The Japanese Skin Cancer Society (JSCS) was founded in 1985, and then in 2001 The Cutaneous Lymphoma Research Society jointed The JSCS. The JSCS has promoted various fields of basic and clinical research of cutaneous oncology in Japan. We have a plan to found a research fund, to change the system of management, and to establish a financial base of this society in order to further our activities and to achieve fruitful achievements in the coming future.[Skin Cancer (Japan) 2011 ; 26 : 255-257]

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The web site of the Japanese Skin Cancer Society provides free download of all the articles published in the academic journal, Skin Cancer, as a PDF file at Journal@rchive for articles up to 2008, and at J-stage for articles from 2009. Members of the Japanese Dermatological Association are permitted to read clinical practice guidelines for skin cancer and cutaneous lymphoma and to read practice algorithms for four skin cancers (melanoma, SCC, BCC and extramammary Paget's disease). Using ‘limitation’ or ‘MeSH’ enables efficient search for intended articles on PubMed. The National Cancer Research Center in Japan provides Cancer Information Service, where patients can obtain correct and updated information, and accordingly doctors could explain disease conditions and suggest therapy more easily. The Cancer Information Site delivers updated and comprehensive cancer information from the United States National Cancer Institute in a Japanese version.[Skin Cancer (Japan) 2011 ; 26 : 258-266]

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Previous reports have demonstrated in immunogenic murine tumor models that bone marrow (BM)-derived DC pulsed ex vivo with synthetic tumor-associated peptides, naturally expressed by tumor cells, serve as effective antitumor vaccines, protecting animals against an otherwise lethal tumor challenge. However, those strong antitumor effects are not observed in treatment models.
Increased concentration of immunosuppressive factors and the accumulation of immunosuppressive cells in the tumor microenvironment indicate that immune regulation has an active role in cancer progression. Recent studies have identified signal transducer and activator of transcription3 (STAT3) as an important molecule that mediates tumor-induced immunosuppression at many levels.
Consequently, STAT3 has emerged as a promising target for cancer immunotherapy.[Skin Cancer (Japan) 2011 ; 26 : 267-273]

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The Second Edition of the General Rules for Clinical and Pathological Studies on Malignant Neoplasms of the Skin, prepared by the Japanese Skin Cancer Society, has been published. For mycosis fungoides and Sézary syndrome, revisions have been made to incorporate definitions of the diseases and their variants based on the updated WHO classification as well as diagnostic criteria for early mycosis fungoides and Sézary syndrome, terminology and staging based on the updated TNMB classification, and treatment recommendations according to the Japanese clinical practice guidelines. These revisions facilitate accurate diagnosis, uniform description, and proper staging for management of the patients, assessing results of clinical trials, and reporting incidence and outcome of the diseases.[Skin Cancer (Japan) 2011 ; 26 : 274-277]

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It was only fifty years ago that Dr. Cicely Saunders first referred to the Brompton cocktail for the relief of terminal cancer pain. Since then an evidence-based palliative medicine including care for social or spiritual pain has been developed.
Dermatologists rarely attend the meetings outside the range of their practice. It was a very fortunate for me to know of the meeting held by professor Alfons Deeken in Tokyo, who taught us the importance of “die Philosophie des Todes.” There should be a way open to dermatologists to learn about palliative medicine.
Physians began to notice that palliative medicine is the route of all medical activity. It is because the aim of medicine has been only to relieve the patients from their complaints. This has been called “medicine returning to the basics.”
May this symposium be the initial step to developing dermatology in palliative medicine![Skin Cancer (Japan) 2011 ; 26 : 278-281]

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Cutaneous metastases from various kinds of carcinomas occur in many patients at the end of life. Therefore, the indication for radical treatment is severely restricted. Because of the poor general condition and unfavorable prognosis, the physician in charge will often avoid treatment for skin metastases or the patient may decline the treatment. However, this may lead to a more severe condition such as fungating tumor, which can develop massive discharge, bleeding, pain, infection, and malodor, causing distress to patients and a decreased quality of life (QOL). Thus, dermatologists should not abandon palliative and radical treatment for cutaneous metastases. The first choice of treatment is surgery, but palliative care that allows a patient to lead a better QOL should also be properly chosen. The aim of this paper is to discuss current wound care for cutaneous metastases with the goal of developing an appropriate strategy for better control of wound-related symptoms.[Skin Cancer (Japan) 2011 ; 26 : 282-288]

