinoma. Subsequently, we added 5 mm of lateral margins around the scar, and observed its progress. At 1 year postoperatively, the patient did not have any recurrence. The aesthetic and functional results were satisfactory.[Skin Cancer (Japan) 2010 ; 25 : 200-204]

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Fine erythematous papules appeared on the left ankle of a 76-year-old male, November 2008. Although most of the papules had disappeared spontaneously, a number of the papules had become enlarged. A diagnosis of CD30-positive lymphoma was made by skin biopsy at another dermatology clinic. Subsequently, he was admitted to our university hospital. At the initial visit, a nodule approximately 1cm in diameter on his left leg, and a red, rough, well-demarcated nodule with ulcer and crust whose size was 5cm on his left ankle were seen. After excision of these lesions, several nodules appeared on other areas of his legs and enlarged rapidly. We successfully treated these nodules with ultraviolet irradiation using a 308nm excimer lamp.[Skin Cancer (Japan) 2010 ; 25 : 205-209]

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Case 1 : A 77-year-old man had an asymptomatic nodular mass in his right temple that had rapidly grown to measure 12mm in diameter. Case 2 : A 65-year-old woman had an asymptomatic pink nodular mass in her right temple that had rapidly grown to measure 20mm in diameter. Both cases were diagnosed as mucinous carcinoma of the skin by skin biopsy. Wide excision was performed on both cases. There was no evidence of local recurrence or regional lymphadenopathy after resection.[Skin Cancer (Japan) 2010 ; 25 : 210-213]

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Actinic keratosis (AK) is an early stage of squamous cell carcinoma (SCC) seen on the chronically sun-damaged skin of elderly persons. It is a common condition in Caucasians, and guidelines for the management have been published in Europe and the USA. In recent years, the number of AK patients has also been increasing in Japan due to the movement toward an aging society. Most AKs are harmless ; however, some of them progress to invasive SCC and induce problems in management, particularly in high-aged patients with various kinds of physical complications. Because we cannot identify which AK is high risk, appropriate treatment should be performed when we detect AK. In this article, the author first summarized the relevant data of recent basic research and the epidemiology of AK, and then described the clinical and histopathologic characteristics of AK in order to increase diagnostic accuracy. Thereafter the present status of treatment of AK was described in detail, which surely helps clinicians to manage AK adequately.[Skin Cancer (Japan) 2010 ; 25 : 214-231]

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