A summary of 118 lesions in 115 patients diagnosed with basal cell carcinoma (BCC) during the past 8.5 years in our department is presented. The average annual number of cases was 13.5, and the male-female ratio was 1 : 1.02. The mean patient age at the first visit was 71.9 years. BCC had most frequently developed in the head and neck region. The mean tumor size was 13.7 mm. Clinically, most of the tumors were nodular type or noduloulcerative type. Resection was performed in all cases, and local flap surgery and direct closure were frequently employed for reconstruction. The mean surgical margin was 4.7 mm. We also surveyed the institutions which referred the patients to our department.[Skin Cancer (Japan) 2014 ; 29 : 158-164]

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An 80-year-old Japanese man presented with a 10-year history of a slowly growing solitary tumor on his right parasternal region. A dermatological examination revealed a reddish erosive tumor, 20×19×5 mm in size, with oozing. No regional lymph node metastasis or other distant metastasis was detected. Under the clinical impression of sweat gland malignancy or amelanotic melanoma, the tumor was resected with a wide margin, and grafting was performed. Histopathological examination showed an asymmetric and elevated tumor with the main lesion located in the dermis. The tumor cells were arranged in a solid-nesting, trabecular, or ribbon-like appearance, which had comparatively regular oval nuclei and eosinophilic cytoplasm. Decapitation secretion was seen in part. Immunohistochemically, the tumor cells were positive for CAM5.2, EMA, gross cystic disease fluid protein-15, cytokeratin (CK)7, synaptophysin, chromogranin A, CD56, estrogen receptor, and progesterone receptor, and negative for CK20 and HER2. Further examination ruled out the existence of breast carcinoma. The patient was finally diagnosed with primary apocrine carcinoma with neuroendocrine differentiation. Sentinel node biopsy was not performed in accordance with the patient's wishes, and he took an anti-estrogen agent, tamoxifen, at 20 mg/day, after the diagnosis was made. No recurrence or metastasis of the tumor has been noted for 1 year and 8 months.[Skin Cancer (Japan) 2014 ; 29 : 165-170]

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Amelanotic vulvar melanoma is a rare and unique type of malignant melanoma, which is difficult to differentiate clinically from other malignancies due to the absence of melanin pigmentation. Furthermore, lack of melanin pigmentation leads to the difficulties of operation due to the ill-defined border of the tumor. The difficulties in diagnosis and treatment aggravate the poor prognosis. We report a case of amelanotic malignant melanoma of the vulva, which required three resections until a pathologically negative margin was obtained. When a red nodule of the vulva is observed, we need to consider the chance of melanoma and undertake treatment as soon as possible.[Skin Cancer (Japan) 2014 ; 29 : 171-175]

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A 22-year-old woman noticed a nodule on the left side of her scalp ten years ago, and it had been increasing in size. It was resected at a nearby hospital in January 2013. Histopathological examination showed a single nodule with central denaturation of the collagen fiber at a lower magnification. Tumor cells were composed of a mixed proliferation of eosinophilic epithelioid cells and spindle cells, together with intercellular collagen deposition at a higher magnification. Immunohistochemical examination showed the tumor cells were positive for AE1/AE3, EMA, and CD34, and negative for smooth muscle actin, desmin, and S-100 protein, and characteristically negative for INI1protein. That result provided a diagnosis of distal type of epithelioid sarcoma.[Skin Cancer (Japan) 2014 ; 29 : 176-180]

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We report 4 cases of Venoneuro-accompanying artery fascio-cutaneous flaps (V-NAF flap) of great saphenous vein after resection of perineal and groin area, and leg. Case1 was a 59-year-old woman who has had an operation for Bowen carcinoma of anus 6 years ago. She had been suffering from recurrence in skin metastasis around pubic area and undergone surgery for several times. This time, perineum lesion was resected and covered with left and right V-NAF flaps of the great saphenous vein. Case 2 was a 90-year-old woman with SCC on pubic region, 8 cm in size. It was resected and covered with left and right V-NAF flaps of the great saphenous vein. Case 3 was an 89-year-old man with myxofibrosarcoma outside of his left knee. It was resected including aponeuroses and covered with reverse V-NAF flaps with the great saphenous vein of left leg. Case 4 was an 80-year-old man with BCC of right groin area, which was 4 cm in size and firmly fixed with inguinal canal. It was resected and covered with right V-NAF flaps of the great saphenous vein. V-NAF flap has various advantages such as reliable blood supply, simple and easy technique, and the availability of both distal and proximal pedicle flap. However, it should be reminded that donor site is a part of lymphatic channel from primary lesion.[Skin Cancer (Japan) 2014 ; 29 : 181-188]