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We report four patients with novel cutaneous manifestations (striaelike epidermal distension) that arose after acute edema of the lower extremities, based on low nutrition in two cases associated with anorexia nervosa and in two other cases with an end stage of internal malignancy. The clinical features included xerosis, edema and numerous linear, reddish or brownish, partially elevated lesions, 2 to 3 mm in width, with blisters and ulcers in one case. Histopathology of the lesions revealed epidermal degeneration and/or necrosis, and swelling and/or degeneration of endothelial cells in the upper dermis, which differed from striae distensae and eczema, although the clinical findings of these patients seemed similar. As the edema decreased, almost all of the lesions formed thin crusts and finally resolved, leaving only residual pigmentation without scarring or atrophy. This symptom must be a cutaneous manifestation which needs to be recognized, although it is not described well in the Dermatology literature.[Skin Cancer (Japan) 2011 ; 26 : 289-293]

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Molecular target drugs often result in unique adverse skin reaction. The kinase inhibitors cause acral erythema, called hand-foot syndrome, or palmar plantar erythrodysathesia syndrome. Due to severe pain or decreased activity of daily living, quite many patients receiving kinase inhibitors choose to stop taking the drugs. This painful skin reaction can be overcome by using topical potent steroid, by wearing proper foot wares, or by adequate foot care. Using foot wares made by prosthetists and orthotists may be encouraged. Cutaneous side effects of epidermal growth factor receptor inhibitors include itching acne-like rash and painful paronychia. Although the treatment is challenging, the former can be treated with topical steroid and oral antiseptic drugs, and the latter can be controlled by applying tape from the distal nail fold around the digits, or by recieving adequate foot care. Dermatologists should play a leading role in controlling skin adverse events due to anticancer drugs.[Skin Cancer (Japan) 2011 ; 26 : 294-300]

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The characteristics and usefulness of a treatment for pressure ulcers were examined in advanced cancer patients requiring palliative care. The subjects comprised advanced cancer patients with pressure ulcers who were admitted to the hospital during the past 2 years. The characteristic found in the patients was a higher incidence of pressure ulcers in the sacral region compared with the bedridden elderly, few patients who had developed pressure ulcers before hospital admission, and patients experiencing malnutrition. For terminal care patients whose levels of functional independence were reduced during the terminal care of their cancer, prevention of pressure ulcers was a priority, while for those who developed pressure ulcers, open wet-dressing therapy with perforated polyethylene film dressings was a useful local therapy to minimize pain from the wounds and treatments.[Skin Cancer (Japan) 2011 ; 26 : 301-304]

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Most cancer patients can achieve satisfactory relief of pain through an approach that incorporates primary treatments, systemic analgesic therapy. WHO published a set of guidelines based on the three-step analgesic ladder with opioid and nonopioid analgesics (nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and adjuvant analgegia). This depends on the underlying pathophysiological mechanisms, which are classified as nociceptive (somatic and visceral), neuropathic and idiopathic. Nerve damage pain and incident pain tend not to respond well to opioids. Some examples which may be resistant to treatment with opioid analgesics are pain associated with decubitus ulcers or skin invasion with cancer. This review will offer one of pharmacotherapy strategy to cancer pain.[Skin Cancer (Japan) 2011 ; 26 : 305-310]

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A 20-years-old man suffered from a rapidly growing tumor on his head. A histopathological survey of the tumor revealed CD99-positive small round cells massively spaced in the dermis and the subcutaneous fatty tissue. Although, EWS-FLI1 and EWS-ERG were negative in RT-PCR, this tumor could be diagnosed as Ewing sarcoma, because an abnormality of the EWS-gene of the tumor cells was detected by a fluorescence in situ hybridization study. Radio-chemotherapy for the tumor and lymph node metastasis was performed, however, the therapy was not effective. Since the bad smell, huge size and heavy weight of the tumor impaired his quality of life, Mohs' paste chemosurgery was applied two times, resulting in the safe reduction of the tumor size and improvement in the patient's quality of life.
Mohs' paste chemosurgery seems to be a palliative, but useful therapy for huge skin cancers in the terminal stage.[Skin Cancer (Japan) 2011 ; 26 : 311-315]

