A statistical analysis of 158 cases of squamous cell carcinoma treated at the Department of Dermatologic Oncology, National Cancer Center Hospital, during the past 7 years (2006-2012) is reported. The patients comprised 104 men and 54 woman with a sex ratio of 1.9 : 1. The incidence tended to increase in those over 60 years of age, and the face was followed by the hand. Pre-cancerous lesions were documented in 77 cases, including 27 actinic keratosis, 27 Bowen's disease and 15 burn scars. The five-year survival rates in terms of TNM classification were as follows : stage 0,100% ; stage I,100% ; stage II, 81.5% ; stage III, 57.6% ; stage IV, 0%.[Skin Cancer (Japan) 2013 ; 28 : 154-159]

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Squamous cell carcinoma (SCC) is the commonest complication in patients with recessive dystrophic epidermolysis bullosa. It is known that a cumulative rate of development and death increase as the patients get older.
These SCCs usually present as hyperkeratotic or papillomatous lesions based on a non-healing ulcer.
However, in our case of a 44-year woman, we were able to detect SCC just presenting as an ulcer without elevation and hyperkeratosis.
We dermatologists must play an important role in detecting the development of SCC as soon as possible through the enforcement of skin biopsy from longstanding ulcers, although it is very difficult because they always have erosions, ulcers, and hyperkeratotic lesions on their whole body.[Skin Cancer (Japan) 2013 ; 28 : 160-163]

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A 69-year-old man presented at our dermatology clinic with a normal skin-colored mass on the anterior chest that had developed 6 years earlier and had gradually enlarged. Physical examination revealed a red mass (20 × 20 mm) on the upper middle anterior chest. Incisional biopsy was performed and eccrine porocarcinoma (EPC) was suspected. He was introduced to our plastic and reconstructive clinic for surgical treatment. There were no findings suggestive of metastasis in a systemic search on whole-body computed tomography. We performed extensive resection and the histopathological diagnosis was EPC. In 2011, Belin and colleagues categorized histopathological images of EPC into infiltrative, pushing, and pagetoid subtypes based on Robson's criteria and reported that recurrence rates differ between the subtypes. The subtype in our case was infiltrative. The treatment of EPC should be guided by the results of evaluation of histopathological subtype.[Skin Cancer (Japan) 2013 ; 28 : 164-168]

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A 49-year-old woman presented with a subcutaneous mass on her right elbow that had enlarged gradually over the course of 1 year. Her medical history was unremarkable. Histologically, there were nodular infiltrates of mature plasma cells in the dermis and subcutis and several germinal centers with infiltrate of lymphoid cells. Immunohistochemistry revealed plasmacytoid cells positive for CD79a, CD138, Bcl-2 and negative for CD10, CD20. Germinal centers showed a CD10+, CD20+, CD21+ phenotype. Plasmacytoid cells showed monotypic expression of immunoglobulin light chain. Positron emission tomography and bone marrow biopsy were normal. She was diagnosed with primary cutaneous extranodal marginal zone lymphoma with prominent plasma cell differentiation. The residual mass on her right elbow was excised, and subsequently radiotherapy was performed. There has been no sign of recurrence after 1 year.[Skin Cancer (Japan) 2013 ; 28 : 169-173]

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Four cases of extramammary Paget's disease (EMPD) were reported to have siblings with the same disease. Three cases were brothers, one case was a father and his son. Thus, 15 cases of familial EMPD were reported in the literature mainly from Japan. Evaluation of these case reports revealed (1) familial occurrence of EMPD may not be so rare but may be ignored, so a detailed and prospective family history should be taken ; (2) in the cases of parents and children, the children were diagnosed to have EMPD at a much younger age. This could be explained by their higher interest in the disease, and may suggest that true age of onset of EMPD is much younger ; (3) the involved regions were similar in each familial member, which suggest the genetic base of MPD.[Skin Cancer (Japan) 2013 ; 28 : 174-180]

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A 73-year-old Japanese woman was referred to our hospital because of a left leg skin tumor which was gradually growing. Clinical examination revealed a 14 × 13mm brownish keratotic plaque on her leg. Since an excisional biopsy specimen taken by a local dermatologist suggested squamous cell carcinoma, we performed an excisional biopsy. Histologically, the lesion consisted of proliferating keratinocytes. The periphery of the tumor showed reticulated seborrheic keratosis ; whereas in the center portion of the tumor, tumor cells consisted of atypical keratinocytes in the entire epidermis which was considered to be Bowen's disease. We should keep in mind that although rare, skin cancer, including Bowen's disease, could arise in a lesion of seborrheic keratosis.[Skin Cancer (Japan) 2013 ; 28 : 181-184]

