Sentinel lymph node (SLN) biopsy has been performed in 25 patients with malignant melanoma for the last four years at the Department of Dermatology, University of Occupational and Environmental Health. SLNs were identified by using both patent blue dye and redionucleotide-labeled colloid methods. The removed SLNs were subjected to routine haematoxylin-eosin staining and immunohistochemical stainings for Melan-A, S-100 protein and HMB45, and 10 of 25 cases had positive SLN metastases. In 8 cases, mRNA for malignant melanoma related molecules, gp100, MART-1 and tyrosinase, was analyzed by RT-PCR, and 7 of 8 cases gave agreement with the histopathological results. One case had negative SLN metastasis on histopathological examination but exhibited amplification of mRNA for the melanoma-related molecules on RT-PCR analysis.

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In the duration from May, 2002 to June, 2005, we performed sentinel node navigation surgery (SNNS) to a total of 13 cases with malignant melanoma at our university hospital. The average observation period was 19.5 months. After the SNNS, two patients showed metastatic disease. One had liver metastasis, the other had in-transit metastasis. The average number of SN was 2.3, and positive rate of the SN metastasis was 8%. Sentinel nodes (SN) were identified in 100% of the cases with a combination method of patent blue dye method, preoperative lymphoscintigraphy and an intraoperative hand-held gamma probe. According to our and previous reports on Japanese patients, increasing tumor thickness was presumed to be associated with SN positive rate. Especially, SN positive rate was 0% for melanoma with tumor thickness less than 1mm. We suggest that SNNS has the best indication for melanoma thicker than 1mm. When we aim to predict patient’s prognosis and reduce surgical stress, SNNS is very useful. However, there were not enough number of the cases, this approach needs further investigation in a larger series of patients.

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A 62-year-old man came to our hospital after he was stung on his right hand by a bee while mowing grass. His right hand and forearm were swollen and severely painful, but vital signs were stable and consciousness was clear. When he returned 2 days later, right upperlimb was swollen. Blood examination results indicated marked elevation of creatine phosphokinase suggesting that rhabdomyolysis had resulted from the bee sting. The patient was admitted. Acute renal failure did not develop. He recovered with intravenous fluid therapy, and was discharged from our hospital 2 weeks after admission. We believe that histotoxic components of bee venom caused rhabdomyolysis in our patient.

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We report a case of angioedema associated with C1 inhibitor deficiency. A 58-year-old man first noticed swelling of the hands in his twenties, which was spontaneously resolved within a few days. He suffered severe facial edema triggered by a dental treatment ten years ago. Subsequently, he had repeated episodes of swelling of the face, hands, feet, or genitalia, and had several attacks of abdominal pain due to an unknown cause. On January 2004, he visited the emergency department in our hospital, complaining of perioral edema after carelessly biting the lower lip. Computerized tomography revealed narrowing of the upper respiratory tract due to laryngeal edema during the stroke. The symptoms subsided within several days. Findings of blood examinations disclosed remarkably low titers of C1 inhibitor function (<25%, normal: 70~130%) and C4 (<2 mg/dl, normal : 14~39 mg/dl). The patient was diagnosed as angioedema associated with C1 inhibitor deficiency. Based on the normal value of serum C1q (10.0 mg/dl, normal : 8.8~15.3 mg/dl), hereditary angioedema was suspected, although his family had no previous experience of angioedema. He was treated with danazol at an initial dose of 200 mg daily, which provided symptomatic relief. Danazol was tapered down to the minimal effective dose of 150 mg daily.

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A case of drug eruption due to non-ionic contrast media, iopamidol (Iopamiron^®) was reported. A 71-year-old man developed skin eruptions on his trunk 10 days after undergoing angiography using Iopamidol. Patch tests with Iopamidol showed positive reactions after 48 and 72 hours, and a diagnosis as a delayed-type drug eruption by Iopamidol was given. In the case of sensitized patient, drug eruption appears from several hours to 1 day after angiography. On the other hand, a delayed-type drug eruption by Iopamidol on non-sensitized patient is known to develop 6-10 days often the use. There is a possibility that Iopamidol might be excluded from the Candidate of the drug eruption because of this peculiar clinical course.