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We report a case of a 66-year-old woman with Sézary syndrome. The patient was diagnosed as having chronic eczema at the local hospital and had been treated since 2007. Although the administration of cyclosporin was started in August 2010, her skin eruption worsened, then she visited our hospital in October 2010. A biopsy specimen revealed dense dermal and epidermal infiltration of CD4-positive lymphocytes. Atypical lymphocytes were observed in the peripheral blood, and clonal TCR cβ1 gene rearrangements were detected by Southern blotting. A few lymphocytes in the epidermis with only scant spongiosis were observed in the previous skin biopsy specimen, which was obtained just before cyclosporin was administration at the local hospital. We suspect that the symptom of Sézary syndrome had become obvious by the administration of cyclosporin in this case. This case reminds dermatologists of the necessity of carefully evaluating erythrodermic patients before embarking on immunosuppressive therapy with cyclosporin.[Skin Cancer (Japan) 2011 ; 26 : 316-322]

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Although most skin cancer on the distal lower extremity drains exclusively into the inguinal lymph nodes, a small number of cases to interval nodes in the popliteal basin. We investigated our skin cancer database of patients who had skin cancer and performed sentinel node biopsy (SNB) on the distal lower extremity between January 2007 and April 2010 at the Department of Dermatology, University of Miyazaki. Of 21 patients who underwent SNB, 17 cases had malignant melanoma and four had squamous cell carcinoma. Six cases (29%) had drainage to the popliteal basin and one (5%) had tumor-positive popliteal SLN. Four cases were on the heel, one was on the Achilles tendon, and one was on the lateral site of the foot. In conclusion, drainage to popliteal sentinel nodes and the pattern of this drainage should be noted in the distal lower extremity skin cancers.[Skin Cancer (Japan) 2011 ; 26 : 323-326]

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Based on the histological findings and the historical safety of phenol in medicine, premalignant skin tumors in elderly patients have been treated with peeling using phenol. Sixty-two patients (44 AK, 18 BD, the mean age 76.6 years) have been treated in our department between April 2001 and 2010. This study was performed on tumor tissues from 9 patients with a complete response and 7 patients with progress disease, as well as the 9 normal skins and 6 squamous cell carcinomas.
We analyzed the histopathological parameters for tumor and horney cell layer thickness and immunohistochemical expression of CXCR4, CCR6 and CCR7 on these cases. We observed a higher expression of CXCR4 in progress disease cases and SCCs as compared with complete response cases and normal skins. These findings suggest that assessment of CXCR4 is a useful marker as adjunctive diagnostic tools to predict the efficacy of phenol treatment of these lesions.[Skin Cancer (Japan) 2011 ; 26 : 327-332]

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We report a case of a 67-year-old man with extramammary Paget's disease on the left axilla. As clinical findings, an oval erythematous plaque with scale and pigmentation was recognized on the lesion at his first visit. Histological findings of the lesion clearly revealed Paget's cells. Namely, microinvasion in the dermis of tumor cells was observed. No erythematous lesions were seen on his right axilla and genital area, and no tumor cells were found on the biopsy specimens. Researchers in our department have tried to analyze clinical findings of 75 cases with extramammary Paget's disease over a period of 20 years. Also, the previous 31 cases of extramammary Paget's disease on the axilla that have been reported in Japan have been summarized.[Skin Cancer (Japan) 2011 ; 26 : 333-336]

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We report a case of a 49-year-old female with malignant peripheral nerve sheath tumor (MPNST) in neurofibromatosis1. There were multiple neurofibromas on her whole body, and two larger subcutaneous tumors on her back and left axilla. Because these two tumors had been developing over the course of several months and she felt pain, the tumors were resected. The pathological diagnosis of the tumor on her back was MPNST, and that on her left axilla was related lymph node metastasis. PET-CT revealed multiple bone and lymph nodes metastases. Three courses of adjuvant chemotherapy with adriamycin and ifosfamide were not effective. We started oral administration of 800 mg of sorafenib daily but the metastatic tumors were enlarging. The sorafenib was discontinued because of liver disfunction on the 48th day from the start of medication. Afterwards, the metastatic tumor had expanded more rapidly, and she died of multiple organ failure two months after the discontinuance of sorafenib.[Skin Cancer (Japan) 2011 ; 26 : 337-341]

