We reported a total of 300 cases (143 males and 157 females) with malignant skin tumors that were treated surgically at the Division of Plastic and Reconstructive Surgery, Hokkaido Cancer Center from 2001 to 2011. The most common malignant skin tumors were basal cell carcinoma (34%), followed by squamous cell carcinoma (24%). The most common tumor site was the head and neck region (64%), followed by the lower extremity (14%) and upper extremity (10%). The cases that were treated at our division have decreased gradually in recent years. Most of the patients (95%) were referred to our division from other departments or other facilities, and 83% of the patients were from the dermatology department at our hospital or other facilities.[Skin Cancer (Japan) 2012 ; 27 : 137-142]

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A 71-year-old man noticed an erythematous plaque on the left axilla 1 year ago. The plaque measured 30×25 mm. A histological examination revealed adenocarcinoma composed of atypical cells with abundant eosinophilic cytoplasm and a finding of decapitation in some parts of the tumor. The tumor cells were PAS (+) (with resistance to diastase), CAM5.2 (+), GCDFP-15 (+), CK7 (+), CK20 (-), ER/PgR (-), MiB-1/Ki67 index 9%. No abnormal laboratory data and no evidence of metastasis to other organs were observed. Based on these findings, the plaque was diagnosed as apocrine carcinoma. It was broadly excised. As of 6 months after surgery, no recurrence has been noted.[Skin Cancer (Japan) 2012 ; 27 : 143-147]

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We report a case of an 82-year-old female with morpheaform basal cell carcinoma (BCC) of the nose to right medial chanthus. She was treated with surgical excision and skin grafting. She had not received follow-up care since the postoperative examination at 2.3 years after surgery. She visited our clinic again at the age of 97 after an interval of 14.5 years, complaining of a destructive ulcer due to recurrence of BCC on the eyelids and orbit. CT images showed infiltration of the right retro-orbital fat and adjacent bones. Subsequently, she had received follow-up care for palliative treatment without orbital exenteration because she was a super-aged patient with mild dementia. The last CT and MRI scans showed probable intracranial invasion into the dura mater, cavernous sinus, and clivus.
Because recurrence is not uncommon, especially with periocular BCC, a close and long-term follow-up is mandatory.[Skin Cancer (Japan) 2012 ; 27 : 148-151]

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A 78-year-old female with a subcutaneous tumor in the left lower abdomen is reported. Incisional biopsy indicated metastatic ovarian carcinoma. However, neither examination by a gynecologist nor computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography-CT could detect the primary carcinom as other than the abdominal subcutaneous tumor. A wide excision was performed under the working diagnosis that the tumor was abdominal carcinoma of unknown primary site. The histopathologic diagnosis revealed extraovarian peritoneal serous papillary carcinoma (EPSPC). Many patients present with a subcutaneous mass in dermatology or plastic surgery outpatient clinics. Carcinoma of an unknown primary site (CUP) is included among them as a rare form of subcutaneous mass. EPSPC, one form of CUP, is more commonly seen by gynecologists and dermatologic surgeons in charge of the treatment of soft tumors. They need to have increased awareness that patients with soft tumors may have EPSPCs.[Skin Cancer (Japan) 2012 ; 27 : 152-157]

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A 61-year-old man complained of swelling and ulceration on the right index finger. The skin region caused severe pain accompanied by high-grade fever over 38°C, and malaise. Laboratory data showed leukocytosis with predominantly increased monocytes in the peripheral blood, and atypical monocytes in the bone marrow. Histological examination of the peripheral ulcer revealed marked infiltration of atypical monocytes positive for CD68. Based on these findings, a diagnosis of chronic myelomonocytic leukemia (CMML) with skin infiltration of leukemic cells was made. Leukemia cutis in CMML is relatively rare, and could be a sign of progression to acute leukemia.[Skin Cancer (Japan) 2012 ; 27 : 158-161]

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A 22-year-old man had noticed a subcutaneous mass on his right buttock for the past 6 years. He visited a local clinic where total excision was performed. Histological examination of the excised tumor revealed that atypical pleomorphic spindle cells had proliferated in the myxoidstoma. Immunohistochemical analysis of the specimen showed positive for vimentin as well as MIB-1 (index 5%). The tumor was diagnosed as myxofibrosarcoma. Subsequently, the patient visited our hospital for further treatment. We perfomed additional resection with a 5 cm margin and under the fascia. Neither recurrence nor metastasis has been found during the past 6 months.
It may sometimes be difficult to make a diagnosis for myxofibrosarcoma as low grade fibromyxoid sarcoma may have similar histological findings.
Therefore, we summarized different findings between two diseases, clinically and histologically.[Skin Cancer (Japan) 2012 ; 27 : 162-165]

