Herein, we report the case of a 66-year-old man with cutaneous B-cell pseudolymphoma. He had a history of an ill-defined red-brown plaque, which appeared on the right side of his chest seven years previously. The biopsy specimen revealed a dense, lymphocytic infiltrate admixed with eosinophils and focal reactive lymphoid follicles with cell atypia. Immunohistochemical findings showed that these cells were CD20+, CD79a+, bcl-2+, weakly bcl-6+, MUM-1-, Cyclin D-, CD10-, CD30-, and CD56-. Immunophenotypic studies did not show the presence of any phenotypic aberrance of the monotypic immunoglobulin (Ig) light chain. However, rearrangement of the DH7/JH gene was positive via polymerase chain reaction analysis. General examinations did not reveal any findings of malignant lymphoma. The plaques spontaneously regressed after a biopsy was performed. This case did not fulfill the criteria of cutaneous B-cell lymphoma, but the wide range of skin plaques should be considered worrisome for potential progression to true lymphoma, especially primary cutaneous marginal zone B lymphoma.[Skin Cancer (Japan) 2015 ; 30 : 163-167]

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A 49-year-old man noticed deformation of the nail of his right thumb 2 years ago, which was diagnosed as a glomus tumor in a local hospital. He presented to our hospital with a linear defect on the nail plate of the right thumb, with a red mass underneath. On ultrasonography, the mass was visualized as a homogeneous, hypoechoic, highly vascular lesion. Pathological examination showed dermal infiltration of atypical tumor cells. Immunostaining revealed tumor cells positive for S-100, HMB-45, and Melan-A. A diagnosis of subungual amelanotic melanoma was made, and resection and sentinel lymph node biopsy of the right axilla was performed. Four months after the operation, partial nail regeneration was observed, and a biopsy specimen showed tumor recurrence. After extensive resection, no recurrence or metastasis has been observed for 22 months after the initial visit. Dermatologists should diagnose subungual tumors carefully, because the diagnosis of amelanotic melanoma is difficult and misdiagnosis or delayed diagnosis often occurs.[Skin Cancer (Japan) 2015 ; 30 : 168-173]

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A known tumor marker, 5-S-cysteinyldopa (5-S-CD), sensitively reflects the state of malignant melanoma. Previously, we demonstrated a poor correlation between serum 5-S-CD and disease type or tumor thickness. Herein, we review 92 patients diagnosed with malignant melanoma during the past six years in our department. We demonstrate that serum 5-S-CD levels statistically correlate with the total size of metastatic tumors.[Skin Cancer (Japan) 2015 ; 30 : 174-178]

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To assess the influence of antithrombotic medications during dermatological surgery, the prothrombin time-international normalized ratio (PT-INR) and incidence of bleeding complications in patients taking antithrombotic agents were compared to those of patients taking no antithrombotic medication. In all, 543 patients underwent dermatological surgery at the Division of Dermatology of the National Hospital Organization at Nagasaki Medical Center between 2012 and 2014. No patients under 50 years of age were taking antithrombotic medication, compared with 17.6% of patients over 50 years of age. Hypertensive heart diseases and aspirin monotherapy were the most common clinical features of the patients on antithrombotic medications. The PT-INR of patients over 70 years of age was significantly higher than that of patients 50 to 69 years of age who were on antithrombotic medications (P<0.05). The incidence of bleeding complications was 1.6% in patients over 50 years of age taking no antithrombotic medication, compared with 1.8% in patients continuing antithrombotic monotherapy, and 30.0% in those on two antithrombotic agents during dermatological surgery.[Skin Cancer (Japan) 2015 ; 30 : 179-184]

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A 66-year-old woman presented with a 3-month history of edema of her left leg. Because radiological examinations showed enlarged lymph nodes in the left inguinal and intraperitoneal regions, which was indicative of epithelial cancer metastasis, she was referred to our department. On physical examination, a 1-cm, red nodule on her lower back and a red plaque on her left lateral malleolus were observed. A histopathological diagnosis of eccrine porocarcinoma was made on the basis of the biopsy findings for the nodule on the lower back. We initiated treatment with thrice-weekly docetaxel in combination with radiation therapy. The lymph node size reduced, but new skin lesions appeared, for which radiation was administered. Although the radiation was temporarily effective for each newly appeared skin lesion, cutaneous metastasis recurred and the patient eventually died of pulmonary failure 11 months after the first visit. Herein, we a case of intractable metastatic eccrine porocarcinoma with a brief review of the literature.[Skin Cancer (Japan) 2015 ; 30 : 185-188]

