Malignant melanoma of the esophagus is a relatively rare disease for which the prognosis is poor. Here, we reported two cases of primary malignant melanoma of the esophagus. Both patients had multiple lesions on the esophagus. They underwent surgical resection of the esophagus and regional lymph nodes. Chemotherapy using dacarbazine was used as an adjuvant therapy, but multiple metastatic lesions developed. We judged dacarbazine to be ineffective and switched to nivolumab for both patients. However, nivolumab was not effective, and both patients died within one year after surgery.[Skin Cancer (Japan) 2017 ; 32 : 6-11]

A 38-year-old woman presented with a gradually increasing vulvar lump. Malignant lymphoma was suspected. No infiltrating tumor cells were observed in her blood or bone marrow, and PET revealed abnormal accumulation of cells only in the vulvar lesion. Histopathological examination showed invasion of tumor cells with small to medium nuclei and clumped chromatin in the dermis and fat tissue. Immunohistologically, the tumor cells were positive for myeloperoxidase, CD68, and CD117. The diagnosis was myeloid sarcoma. According to the recommended treatment for acute myeloid leukemia, the patient underwent chemotherapy, radiotherapy, and peripheral stem cell transplantation. However, her condition worsened and she died 3 years after the diagnosis.[Skin Cancer (Japan) 2017 ; 32 : 12-15]

A 70-year-old man presented with a solitary reddish nodule on the left axilla, which he had for five years. The skin biopsy was performed at the previous hospital during the treatment of prostate carcinoma. He was referred to our hospital for further treatment. The physical examinations revealed an 80×50-mm hemorrhagic pedunculated tumor and a swollen left axillary lymph nodule on the left axilla. The positron emission tomography-computer tomography (PET-CT) scan showed no metastatic lesions on the whole body. We performed the tumor resection with a 2-cm margin from the tumor and a left axilla lymph nodes biopsy under local anesthesia. Histological examination revealed tumor cells having acidophilic cytoplasm and clear nucleolus with glandular structures and decapitation secretion in the primary lesion and lymph nodule. We performed the total axillary lymph node dissection. We diagnosed the patient with primary pedunculated cutaneous apocrine carcinoma on the axilla with lymph node metastasis. Primary pedunculated cutaneous apocrine carcinomas are rare.[Skin Cancer (Japan) 2017 ; 32 : 16-20]

Basal cell adenocarcinoma is a rare tumor of the salivary gland and commonly arises in the parotid gland. We report a case of basal cell adenocarcinoma of the upper lip that is very rare.
A 70-year-old male presented with an upper lip tumor. The tumor was excised with full thickness of the upper lip, and was reconstructed using Abbe’s flap. Postoperative radiotherapy was administered at 2.5Gy/fraction/day, and the total dose was 50 Gy. Histologically, the basaloid cells had invaded in a trabecular and solid nest pattern. The pathological diagnosis was basal cell adenocarcinoma in a minor salivary gland of the upper lip.[Skin Cancer (Japan) 2017 ; 32 : 21-27]

To evaluate the significance and indications of sentinel lymph node biopsy in patients with cutaneous squamous cell carcinoma (SCC), we retrospectively studied 152 patients. Sentinel lymph node biopsy was performed in 72 of the 152 patients, of whom 6 were positive for metastasis (positivity rate of 7.9%). All the positive cases presented stage T2 tumors. Regimens of lymph node dissection were performed in 5 of the positive patients, and none of them have suffered relapse or metastasis so far (average observation period of 28.3 months). Although the findings of early lymph node metastasis obtained by sentinel lymph node biopsy may contribute to the improvement of prognosis, positive evidence is still lacking. Therefore, further accumulation of cases, as well as observations of long-term outcomes, will be necessary.[Skin Cancer (Japan) 2017 ; 32 : 28-32]

A 68-year-old woman noticed enlargement of her right axillary lymph node in March 2015. Histological examination of the lymph node showed malignant melanoma and physical examination pointed out a primary cutaneous lesion on her right back. After resection with a 20 mm surgical margin of the primary lesion and right lymph node dissection in June 2015, she visited our department for adjuvant therapy consisting of intradermal injections of interferon-β and intravenous dacarbazine. Although two courses of adjuvant therapy had been administered, multiple metastases, including bone metastasis of the right tibia and fibula, appeared in September 2015. Administration of vemurafenib was initiated, as the BRAF V600 mutation of the resected right lymph node was positive. Additionally, owing to the aggravated pain of the right tibia and fibula, concomitant radiation therapy (39 Gy/13 fr) was started 19 days after oral vemurafenib had been initiated. When the radiation dose reached 27 Gy, hyperkeratotic red papules and blisters appeared on the right knee. Although diflucortolone valerate cream was locally administered, erythema appeared at all the irradiation sites with clear borderlines, and the right lower limb was swollen with purpura when the radiation dose reached 33 Gy. The skin lesions were diagnosed as radiation dermatitis caused by vemurafenib with radiosensitizing effects.[Skin Cancer (Japan) 2017 ; 32 : 33-38]