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The Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society is conducting a survey of malignant melanoma patients in Japan, and has collected 2978 cases from 2005 to 2013. The average follow-up is 32.0 months. The details were as follows : male/female ratio : 1392/1583, age : average 63.6 years, TNM staging : Tis-17%/Ⅰ-20%/Ⅱ-24%/Ⅲ-22%/Ⅳ-11%, disease-specific 5-year survival rate of each TNM stages : Tis-99%, 1a-96%, 1b-92%, 2a-85%, 2b-80%, 2c-61%, 3a-74%, 3b-58%, 2c-39%, 4-21%. The most common type of recurrence was distant failure, and accounted for 51% of all recurrences. The next common types were lymph node metastasis (29%), in-transit metastasis (13%), and local recurrence (7%). The median time to recurrence was about 12 months. Patients with stage 1 were shown to have longer time to recurrence compared with stages 2 and 3.[Skin Cancer (Japan) 2014 ; 29 : 189-194]

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A case of occult breast cancer, found after scalp metastasis is presented. An 84-year-old woman noticed a hard nodule (Φ4 cm) on her scalp. A skin biopsy was done, and histopathological findings showed suspected metastatic adeonocarcinoma. A whole body examination including PET revealed no evidence of malignant tumor in the mammary glands or other organs. Immunohistochemical findings showed that the tumor cells were positive for CK7, CK20, ER, PGR, while they were negative for CK5/6, p63. On the immunohistochemical features, metastasis of occult breast cancer was strongly suggested. It is very difficult to distinguish cutaneous metastasis of breast cancer from primary sweat gland carcinoma. But Marian Rollins et al. reported that the CK5/6 and p63 were weakly expressed in cutaneous metastasis of breast cancer, whereas they were strongly expressed in primary sweat gland carcinoma.[Skin Cancer (Japan) 2014 ; 29 : 195-200]

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A 57-year-old woman presented with a tumor from childhood in the left postauricular region that increased gradually in size. She showed an elastic, hard, and moist red tumor in the left postauricular region at the first medical examination. Although it was diagnosed as syringocystadenoma papilliferum by biopsy, a sample taken at surgery showed atypical cells with acidophil cytoplasm as a solid nest or a papillary duct with necrosis. The patient was diagnosed with apocrine adenocarcinoma, and additionally with syringocystadenocarcinoma papilliferum because of pathologic similarity of syringocystadenoma papilliferum. Apocrine adenocarcinoma without a physiological apocrine gland is rare, and only 3 cases in the postauricular region have been reported in Japan. The frequency of recurrence and metastasis of apocrine adenocarcinoma is high, making continued observation important.[Skin Cancer (Japan) 2014 ; 29 : 201-205]

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A 29-year-old male with a subcutaneous tumor of the right thigh was referred to our hospital. Physical examination revealed a 73×63 mm, elastically hard subcutaneous tumor with high mobility on the anterior side of the right thigh. Power Doppler ultrasonography showed the lesion to be oval, well-circumscribed, and well vascularized within the mass. The periphery of the mass was elastically hard, and the central part was medium-soft under elastography.
Surgical excision found the surgical specimen to be composed of basophilic myxoid matrix, signet-ring-like cells, and chicken-wire-like arborizing vasculature. Basophilic myxoid matrix was positive under Alcian blue. We made the diagnosis of myxoid liposarcoma. Retrospectively, we were able to propose that the elastography accurately reflected the distribution of the myxoid matrix. It is hoped that more reports with features of elastography will be gathered.[Skin Cancer (Japan) 2014 ; 29 : 206-209]

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