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A 79-year-old man noticed a pigmented macule with erosion on his glans penis. There was no palpable inguinal lymphadenopathy. Staging with a positron emission tomography and computed tomography showed no evidence of metastasis. Partial penectomy with a 2-cm free margin and a sentinel lymph node biopsy were performed. Histopathological examination revealed malignant melanoma with lymphatic invasion, Breslow's tumor thickness of 3 mm invasion and 3/5 positive sentinel lymph nodes. Bilateral inguinal and intrapelvic dissection of lymph nodes was performed followed by DTIC chemotherapy with local injection of interferon-β. However, four months after surgery, during the post-operative DTIC-feron treatments, multiple in-transit metastatic lesions developed. Taxol-feron treatments failed to control the in-transit metastasis, and the patient died one year and two months after surgery. This case suggests the importance of considering the patient's quality of life when planning treatment strategy for a patient with malignant melanoma at a high risk for in-transit metastases.[Skin Cancer (Japan) 2011 ; 26 : 342-347]

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A 60-year-old woman presented with a one-year history of a slow-growing nodule on her left upper eyelid. Physical examination revealed a subcutaneous nodule measuring 1.4×1.4 cm in diameter. Histopathology showed an island of uniform-appearing epithelial cells within pools of mucin. Tumor cells were immunopositive for CK7, GCDFP-15, but not for CK20. The p63 staining was focally positive in peripheral cells in situ component. Investigation for a primary internal malignancy was negative, and the results led to a diagnosis of primary mucinous carcinoma of the skin.
The appropriate surgical margin for mucinous carcinoma of the skin is still controversial in Japan. Recently Mohs surgery has become the most useful surgical method for high-risk skin cancer in United States and European countries. Our case underwent complete excision followed by modified Mohs micrographic surgery, and the defect was reconstructed with a bilobed flap. There is no evidence of recurrence at 18 months post operation.[Skin Cancer (Japan) 2011 ; 26 : 348-353]

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A 38-year-old woman was referred to our department with a brown macule on the fifth toe of her right foot that had enlarged gradually over the course of 4 years. Physical examination revealed a brownish macule 14×15 mm, with accompanying scales. The lesion had spread to the nail plate, and melanonychia was observed.
Histopathological findings showed acanthotic epidermis with atypical dyskeratotic keratinocytes that included clumping cells. We made the diagnosis of Bowen's disease and treated the lesion with wide local excision (5-mm margin from the macule), longitudinal excision of the nail bed and the proximal and lateral nail fold, and full-thickness skin graft.
Bowen's disease presenting with longitudinal melanonychia is extremely rare. In the case of longitudinal nail plate pigmentation, Bowen's disease should be included in the differential diagnosis.[Skin Cancer (Japan) 2011 ; 26 : 354-358]

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We report a case of pigmented squamous cell carcinoma of the temporal scalp. An 81-old-man was referred to our clinic because of a black skin nodule. On dermoscopy, the lesion showed ulceration, leaf-like areas and diffuse grey-blue color. Histopathological examination revealed atypical keratinocytes and coexisting melanocytes. There were many melanophages in the peripheral stroma. It may be difficult to distinguish pigmented squamous cell carcinoma from basal cell carcinoma by dermoscopy.[Skin Cancer (Japan) 2011 ; 26 : 359-363]

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A comparative study was conducted to evaluate the efficacy of imiquimod 5% cream in the treatment of actinic keratosis (AK) for Japanese patients. Imiquimod 5% cream was applied once daily, 2 or 3 times/week for 4 or 8 weeks. The complete clearance rates were 57.1% (3 times/week), 37.1% (2 times/week) and 16.9% (vehicle). A significant dose-response relationship was found (p<0.001). The complete clearance rate was also significantly better for the imiquimod 3 times/week group compared to the imiquimod 2 times/week group and the vehicle group. Furthermore, there were no recurrences after a 1-year follow-up period in 32 patients who demonstrated complete clearance with the imiquimod 3 times/week treatment. The incidences of adverse events were 93.7% (3 times/week), 85.5% (2 times/week) and 81.4% (vehicle). The most frequent adverse events were local reactions, mostly being mild to moderate. Imiquimod 5% cream is an effective and well-tolerated treatment for Japanese AK patients.[Skin Cancer (Japan) 2011 ; 26 : 364-377]

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