Hydroxyurea (HU) is an anti-metabolic agent used in the treatment of myeloproliferative disorders. Recently, there have been many reports of various cutaneous adverse effects due to HU. An 80-year-old woman with a history of essential thrombocythemia (ET) had been treated with HU for 5 years. She presented with recalcitrant leg ulcers, erythema, and erosions on the hands. The ulcer on the heel appeared 3 years and 8 months after the initiation of HU administration and a red nodule developed 1 year and 4 months later. She also had an ulcer on her Achilles tendon. A biopsy from the heel and Achilles tendon showed squamous cell carcinoma (SCC) and Bowen's disease, respectively. She underwent excision with skin graft. Both resected lesions revealed SCC. Both the skin ulcers and SCCs were considered to be associated with HU treatment. The dose of HU was gradually reduced and anagrelide acid (AGA) was started. No recurrence was observed for 1 year and 4 months after the surgery.[Skin Cancer (Japan) 2017 ; 32 : 39-43]

Case 1 : A 51-year-old man, who underwent resection of basal cell carcinoma in his lower abdomen 11 years ago, noticed edema of his left leg last year. Computed tomography scans revealed metastasis in his lungs, left inguinal lymph nodes, and left ilium. The number of nodules on his scrotum gradually increased. Case 2 : A 64-year-old woman underwent an operation for basal cell carcinoma on her right foot, and right inguinal lymph metastases were removed 4 years later. Nine and a half years after the primary visit, her chest X-ray scan showed multiple lung nodules. Mediastinal, periaortic, and right external iliac lymph metastasis were also found. Both cases were treated with cisplatin and adriamycin, and gained partial response. However, due to renal impairment, treatments were changed to carboplatin and adriamycin. Partial response was maintained in case 1, but in case 2, the disease progressed and the patient died.[Skin Cancer (Japan) 2017 ; 32 : 44-50]

Non-pigmented basal cell carcinomas (BCC) are rare in Asians and thus often difficult to diagnose. We report a case of non-pigmented BCC in a 39-year-old Japanese woman. The patient presented with a slow growing ulcerated erythema without a pigmented lesion on her right cheek. Histopathologic findings revealed a superficial BCC. With S100 staining, round and small melanocytes with poorly developed dendrites were identified in the tumor nests. A total of 131 patients were diagnosed with BCC at our hospital from 2006 to 2015. Patients were all Japanese, except for one who was Caucasian. Of these, eight patients (seven Japanese, and one Caucasian) had non-pigmented BCC.[Skin Cancer (Japan) 2017 ; 32 : 51-54]

Malignant melanoma is a skin cancer with extremely high malignant potential, originating from pigment and nevus cells. The incidence of malignant melanoma as a primary cancer occurring on the scalp is low, and its prognosis is poor.
We report a case of nodular malignant melanoma of the scalp, which presented diagnostic difficulties.
A 74-year-old woman presented to our dermatology clinic with a skin nodule on her scalp. She reported being aware of the lesion for 4 years prior to her visit to our clinic. An incisional biopsy confirmed the diagnosis of a compound nevus, and she was advised to follow-up. However, the nevus was observed to gradually increase in size.
She returned to our dermatology clinic 2 years after the biopsy, and with a high index of suspicion for malignancy, she was referred to our department that same year. We performed an excisional biopsy, and a diagnosis of malignant melanoma was confirmed. She underwent an extended excision and sentinel lymph node biopsy, and closure of the wound with a rotation flap. TNM classification was pT4aN0M0, and it was a stage IIB cancer. We administered postoperative adjuvant chemotherapy with dacarbazine, nimustine, vincristine, and interferon beta (DAV-Feron). She presented with metastases throughout the body 8 months after surgery and was transferred to the palliative care department in the hospital.[Skin Cancer (Japan) 2017 ; 32 : 55-60]

A 75-year-old Japanese male presented with a subcutaneous mass that developed from a small nodule over 1 year. Physical examination revealed a mass measuring 18 cm×15 cm in size in his left chest wall. Although biopsy specimens of the mass indicated a granular cell tumor (GCT), a diagnosis of malignant granular cell tumor (mGCT) was made based on the clinical course. The tumor was completely excised. Excised specimens in the shallow area were identified as GCTs ; on the other hand, those in the deep area were found to be mGCTs. During 4 years of follow-up, contrast-enhanced computed tomography revealed masses in his lungs and liver. Due to his age, palliative care was recommended. The origin of mGCTs is unclear. In our patient, mGCTs were accompanied by GCTs, suggesting transformation from a benign tumor to a malignant one. Further studies are required to elucidate the nature of mGCTs.[Skin Cancer (Japan) 2017 ; 32 : 61-65]