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This report describes a 75 year-old woman with recurrent pyoderma gangrenosum in whom there were co-existent pulmonary aseptic abscess. Chest x-ray examination revealed infiltrative shadow, which disappeared spontaneously, in November 2000. She developed pyoderma gangrenosum on the right clavicular region in June 2001. Cutaneous ulcer improved after starting oral predonisolone 20mg/day. The pulmonary lesion recurred in March 2003, soon after stopping predonisolone. She presented with another ulcer on her waist in May 2003. Both pulmonary and cutaneous lesion responded well to oral predonisolone 40mg/day, however, she died of sudden peritonitis.

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We report here a rare female case of pseudohypoparathyroidism with multiple cutaneous osteomas. She also represented both of hypothyroidism without autoantibodies and Albright’s hereditary osteodystrophy (AHO) with characteristic phenotypic disorders such as short stature, obesity, brachydactyly, enamel hypoplasia, and multiple cutaneous osteomas. Ever after 8 years old, she has suffered from severe sensory disturbance on distal bodies and repetitive appearance of cutaneous osteomas because of the instability of serum calcium level. Pseudohypoparathyroidism (PHP) is a heterogeneous disease characterized by PTH resistance and classified as types Ia, Ib, Ic and II, according to its different pathogenesis and phonotype. Recent molecular analyses clarified that heterozygous inactivating Gsα mutation, a cofactor encoded by GNAS1 gene, led to AHO and pseudohypoparathyroidism with PTH resistance. Gsα protein is activated by the intracellular domain of PTH-binding receptor and mediates ATP to cAMP transition, resulting in maintaining calcium homeostasis in PTH-targeted organs. Although it has been estimated that cutaneous ossification is found in 42% of the patients with PHP, the reason for bony formation in cutaneous tissue is unknown. While discussing the correlation between the inactivation of Gsαand osteogenesis, we propose putative mechanisms of cutaneous ossification in AHO with PHP.

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Regression of a keratoacanthoma after biopsy is reported. Three-weeks before she presented, a 56-year-old woman noted a small nodule on her forehead. The lesion grew rapidly. Initial examination disclosed a dome-shaped nodule with a central crater on the left side of the forehead. Histopathologic findings in a biopsy specimen confirmed a clinical diagnosis of keratoacanthoma. On our advice the patient chose a period of close follow-up over immediate complete excisions for cosmetic reasons. The tumor gradually became smaller and disappeared leaving only a minute scar.

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Merkel cell carcinoma behaves aggressively and frequently causes both local recurrence and metastasis. We report two cases of Merkel cell carcinoma.
A 72-year-old man was referred to our hospital in February 2003. He had noticed a cutaneous nodule on the right upper arm 6 months earlier, then the nodule began growing larger and became flesh colored. Biopsy was performed, and Merkel cell carcinoma was diagnosed. We performed wide resection along with right axillary lymph node dissection.Post-operatively, radiotherapy and chemotherapy were performed. He has remained free from tumors for more than 1.5-years after treatment.
Another 83-year-old woman presented with cutaneous nodule on her forehead. Biopsy was performed, and Merkel cell carcinoma was diagnosed. However, the nodule regressed completely one month after biopsy.

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We report a case of a 84 year-old woman with malignant melanoma which showed a remarkable effect by interferon-β injection therapy. The black~brown macule and nodule spread from the left angle of mouth to the upper lip and mucosa of mouth. At first, brown macule appeared in the left angle of mouth, three years before first visit. Before one year of the first visit, the pigmented lesion spreaded rapidly, and black nodule appeared in upper lip. Pathological examination revealed that it was malignant melanoma. Patient refused the operation therapy. We administrated DAVFeron therapy once. But the patient refused to continue DAVFeron therapy because of the side effect thrombocytopenia. Since then we attended with interferon-β injection therapy. Brown and black macule disappepred almost entirely. Only the black nodule at the angle of mouth was resected. General examination have not pointed out metastasis from the first visit.