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A 70-year-old man presented with a history of congenital prepubic sinus. He did not have it assessed, but recently he noticed the lesion had been increasing discharge. A histological examination revealed adenocarcinoma. Immunohistochemical findings showed that the tumor cells were positive for CEA and CK20, while they were partially positive for CK7. We suspected skin metastases from adenocarcinoma of the intestine, but there were no tumor cells. A whole body examination including PET revealed no evidence of lymphatic and visceral metastases. Based on these findings, we diagnosed this case as primary adenocarcinoma of the prepubis. We performed wide local resection and reconstruction using a vertical abdominis musculocutaneous (VRAM) flap. There is no dogma for the etiology of congenital prepubic sinus. Based on the postulate that it is a remnant of the cloaca, we can explain this case. This case is the first report of adenocarcinoma from congenital prepubic sinus.[Skin Cancer (Japan) 2013 ; 28 : 185-189]

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A 65-year-old woman developed a small, pigmented lesion above her eyebrow several decades previously, under which a subcutaneous mass had been growing for 1 year. The mass was suspected to be an atheroma and was excised at a previous hospital 1 month before presentation at our hospital. Histopathological examination showed that the tumor-composed of atypical spindle cells and round cells containing melanin-was situated in the dermis and subcutaneous tissue, and had invaded the muscle layer. No atypical melanocytes in the epidermis, nevus cells in the dermis, or increase in dermis melanocytes were observed. Due to the lack of other tumor lesions on CT and PET/CT, we diagnosed this lesion as primary dermal melanoma. Many subcutaneous tumors located between the eyebrow and swollen parotid gland were suspected to be metastases. Wide excision with a 3-cm margin from the operative scar, and neck dissection were performed. Due to in-transit metastasis and metastasis of the parotid lymph node, the final diagnosis was pTN3M0, stage IIIc. Despite 5 courses of chemotherapy (DAV-feron), 15 months later, FDG-PET/CT revealed metastatic lesions in the small intestine, and enterectomy was performed. No additional recurrence or metastasis has been observed for 24 months since the first tumor removal procedure.[Skin Cancer (Japan) 2013 ; 28 : 190-194]

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In order to investigate the current situation of squamous cell carcinoma and Bowen's disease in Japan, we performed a national survey in Japan. We sent questionnaires to about 180 selected institutions. The survey in 2008 collected 1050 cases of squamous cell carcinoma and 741 cases of Bowen's disease. The details concerning squamous cell carcinoma were as follows : male/female ratio : 562/488 ; age : ranging from 29 to 106 with an average of 77.8 ; location on the body : head and neck 51.0%, trunk, 9.6%, upper extremities, 8.7%, lower extremities 16.9%. The cases arising from burn scar tended to a high proportion of stage IV. The details concerning Bowen's disease were as follows : male/female ratio : 334/407, age : ranging from 32 to 102 with an average of 75.2, location on the body : trunk 26.2%, upper extremities 18.2%, lower extremities 38.3%. Multiple lesions were seen in 59 cases. In the analysis of risk factors for lymph node metastasis of squamous cell carcinoma, we found that the genital area, trunk and lower extremities became high risk areas relative to the head and neck.[Skin Cancer (Japan) 2013 ; 28 : 195-204]

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In order to investigate the current situation of basal cell carcinoma in Japan, we performed a national survey in Japan. We sent questionnaires to about 180 selected institutions. The survey in 2010 collected 1578 cases. The details were as follows : male/female ratio : 813/761 ; age : ranging from 13 to 100 with an average of 72.6 ; growth pattern : nodular ulcerative type 77.9% ; superficial type 19.5% ; morpheaform type 2.0% ; location on the body : head and neck 78.5%, trunk 14.7%, upper extremities 1.7%, lower extremities 5.1%. The most common location of basal cell carcinoma was the face, especially the nose. In particular, basal cell carcinomas were most likely to occur on the tip and alar regions of the nose.[Skin Cancer (Japan) 2013 ; 28 : 205-211]

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A 59-year-old man recognized a subcutaneous mass of the right groin 2 months before his hospital visit. A needle biopsy of the swollen lymph node demonstrated CD20-positive and TTF-1 negative small cell carcinoma. The level of serum NSE was elevated, while computed tomography of the chest and abdomen detected no lung cancer. Repeated medical interviews confirmed no preceding cutaneous lesion. Considering the above results, the diagnosis of Merkel cell carcinoma of unknown primary origin (MCCUP) was made. The patient underwent inguinal and external iliac lymphadenectomy and postoperative radiation therapy.[Skin Cancer (Japan) 2013 ; 28 : 212-215]

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