Skin Cancer

A case of psoriasis vulgaris with multiple squamous cell carcinomas that presented with right inguinal lymph node metastasis

Kyosuke OISHI, Yuri ENOKIDO, Yuki SAITO, Shintaro MAEDA, Takashi HIRAN ...

2016 Volume 31 Issue 1 Pages 1-5
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.1

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Here, we report a patient with psoriasis vulgaris with multiple squamous cell carcinomas (SCCs), who developed metastasis to the right inguinal lymph node. He had been treated with corticosteroid and vitamin D3 ointment, PUVA therapy (a total of 378 times for a total radiation dose of 393 J/cm²), and oral cyclosporine, methotrexate, and retinoid. He presented with his first SCC lesion at 78 years of age. When he was 85 years old, he was diagnosed with right inguinal metastasis on histological examination. He had three SCC lesions whose residual lymph node was the right inguinal node, and the tumor thicknesses of all three lesions were less than 2 mm. We hypothesized that skin thinning in response to long-term use of the corticosteroid ointment resulted in lymph node metastasis despite the relatively shallow TT.[Skin Cancer (Japan) 2016 ; 31 : 1-5]

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A case of lower lip squamous cell carcinoma with deltopectoral flap reconstruction

Michiko SAKAKIBARA, Nozomi YOKOYAMA, Akihiro SATOU, Noriyuki SUZUKI, M ...

2016 Volume 31 Issue 1 Pages 6-9
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.6

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A 73-year-old man presented with a 3-month history of lower lip erosion. He was treated with ointment at a local hospital, but the lesion gradually spread to his bilateral lower lip. Then, he was referred to our hospital. 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 deltopectoral flap.
Ingestion and conversation were possible from the day after surgery. However, the aesthetics were a little unnatural after surgery, and thus, we reconstructed of lower lip.
No issues with meal intake or conversation were observed postoperatively, and satisfactory cosmesis was also achieved. Right submandibular lymph node metastases were present at the 6-month follow-up, We performed right neck dissection and postoperative irradiation. Since that time, the patient has remained alive without relapse or metastasis.[Skin Cancer (Japan) 2016 ; 31 : 6-9]

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A Case of aggressive digital papillary adenocarcinoma on the left thumb

Chiyo MORITA, Kan TAKANOBU, Maiko TANAKA, Mikio KAWAI, Michihiro HIDE, ...

2016 Volume 31 Issue 1 Pages 10-15
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.10

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Aggressive digital papillary adenocarcinoma (ADPAca) is a rare malignant skin tumor that often presents on a digit of the hand or foot, with eccrine sweat gland origin. For treatment, primary wide excision is most often recommended because of the high potential for local recurrence and distant metastasis.
We here report a 60-year-old Japanese man with ADPAca on the left thumb. Four months after the primary operation, we conducted wide tumor excision with 6-10-mm margins from the primary surgical scar and performed axillary sentinel lymph node biopsy. No recurrence or metastasis has been observed during the 1 year and 6 month follow-up period until now.[Skin Cancer (Japan) 2016 ; 31 : 10-15]

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A case of lymph node metastasis from auricular squamous cell carcinoma that occurred seven years after surgery

Yoshitaka KAI, Mayuko GOTO, Yasuji YOSHIKAWA, Yukako ITO, Yutaka HATAN ...

2016 Volume 31 Issue 1 Pages 16-20
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.16

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A 76-year-old man presented with lymph node metastasis from auricular squamous cell carcinoma (SCC). Seven years ago, in 2007, he noticed a nodule on the posterior side of his auricle. Surgical excision with 10-mm margins was performed, but a sentinel lymph node biopsy was not done because of the lack of a hot spot with lymphoscintigraphy and gamma probe detection. After surgery, the patient was examined twice yearly, and he noticed a subcutaneous nodule on the post-auricular area in 2014. A biopsy was performed, and the nodule was histopathologically diagnosed as lymph node metastasis of SCC. Selective neck dissection was performed followed by radiation therapy (X-rays, 60 Gy), and two metastatic tumors were found in the post- and sub-auricular areas. Usually, SCC metastases occur within one to three years after surgery. Metastasis seven years after surgery in this case is exceptionally rare. Careful follow-up by physicians and patient skin self-examination are important in long-term care after surgery for malignant cutaneous tumors.[Skin Cancer (Japan) 2016 ; 31 : 16-20]

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Management of Basal Cell Carcinoma of the Genitalia

Erika KUSAJIMA, Kosuke ISHIKAWA, Chigusa OMOTE, Kikuko TAKAHASHI, Chu ...

2016 Volume 31 Issue 1 Pages 21-25
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.21

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Basal cell carcinoma (BCC) growth on non-sun-exposed sites-especially the genitalia-is very rare and etiologically unclear. We analyzed age, sex, clinical features, tumor site, treatment, and prognosis for all BCCs treated at our institution between 1996 and 2015. Ages ranged from 59 to 83 years. There were two male and three female patients. Two tumors arose on the scrotum, and three tumors arose on the labia majora. One patient had a history of chronic dermatitis of the scrotum. The average BCC size was 22.0 mm, and three tumors were ulcerated at initial presentation. All lesions were excised with adequate margins. Tumors were directly closed in four cases, and in one case, the area was reconstructed with a skin flap. There were no recurrences to date.[Skin Cancer (Japan) 2016 ; 31 : 21-25]

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A case of Spitz nevus on the right fifth toe, which was difficult to distinguish from malignant melanoma

Erina MIKAMI, Akiko KANZAKI, Shinichi ANSAI, Satomi TATSUMI, Ayako FUT ...