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An 86-year-old man presented to us with an ulcerative exophytic tumor in the left preauricular area. The tumor was 50 × 40 × 50mm in size, and had invaded the superficial layer of the parotid gland. Histologically, it was diagnosed as sebaceous carcinoma. The scheduled surgical operation needed to be postponed due to complications of pneumonia. The tumor was treated with radiation therapy using 60 Gy of X ray beam instead of an operation, because the tumor had become too large. The tumor responded to the therapy and became flattened 5 months after the therapy.[Skin Cancer (Japan) 2012 ; 27 : 166-170]

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The major method for sentinel lymph node (SLN) navigation is using radioisotopes and blue dyes. In addition to these, (99mTc-phytate, patent blue V dye), we performed preoperative CT-lymphography (CTLG) in 28 patients (12 men, 16 women). CTLG clearly visualized the draining lymphatics and SLNs in 17 out of 28 patients. We can detect the lymphatic flows and SLNs near the tumor without the influence of shine-through, especially in the head and neck regions. It is considered that CTLG is useful to determine the range of lymph node dissection.[Skin Cancer (Japan) 2012 ; 27 : 171-178]

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The cases of 82 patients with extrmammary Paget's disease treated at the Department of Dermatology at Jichi Medical University Hospital between 1999 and 2010 were statistically studied. The average age was 71.4 years old, and the male/female ratio was 1.8 : 1. Seventy patients had lesions on the genital area. Six patients had lesions on the axilla, and two patients each had lesions on the abdomen or perianal area. 8.5% of the patients studied had lymph node metastases. All of them had invasive primary lesions. 4.1% of the patients showed local recurrence, and the primary lesions of all of the patients were in situ. The five-year survival rate of the patients was 100%, 65% and 0% with no, unilateral or bilateral lymph node metastases, respectively. The five-year survival rate of stages 1, 2, 3 and 4 was 100%, 100%, 75% and 0%, respectively. Both of the survival curves were very similar. Therefore, it seems that the prognosis of extramammary Paget's disease is strongly related with the existence of lymph node metastasis.[Skin Cancer (Japan) 2012 ; 27 : 179-185]

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It is important to have sufficient thin, vascular lining for persistent good contour and nasal function in a nasal reconstruction. We have used the nasolabial flap as lining for two patients which required full-thickness reconstruction of the nose because of skin cancer. Case 1 : A 78-year-old man underwent resection for basal cell carcinoma of the nasal tip and ala. A nasolabial flap, median forehead flap and nasal septum cartilage were used for reconstructing the alar defect. Case 2 : A 76-year-old woman presented with contraction of the ala and columella after forearm flap transfer. The nasolabial flap was chosen to restore the nasal vault and columella. There were no complications and the postoperative result was acceptable. It is said that the nasolabial flap is thick and not highly vascular. Based on our experience, however, this flap can be safely used for nasal lining with satisfactory thinness.[Skin Cancer (Japan) 2012 ; 27 : 186-190]

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A 75-year-old woman had suffered from lymphedema of the left upper extremity for 7 years after undergoing a radical mastectomy with lymph node dissection followed by radiation treatment for the left breast cancer. She visited our hospital with a solitary reddish nodule which measured 6 × 5 × 3 cm. Histological findings of the nodule revealed numerous spindle shaped cells with marked cellular atypia forming slit-like spaces, confirming the diagnosis of Stewart-Treves syndrome. The tumor was surgically resected with wide free margin and treated with radiation therapy. No local recurrence or metastasis has been seen for 34 months after the resection.[Skin Cancer (Japan) 2012 ; 27 : 191-194]

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We analyzed the data from a nationwide survey of 3,179 melanoma patients collected between 2005 and 2006 and from a 2005-2010 follow-up survey. The details were as follows : male/female ratio : 1,501/1,674, mean age : 62.5, growth pattern : ALM 444%/ SSM 19%/NM 14%/LMM 8%/mucosa 5%/ undefined 10%, UICC (2002) TNM stage : Tis 18%/Ⅰ-22%/Ⅱ-28%/Ⅲ-21%/Ⅳ-11%. The proportion of patients who received adjuvant therapy were as follows : DAVFeron : stage Ⅰ-10%, Ⅱ-50%, Ⅲ-65% : feron therapy : stage Ⅰ-16%, Ⅱ-15%, Ⅲ-17% : feron maintenance therapy : stage Ⅰ-16%, Ⅱ-29%, Ⅲ-32%. Multivariate analysis revealed that the following factors were the risk for lymph node metastasis : tumor originated in trunk (odds ratio, OR : 2.30), lower extremity (OR : 1.72), tumor with regression (OR : 2.05), increase of T classification (OR : 2.19). On the other hand, patients with LMM had lower risk of lymph node metastasis (OR : 0.39). This analysis may be useful to ascertain the present status of melanoma and improve the treatment of this disease.[Skin Cancer (Japan) 2012 ; 27 : 195-204]