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An 82-year-old woman noticed a mass in the left axilla 2 years ago. Upon medical examination, an elastic, soft, red tumor measuring 15 mm was detected. Histopathological examination indicated adenocarcinoma containing glandular structures with decapitation secretion in the dermis and subdermis. The cells had eosinophilic cytoplasm and prominent nucleoli. Immunohistochemical examination showed that the tumor cells were positive for PAS, GCDFP-15, and HER2(1+) and negative for mammaglobin and ER/PgR. The Ki67 index was 40%. No evidence of other malignant tumors or metastases were observed. The patient was diagnosed with a primary cutaneous apocrine carcinoma of the left axilla. No recurrence or metastasis of the tumor has been noted thus far.[Skin Cancer (Japan) 2015 ; 30 : 189-192]

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Case 1 : An 88-year-old woman noticed a mass on her left upper eyelid a year and a half ago. She visited our hospital because the mass became larger and hemorrhagic. We performed incisional biopsy and diagnosed the tumor as sebaceous carcinoma. The patient received radiation therapy (70 Gy electron beam). Case 2 : An 87-year-old man noticed a nodule on his left lower eyelid 2 months ago. Subsequent to incisional biopsy, we diagnosed the nodule as sebaceous carcinoma and administered radiation therapy (70 Gy electron beam). After treatment, both tumors disappeared macroscopically and no signs of recurrence or metastasis have been observed thus far (case 1 : 3 months after radiation ; case 2 : 5 months after radiation). No serious side effects have been reported in these patients. Sebaceous carcinoma of the eyelid is usually treated with operation. However, radiation therapy may be a suitable alternative option for patients in whom operation would be difficult owing to old age.[Skin Cancer (Japan) 2015 ; 30 : 193-197]

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A 58-year-old man consulted our hospital for a 6-month history of a red nodule located on the parietal region. The nodule was 27×20mm in size with 8 mm of elevation. Histological findings indicated the lesion to be a moderately differentiated squamous cell carcinoma (SCC). No metastasis was found at diagnosis. The nodule, including the periosteum, was surgically resected with a 1-cm margin. Six months after the surgery, follow-up examination revealed three solitary cutaneous nodules between the primary lesion and the left neck, swelling in the left cervical lymph nodes, and a nodule in the parotid glands. Hence, the cutaneous nodules, the left cervical lymph nodes, and the left parotid glands were surgically removed. Histological evaluation revealed moderately to poorly differentiated SCC. A diagnosis of SCC with in-transit metastasis was made. After surgery, the patient received radiotherapy (50Gy). We present a rare case of SCC with in-transit metastasis and include a review of the relevant literature.[Skin Cancer (Japan) 2015 ; 30 : 198-202]

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We report a case of verrucous carcinoma successfully treated with etretinate. The patient was a 60-year-old woman with a chronic ulcer on her left heel since she experienced a low-temperature burn in 2002. The ulcer developed slowly. Clinical examination revealed a 13 × 8cm papilloma-like plaque on her heel in June 2014. Histopathological examination of the skin biopsy showed hyperkeratosis, parakeratosis, and acanthosis with some cancer pearls. However, low nuclear atypia and individual cell keratinization was observed. We diagnosed this case as verrucous carcinoma. The patient was administered etretinate at 50mg/day, which was maintained at 20mg/day. Two and a half months later, clinical examination revealed a flat erosive plaque with yellow necrotic tissue in the center. We performed total resection of the tumor. Histopathological examination of the edges of the resected tumor did not show tumor cells but a few Ki-67-positive cells.[Skin Cancer (Japan) 2015 ; 30 : 203-207]