An 89-year-old man underwent local excision of a squamous cell carcinoma. Three years and 8 months after the surgery, he developed a new tumor near the scar at the previous operation site. The new lesion was not a recurrence of his squamous cell carcinoma, but a malignant melanoma that metastasized to his cervical lymph nodes and lungs (stage IV). Palliative excision of the primary skin lesion and other therapeutic modalities such as targeting, immunotherapy or chemotherapy were out of options among the patient, his family and medical team. The second primary skin cancer has been less concerned in Japan. The issue would be more discussed as well as in Caucasian societies.[Skin Cancer (Japan) 2017 ; 32 : 66-70]

A 58-year-old male with type 2 diabetes for over 10 years noted small blisters on the sole of his right foot 2 years ago. One month ago, he visited the dermatology department of a general hospital. Verrucous carcinoma was suspected based on clinical findings, and he was referred to our hospital. Magnetic resonance imaging revealed a 4-cm-sized tumor in the adipose tissue, which infiltrated up to the adjacent muscular layer. Blood tests showed a markedly elevated HbA1c level of 10.8%. A supra-aponeurotic tumor resection with a horizontal margin of 1 cm was performed. The defect after resection was covered with artificial dermis. Since strict treatment of diabetes and topical therapy was performed, and granulation tissue was gradually observed, Thiersch skin grafting was performed. There has been no apparent recurrence or distal metastasis during the 15 months after surgery. [Skin Cancer (Japan) 2017 ; 32 : 71-75]

A 48-year-old man visited our hospital with a black ulcerated nodule on his right upper flank, which developed from a large melanocytic-nevus present since childhood. His right axillary lymph node was swollen. He was diagnosed with malignant melanoma ; wide excision and axillary lymph node dissection and postoperative radiotherapy to his right axilla were performed. In April 2015, PET-CT revealed metastases to the bone, lung, and gallbladder. His melanoma harbored a BRAF mutation ; therefore, vemurafenib was administered. Although he had a renal dysfunction due to gout, it was controlled by a dose reduction and holding treatment of vemurafenib, in addition to hydration. After administration of vemurafenib, he achieved stable disease for several months. In September, the patient experienced confusion. Multiple brain metastases were detected by CT and MRI. Stereotactic irradiation was administered during a 1.5-day vemurafenib withdrawal period. After irradiation, the confusion improved. Further, CT scans did not reveal radiation necrosis or new brain abnormalities.[Skin Cancer (Japan) 2017 ; 32 : 76-81]

We describe a case of a 49-year-old woman with a history of scalp melanoma that was excised 12 months previously. A follow-up PET-CT revealed focal FDG uptake in the right breast. A core needle biopsy was performed and histological examination showed that some cells contained melanin. The cells showed weak positivity for HMB45 and melan-A, and a diagnosis of metastatic melanoma was confirmed. The patient was treated with vemurafenib and showed an excellent response, initially. However, the right breast lesion regrew after 21 months. Despite switching to nivolumab, the lesion continued to grow. Imaging studies showed no other metastasis. Partial mastectomy was performed. Six months after the mastectomy, and 42 months after the breast metastasis diagnosis, the patient had no evidence of recurrence. Concurrent metastases to other organs are frequent ; however, solitary breast metastases from melanoma are extremely rare. If solitary metastasis is confirmed, partial mastectomy may improve prognosis. [Skin Cancer (Japan) 2017 ; 32 : 82-88]

Case 1 : A 65-year-old female patient noticed itching on her vulva about 5 years before her first visit. She had painful urination and was aware of a tumor on her vulva for 4 years. She presented with a sclerous whitish area on her vulva and a reddish tumor 18 mm in diameter on her left vulva. Histopathological examination of skin biopsy revealed squamous cell carcinoma (SCC) with lichen sclerosus et atrophicus (LSA). We performed a resection 20 mm away from the mass including LSA. Sentinel lymph node biopsy was negative for metastasis, and she has not since developed recurrence or metastasis. Case 2 : An 83-year-old female patient noticed itching and pain on her vulva. She presented with a sclerous whitish area and a tumor on her vulva approximately 30 mm in diameter. A biopsy specimen revealed SCC with LSA. We performed resection a 10 mm away from the mass including LSA. However, she developed lymph node metastasis on both sides of the groin 2 months postsurgery, and died after 8 months.[Skin Cancer (Japan) 2017 ; 32 : 89-94]

We report the case of a 73-year-old man who presented with a painful erosion on his left heel. On the basis of the biopsy results, we made a diagnosis of malignant melanoma. Although no groin or popliteal lymph node was palpable and preoperative positron emission tomography-computed tomography did not show swelling of the groin and popliteal lymph nodes, intraoperative indocyanine green (ICG) fluorescence detected the histological involvement of a sentinel lymph node in the popliteal region. Popliteal lymph node metastasis is rare and difficult to correctly diagnose at the first surgery. In our case, popliteal lymph node metastasis was detected by using ICG fluorescence, which may be useful for the early detection of metastasis.[Skin Cancer (Japan) 2017 ; 32 : 95-99]