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A 81 year-old female with a nodule on her right leg visited our clinic. The dark red nodule had grown in size 15mm × 9mm. A new subcutaneous nodule developed at proximity of the original lesion. There is no history of local trauma. Histopathologically, granuloma with polymorphous inflammatory cells was observed and a number of acid-fast organisms were detected. Mycobacterium chelonae was isolated and identified by DNA-DNA hybridization. The lesions disappeared in 12 weeks by oral administration of minocycline 200mg daily. Forty-four reported cases in Japan were reviewed.

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ANTEBATE LOTION 0.05%^®(TORII PHARMACEUTICAL CO., LTD. Tokyo, Japan)is an emulsion lotion which contains 5mg betamethasone butyrate propionate in 1g of this product, and it is a topical corticosteroid preparation with a moderate viscosity and good extensibility. In this study, we examined the efficacy of this product on various inflammatory skin diseases other than the hair covered part. With observation period up to 8 weeks, 30 patients with contact dermatitis, chronic eczema, psoriasis, etc. on the trunk or extremities were enrolled. The skin symptoms rapidly.

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We investigated the efficacy and safety of A-DERMA EXOMEGA CREAM in a total of 55 patients with atopic dry skin. A-DERMA EXOMEGA CREAM is a cosmetic emollient containing Avena Rhealba^® (Oat) total extract and evening primrose oil.
After 4 weeks of topical application, skin dryness, scaling and pruritus were greatly improved in almost all cases, and the moisture content of the stratum corneum was increased significantly.
The results of this study indicated that the product was safe and efficient in clinical application for the dry skin of atopic dermatitis, improving patients’ quality of life.

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In response to current patient’s needs, we dermatologists should take the initiative in anti-aging medicine. In the light of EBM, interventions for wrinkles were critically appraised. Treatments with reasonably established efficacy include topical retinoids. Analysis of patient’s preference and economical evaluation for wrinkles treatments would be warranted.

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I treat wrinkles and concaves with collagen, hyaluronic acid, botulinum toxin, polylactic acid. The indication of use and the method of injection for these products were investigated. I often use injectable collagen implant. The treatment with collagen was more effective than with any other materials I used. Injectable human collagen has been available since April 2003, and it has an advantage over bovine collagen, whose injectable form has been available since 1981, because the human collagen material is less likely to cause the allergic reaction. Hyaluronic acid causes stiffness and slight pigmentation on the injected regions. However, it has a merrit of long-lasting effect. Botulinum toxin is used with collagen in combination in the treatment of wrinkles on the forehead and crow’s feet. Polylactic acid is difficult to handle, but it has a long duration of effect.

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Aromatherapy is defined as the art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit. Aromatic essences are highly concentrated extracts which are distilled from a variety of aromatic plant material including grasses, leaves, needles, twigs, peel of fruit, wood and roots. It is not intended to replace traditional medicine or traditional healthcare. It is a natural non-invasive treatment system designed to affect the whole person not just the symptom or disease and to assist the body’s natural ability to balance, regulate, heal and maintain itself by the correct use of essential oils. It has proven therapeutic benefits for a variety of conditions. Two cases successfully treated with aromatherapy were introduced.

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Recently, the number of patients for facial rejuvenation increase in my clinic. They prefer non-invasive treatment. We used a new RF device “ThermaCool” for skin tightening to some patients. I introduce this device and report my results.

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Introduction of psychosomatic medicine to dermatology is promising way for better management of allergic skin diseases. The author is confident of this through many clinical experiences of treatment and care for atopic dermatitis patients. Three points of view are emphasized to achieve incorporation of psychosomatic medicine into dermatology. First point is the importance of sympathetic and acceptant initial interview which enables to establish the patient-doctor relationship and to find a constellation of the patient’s problems. Second one is making proper dermatological treatment to relieve suffering patients from skin diseases. Third one is considering psychosocial background of the patients and supporting them to solve these problems. Additionally typical psychosocial problems of atopic dermatitis patients in each generation of human life were described.

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