[in Japanese]

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A 56-year-old Japanese man, who had been treated for nodular prurigo, developed blisters on the pruritic nodules and erythemas 6 months after cryotherapy. Biopsy from the skin lesion disclosed parakeratosis, hyperkeratosis, acanthosis of the epidermis, and subepidermal blister. Direct immunofluorescence study showed a linear deposition of IgG and C3 on dermo-epidermal junction. On immunoblot analysis, his serum reacted with BP230 in the epidermal extracts, as well as the recombinant protein of BP180 NC16a domain. Based on these clinical, histopathological and immunological findings, we diagnosed this case pemphigoid nodularis. Betamethasone, minocycline and nicotinamide quickly improved his symptoms.

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We report two cases of hyperkeratosis of nipple and areola.
Case 1 was a 55-year-old man.He visited our hospital after scattered black papules were observed on both areolae at a medical examination for healthcare survey.Case 2 was a 32-yearold man.He visited a local clinic, because of dark-red papules present on the left nipple and areola for several years.Both subjects were diagnosed with hyperkeratosis of nipple and areola based on clinical and pathological findings. Case 1 was associated with malignant melanoma, and Case 2 was associated with rachitis. Because this skin disorder was sometimes reported to be associated with malignant tumors or cryptorrhea in the past, it should be considered with more attention at the level of clinical practice.

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Sixty seven year-old male received surgical excision of the subcutaneous tumor of the head, which recurred two months later. Although wide local excision was carried out in October, 1997, recurrence was again observed 1 year later at the right postauricular region. The patient died of respiratory dysfunction after series of recurrence of the tumor which subsequently enlarged over time. Histopathological examinations demonstrated tumor islands consisted of atypical cells with basophilic cytoplasm. Immunohistochemical study showed that tumor cells reacted positively for the antibodies to K7, Ks8.18 and K19, while they were negative to the antibodies to gross cystic disease fluid protein-15 or human milk fat globulin. Based on the results from usual image analytic investigation, and negative result to K20, skin metastasis of the visceral adenocarcinoma was ruled out. This case was thereby diagnosed as an eccrine adenocarcinoma with possible differentiation toward the secretory portion of the eccrine gland.

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A 40-year-old female has noticed a macule on right zygomatic region since childhood. A darkred nodule suddenly appeared on the macule in January 2000, and she visited a hospital 4 months after she noticed the lesion. Excisional biopsy was performed, with resultant diagnosis of malignant melanoma. She was transferred to our hospital, where a wide excision of the lesion as well as sentinel node biopsy using patent blue dye was performed. Since the metastasis was confirmed histologically by the stained superficial cervical lymph node, the complete modifiedradical neck dissection of lymph nodes was performed. No metastasis was observed in those radically dissected lymph nodes by pathological examination. Since no metastatic lesion of other internal organs was detected by radiological examination, this case was categorized into superficial spreading melanoma with sentinel lymph node metastasis (stage III, pT4a N1 MO, UICC, 1997). SNB works as a good tool for decision of lymph node dissection in this case.

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A case of erythema annulare due to tipea pedis is reported. A 33-year-old Japanese female had several, pruritic, annular erythema on the limb for eight years.
The lesions appeared during the warm months of the year and subsided spontaneously during the winter. Trichophyton rubrum was isolated from scaly tinea pedis. The trichophytin skin test showed positive reaction at 48 hours and produced annular erythema at two weeks. The lesions was treated with oral terbinafine, antihistamin, topical steroid. The lesion disappeared one month later without recurrence. On the basis of above mentioned evidences, we believe the present case of erythema annulare centrifugum is dermatophytid.

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