Hiroyuki Goto

Unique dermoscopic findings of penile Mondor's disease

ejd.2013.2053 Auteur(s) : Takamichi Ito1,2, Yuichi Yoshida1, Hiroyuki Goto1, Nanako Yamada1, Masutaka Furue2, Osamu Yamamoto1 1 Division of Dermatology, Tottori University, Tottori, Japan 2 Department of Dermatology, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan Penile Mondors disease is a rare benign condition that is characterized by thrombosis in the superficial dorsal penile vein [1]. A diagnosis of Mondors disease is primarily made by medical history and physical examination. [...]

Retrospective evaluation of factors influencing successful skin grafting for patients with skin cancer of the foot

Skin grafting is a simple method for reconstruction of a large defect on the foot. Although skin grafting on the foot sometimes fails, it is not clear what factors influence the success rate of skin grafting. We analyzed data for 71 patients with skin cancer of the foot who underwent reconstruction of defects with skin grafting. The factors we evaluated were success rate of skin grafting, weight‐bearing or non‐weight‐bearing area, immediate or delayed reconstruction, and whether a tie‐over bolster was used or not. The success rates were higher in patients with lesions in non‐weight‐bearing areas than in patients with lesions in weight‐bearing areas and in patients who underwent delayed reconstruction than in patients who received immediate reconstruction. On the other hand, the use of a tie‐over bolster did not improve the success rate. In conclusion, delayed reconstruction is desirable if the lesion is located in a weight‐bearing area.

Characteristics of multiple basal cell carcinomas: The first study on Japanese patients

Basal cell carcinoma (BCC), the most frequent skin cancer, has been increasing in incidence. However, the characteristics of multiple BCC have not been clarified in Japan. Therefore, we conducted a retrospective study to elucidate the features of multiple BCC compared with solitary BCC. The study population consisted of 327 patients with histopathologically proven BCC who were referred to the Department of Dermatology in Tottori University Hospital between November 2006 and April 2016. Of the 327 patients, 304 (93.0%) had solitary BCC and 23 (7.0%) had multiple BCC. The mean age of the patients with solitary BCC was 74.7 years (range, 31–102) and that of patients with multiple BCC was 79.3 years (range, 63–91). There was a significant difference in mean age between the two groups (P = 0.01). Approximately four‐fifths of the BCC were located on the head or neck in the total study population. In the group of patients with multiple BCC, the incidence of lesions on the head and neck was lower and that on the trunk was higher than those in patients with solitary BCC. There was a significant difference in the tumor site between the two groups (P < 0.0001). With respect to tumor histopathology, the ratio of superficial BCC was significantly higher in the group of patients with multiple BCC than in the group of patients with solitary BCC (P < 0.0001). In conclusion, we demonstrated that older age, truncal location and superficial histopathological type of tumor are features of multiple BCC in Japanese subjects.

Lichen sclerosus on the face

Lichen sclerosus (LS) is a chronic inflammatory disease that most often affects the genital and perianal areas and shows hypopigmented and atrophic patches. The predilection sites are a hallmark for making the diagnosis, and dermatologists may miss a differential diagnosis of LS for lesions occurring on other sites. Indeed, only 15% of patients with LS have extragenital lesions, including those on the neck, shoulder, axilla or trunk. Here, we report a case of LS on the face with unique dermoscopic findings and review of the literature.

Symptom prevalence in patients with advanced skin cancer

Knowledge of the prevalence of symptoms in patients with incurable cancer in the terminal stage is important for clinicians. However, there has been no report on the prevalence of symptoms in patients with incurable skin cancer. We analyzed the prevalence of symptoms in 224 patients who died due to skin cancer in our center. These data were obtained from medical records compiled by a miscellaneous population of medical staff retrospectively. We evaluated the symptoms at 3 months, 1 month, 2 weeks, 1 week and 3 days before the patients died. Data for symptoms included Eastern Cooperative Oncology Group performance status and the presence or absence of the following 13 symptoms: (i) bleeding or exudate; (ii) pain or necessity for an analgesic; (iii) fatigue; (iv) anorexia; (v) nausea; (vi) dyspnea or need for oxygen administration; (vii) bloating; (viii) insomnia; (ix) delirium; (x) drowsiness; (xi) anemia; (xii) spasm; and (xiii) paralysis. The average performance status gradually progressed. Pain and anorexia were the most common symptoms in patients with advanced skin cancer. Dyspnea, anemia and drowsiness also tended to be frequent as death approached despite the fact that the frequencies of these symptoms were not high 3 months before death. We considered that frequencies of prevalence of pain and dyspnea were due to bone and lung metastases. Bleeding or exudate from lesions is a characteristic symptom in patients with skin cancer. Our results regarding the prevalence of symptoms in patients with advanced skin cancer will be helpful for medical professionals to assess patients conditions and to plan treatment.