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Prophylactic surgical excision of nevus sebaceus (NS) was often recommended because basal cell carcinomas could occur on NS. But it was recently reported that trichoblastomas were most common among neoplasms arising in NS, and basal cell carcinomas were not so common. We report a case of NS showing various differentiation on the lateral head of a 59-year-old female. Several immunostainings should be needed to diagnose various tumors arising from NS. Tumors arising in NS were reviewed with some literatures. [Skin Cancer (Japan) 2012 ; 27 : 205-210]

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A forty-five-year old male had presented with multiple dark red macules on his forehead, chest and back since two years before his first visit to our hospital. There was no improvement with topical steroid treatment, and the condition was followed by cervical and axillary lymph nodes swelling. Blood tests showed slight anemia, an increased level of acute phase protein, polyclonal hypergammaglobulinemia and an increase in serum IL-6. Histopathological examination of both skin and lymph nodes revealed polyclonal proliferation of plasma cells with no atypia. The characteristic dark red macules, systemic lymphadenopathy and the histopathological findings with polyclonal plasma cell proliferation led to the diagnosis of multicentric Castleman's disease.[Skin Cancer (Japan) 2012 ; 27 : 211-214]

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For melanoma patients with a positive axillary sentinel lymph node (SLN), there is still debate over whether level Ⅰ-Ⅲ axillary lymph node (ALND) dissection is needed.
Between 2002 and 2011, 22 patients had level I or Ⅰ and Ⅱ ALNDs for positive SLNs at National Cancer Center. The median number of SLNs removed was 2.3, while the median number of involved SLNs was 1.3. 4.5% had positive non-SLN. After a mean follow-up of 38.5 months, 1 patient had a regional recurrence in the axillary basin (4.5%).
The regional recurrence rate for patients undergoing ALND without level Ⅲ dissection for a positive SLN is low, suggesting that level Ⅰ/Ⅱ dissection may be adequate for a positive axillary sentinel lymph node in melanoma.[Skin Cancer (Japan) 2012 ; 27 : 215-217]

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An 80-year-old woman presented with a tumor with erythema on the genitalia and right metastatic inguinal lymph node. The postoperative pathological diagnosis was extramammary Paget's disease (EMPD). Six months after the operation, multiple lung and skin metastases were found. The patient was suffering terribly from the appearance of rapidly growing metastatic lesions in the hilum, and foul-smelling exudate. Radiotherapy was performed, and the irradiated tumor had disappeared 5 months after the radiotherapy and was controlled during the follow-up period. Although there is no well-established evidence for the use of radiotherapy for EMPD, this case indicates that radiotherapy may be effective for controlling metastatic skin lesions in progressive EMPD.[Skin Cancer (Japan) 2012 ; 27 : 218-225]

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A 72-year-old male presented with a 6-month history of a lower lip nodule with erosion. We suspected lichen planus or solar dermatitis. The histopathology of 2 biopsies showed benign epithelial hyperplasia. The nodules grew in size from 15 mm to 45 mm in diameter. From the clinical and pathological findings, we diagnosed the lesion as a squamous cell carcinoma. The tumor was surgically excised and the defect was closed by an Abbe flap. Histopathological examination of the specimen showed squamous cell carcinoma. Early stage squamous cell carcinoma of the lip often shows mild features clinically and pathologically. It may be difficult to diagnose early stage squamous cell carcinomas of the lip by a partial biopsy.[Skin Cancer (Japan) 2012 ; 27 : 226-230]

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Patients with lymph node metastasis of melanoma of unknown primary (MUP) could be assumed as stage Ⅲ (regional nodal metastasis) or as stage Ⅳ (distant nodal metastasis). We report 3 cases of MUP with palpable nodal disease (N1b/N2b/N3 1/1/1 case, respectively). Considering the possibility of stage Ⅳ, we planned to administer neoadjuvant chemotherapy at first to evaluate its efficacy and then perform surgery. Two complete responses and 1 partial response were observed with DAC-Tam-Feron therapy. Subsequently, N1b and N3 stage patients received lymph node dissection. Although N3 patients experienced visceral metastasis 12 months after starting the treatment, the other two patients (N1b and N2b) have been disease free for more than 44 months. These cases implied that MUP patients with palpable nodal disease could be sensitive to chemotherapy and importantly, if they are operable, addition of lymph node dissection might obtain a favorable prognosis.[Skin Cancer (Japan) 2012 ; 27 : 231-236]

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