2016 Volume 31 Issue 1 Pages 26-29
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.26

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A 29-year-old Japanese woman presented with a brownish papule, 5×8 mm in size, on the lateral aspect of the right fifth toe, which had developed within 3 years. The papule was asymmetrical with hyperkeratosis on the surface, at the center of the lesion. Dermoscopy showed biphasic features consisting of a starburst pattern and a region of regression structures at the distal half of the lesion. Histological examination revealed nests of large spindle cells extending from the epidermis into the dermis. Kamino bodies were observed in the epidermal nests, and the tumor cells exhibited maturation.
The nests in the epidermis of the sweat gland, and the asymmetric features of the epidermal nests made it difficult to distinguish typical Spitz nevus from malignant melanoma and atypical Spitz nevus. However, the lateral aspect of the toe is a specific site, which often appears to be histologically atypical. Therefore, the patient was diagnosed with typical Spitz nevus.[Skin Cancer (Japan) 2016 ; 31 : 26-29]

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A case of Merkel cell carcinoma of the right big toe with Merkel cell polyomavirus infection

Shintaro MAEDA, Miyu KANO, Tadahiro KOBAYASHI, Kyosuke OISHI, Takashi ...

2016 Volume 31 Issue 1 Pages 30-34
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.30

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A 65-year-old man noticed a nodule on his big toe 3 months previously. He was referred to our hospital because of rapid enlargement. A 25-mm dusky red tumor was observed on his right big toe. Histological findings from a skin biopsy revealed proliferation of relatively small CK20-positive atypical cells from the superficial dermis to the subcutaneous tissue. Therefore, this tumor was diagnosed as Merkel cell carcinoma. Amputation of the right big toe was performed. We performed right inguinal lymph node resection, and the lymph nodes were negative for disease. Additional radiation therapy at the original site was administered after the operation. Two years after the first operation, local recurrence occurred at the right external condyle, without any distant metastasis. Merkel cell polyomavirus was detected on polymerase chain reaction. The face is a well-recognized site considering the predilection for Merkel cell carcinoma. The present case is considered very rare because the original site was the big toe.[Skin Cancer (Japan) 2016 ; 31 : 30-34]

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A case of myxofibrosarcoma with lung metastasis

Shintaro MAEDA, Tadahiro KOBAYASHI, Kyosuke OISHI, Takashi MATSUSHITA, ...

2016 Volume 31 Issue 1 Pages 35-39
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.35

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A 40-year-old woman noticed a tumor on her left shoulder 2 month previously. As the tumor enlarged rapidly, she was referred to our hospital. The tumor was 60 mm in diameter at her first visit. Histological findings revealed proliferation of spindle cells with myxoid tissue. The tumor also contained highly cellular lesions with numerous atypical cells. We diagnosed this tumor as a high-grade myxofibrosarcoma. The patient underwent wide resection with 30-mm safety margins. Five months after extended resection, a 6-mm solitary nodule was found in the left upper lung lobe on both computed tomography and positron-emission tomography. Partial resection of the left upper lobe was performed, and the nodule presented with the same histological findings as the primary cutaneous lesion. Currently, 2 years since she underwent the partial resection, no local recurrence or distant metastasis has been detected. Physicians should pay attention to not only local recurrences, but also distant metastases, when they examine patients with myxofibrosarcoma.[Skin Cancer (Japan) 2016 ; 31 : 35-39]

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A case of cutaneous extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue diagnosed with difficulty

Yuri UJINO, Natsuki YAGI, Kiyohiro TSUTSUI, Shizuko OHASHI, Kazuyoshi ...

2016 Volume 31 Issue 1 Pages 40-45
Published: 2016
Released on J-STAGE: June 30, 2016

DOIhttps://doi.org/10.5227/skincancer.31.40

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A 72-year-old man developed an erythematous tumor with induration of his upper left arm. Similar tumors extended into his right axilla, right arm, and back. Histopathologically, there was a massive dense lymphocytic infiltration from the upper dermis to the subcutis. Immunohistochemically, infiltrating lymphocytes were positive for CD3 and CD20, while they were negative for CD10 and CD30. No monoclonal light-chain restriction was detected by in situ hybridization. DNA polymerase chain reaction did not show immunoglobulin light-chain Cλ rearrangement. After a 10-month follow-up and a tentative diagnosis of pseudolymphoma, we performed an incisional biopsy again. Immunohistochemically, infiltrating lymphocytes were positive for CD20 and CD79a, while they were negative for CD10, CD30, and EBER. In situ hybridization revealed λ-chain restriction. No other lymph node or organ involvement was detected. The patient was diagnosed with cutaneous marginal zone B cell lymphoma (MALT lymphoma) based upon the results above. He received irradiation at a dose of 30 Gy for each tumor.[Skin Cancer (Japan) 2016 ; 31 : 40-45]

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