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A 39-year-old woman came to the clinic with a one-year history of a hard nodule on her left thigh. The tumor was marginally excised. The histological findings showed an ill-demarcated, circumscribed nodule in the deep dermis and superficial subcutis. The tumor was composed of intersecting cellular fascicles of monomorphic, spindled cells and loose fascicles or sheets of pleomorphic cells with abundant granular, glassy or pale xanthomatous cytoplasm. Some neoplastic cells displayed marked nuclear pleomorphism, with bizarre nuclei containing giant macronucleoli and intranuclear pseudoinclusions. Mitotic figures were relatively uncommon, numbering <15/50 high-powered fields. Immunohistochemically, the neoplastic cells showed strong, diffuse CD34 positivity. AE1/AE3, S-100 protein, alpha-SMA, Desmin, CD68 and Factor XIIIa were negative. Positivity for Ki-67 expression was observed in less than 5% of the neoplastic cells. The features of the small, circumscribed lesion, including its superficial location, development by an early middle age, presence of pleomorphic cells with diffuse CD34-positivity, relatively rare mitotic figures and low mitotic activity, suggest a diagnosis of a superficial CD34-positive fibroblastic tumor, which is rare, low-grade, soft tissue tumor. Herein, we discuss the differential points of this entity compared with other soft tissue tumors.[Skin Cancer (Japan) 2015 ; 30 : 208-213]

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A 75-year-old man was diagnosed with myelodysplastic syndrome (RAEB-1)-overt leukemia. Although remission induction therapy lead him to complete remission, a reddish nodule developed on his arm. Histopathology showed that the tumor mass was composed of lymphoid cells in the dermis. Immunohistochemical staining showed tumor cells positive for CD45, CD31, and CD15 and negative for CD34 and myeloperoxidase. The laboratory findings revealed no evidence of recurrence ; therefore, a diagnosis of myeloid sarcoma was made. Although the nodule resolved spontaneously within a month, acute myeloid leukemia recurred.[Skin Cancer (Japan) 2015 ; 30 : 214-217]

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A 36-year-old Japanese woman presented with a 7-cm, dark red nodule on her upper back. Histopathologic examination revealed diffuse infiltration with atypical large lymphocytes in the skin. Immunohistochemically, the atypical cells were positive for CD30 and EMA but negative for ALK and DUSP22 rearrangement. The tumor was excised, and additional radiotherapy was administered for her back and enlarged regional lymph nodes that were detected using PET-CT. Vertebral bone metastasis and new skin lesions appeared 2 months later. We finally diagnosed this case as systemic anaplastic large-cell lymphoma. A stem cell transplant was administered after 6 courses of CHOP chemotherapy. Complete remission was sustained for 6 months. Differentiation between primary cutaneous ALCL and systemic ALCL is sometimes difficult. We reviewed 13 Japanese cases of primary cutaneous ALCL with poor prognoses, and found that three or more systemic ALCL cases showed EMA positivity.[Skin Cancer (Japan) 2015 ; 30 : 218-222]

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We report a case of multiple primary melanomas detected after long-term follow-up for the first primary melanoma. A patient with cutaneous melanoma in the left breast region received treatment at 42 years of age. After the initial treatment, we followed the patient on a yearly basis. A new primary cutaneous melanoma was observed in the right femoral region at age 66 years. Wide local excision and sentinel lymph node biopsy were performed, which did not reveal any metastasis. Five years after the second treatment, a recurrent lesion was detected at the right inguinal lymph node. Extensive resection and lymph node dissection was performed, and the patient did not show any recurrence at the follow-up. In most cases of multiple primary melanomas, the second primary melanoma has been detected within a decade. We experienced a rare case of multiple primary melanomas occurring 24 years after the first primary tumor was detected.[Skin Cancer (Japan) 2015 ; 30 : 223-227]

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A 96-year-old woman visited our department and presented with a rapidly growing reddish nodule on her right cheek. The clinical findings were highly suggestive of malignant neoplasm. The patient had a low performance status and severe comorbidities such as dementia and diabetes mellitus. Moreover, the patient and her family were unwilling to undergo close monitoring or curative treatment. Therefore, only minimally invasive surgical resection of the nodule was performed. Histopathological findings showed proliferation of CK20-positive neoplastic cells with atypical nuclei in the dermis. Accordingly, the patient was diagnosed with Merkel cell carcinoma. The patient and her family refused administration of further treatment. Herein, we discuss the therapeutic strategies for elderly patients with skin cancer and review the Japanese medical literature concerning elderly cases of Merkel cell carcinoma.[Skin Cancer (Japan) 2015 ; 30 : 228-231]

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