Translocation of the MAML2 gene in hidradenocarcinoma

Dear Editor, Mastermind-like transcriptional coactivator 2 (MAML2) translocation is known as a molecular marker unique to mucoepidermoid carcinoma (MEC), which is the most common malignant tumor of the salivary gland. However, there is no report on the translocation of the MAML2 gene in hidradenocarcinoma. A 54-year-old woman was referred to our department for a tumor on the right axilla, which had appeared more than 10 years prior. Physical examination revealed a granular, pale pink, 61 mm 9 45 mm 9 21 mm hard tumor (Fig. 1a). Computed tomography revealed no distant metastasis but several swollen right axillary lymph nodes. A skin biopsy was

Basophils are recruited and localized at the site of tick bites in humans

To the Editor: Basophils are circulating granulocytes that account for less than 1% of blood leukocytes. They also play nonredundant roles in the pathogenesis of specific types of allergic inflammation in the skin. In humans, basophils infiltrate into the skin in several diseases including atopic dermatitis, contact dermatitis, chronic urticaria, prurigo and bullous pemphigoid, and they have been implicated in their pathogenesis. In mouse models, basophils have been shown to participate in IgE-mediated chronic allergic inflammation of the skin and play a protective role in tick bites as well as in helminth infection. Intriguingly, mouse basophils appear in the skin of tick bites. However, there is no clear-cut evidence of basophil infiltration in the skin of tick bites in humans. In addition, translation of the relevance of mouse models to human skin diseases is very difficult considering the inherent differences in human and mouse basophils. These challenges prompted us to analyze basophil infiltration and localization in the skin lesions of tick bites both clinically and histopathologically. Here, we describe basophil localization in tick bites and we also discuss the localization of basophils in the pathophysiology. This study was carried out in accordance with the Declaration of Helsinki and was approved by the Ethical Committee of Tottori University Faculty of Medicine, Japan. Informed consent was obtained from all patients enrolled in this study. Skin biopsy specimens were taken from 12 patients of tick bite by Amblyomma testudinarium (males 3; females 9; age range 1-80 years; mean age SD 49.4 29.6 years) (Table 1). We found 7 cases of tick mouthparts among 12 patients. Hematoxylin-eosin staining and immunostaining to detect basophils using 2D7, a basophil-specific monoclonal antibody (BioLegend, San Diego, California), were performed. Both the number and density of basophils were evaluated at mouthpart and nonmouthpart areas using quantifying NanoZoomer Digital Pathology Imaging software (HAMAMATSU, Hamamatsu, Japan) (Figure 1A). According to the previous study involving a mouse model of tick bites, basophils were recruited to and clustered in the skin lesions caused by tick feeding. In order to analyze basophil accumulation in humans, we thus defined “mouthpart” as the tick-feeding sites and “nonmouthpart” as the area just around the tick-feeding sites. We determined the “mouthpart” and “nonmouthpart” areas as follows: A mouthpart area is a dermis

Fatal venous embolism in a patient with advanced extramammary Paget disease

647 Lupus-like skin lesions are uncommon in 5-FU-treated patients [3], and most cases of 5-FU-induced DIL manifest as CCLE [2] or SCLE [4]. Other chemotherapeutic agents, such as docetaxel, paclitaxel, tamoxifen, capecitabine, and doxorubicin plus cyclophosphamide, can be associated with SCLE [4]. Interestingly, our patient did not develop SLE during four months of 5-FU chemotherapy. Of note, capecitabine (which is converted to 5-FU), but not 5-FU alone, was reported to induce SCLE [5]. Our patient had anti-SSA/Ro Ab before developing DIL. Although the antiSSA/Ro Ab is a serological marker of SCLE, our patient’s skin lesions differed from those of SCLE [6]. In addition, his anti-SSA/Ro titre remained relatively stable before and after TS-1 treatment. The positivity for anti-SSA/Ro and antiSSB/La Abs detected before presentation suggests that our patient could be predisposed to DIL. It has been shown that chemotherapeutic agents, including 5-FU, induce apoptosis [7]. Since the pathogenesis of SLE involves a dysregulation of apoptosis [8-10], increased TS-1-induced apoptosis might cause overt SLE in susceptible individuals.

Effective treatments for paronychia caused by oncology pharmacotherapy

Cutaneous adverse events are relatively common in patients being treated with molecular‐targeted drugs. Paronychia is one of the cutaneous adverse events that influences the patients quality of life because of pain, and it often affects anticancer treatments in severe cases. However, there are few effective treatments, especially for severe paronychia. Here, we present our experiences of treatment for paronychia due to oncology pharmacotherapy. Although we treated paronychia with various methods, only corticosteroid ointment and phenol chemical matricectomy significantly improved the paronychia. Dermatologists must perform appropriate and effective treatments for paronychia in order to enable patients to continue anticancer drug treatment without impairing their quality of life.

Palliative surgical treatment for cutaneous metastatic tumor is a valid option for improvement of quality of life

A cutaneous metastatic tumor is relatively rare, and patients with such a tumor usually have a poor prognosis. Even if the metastases can be treated, the treatment cannot improve the prognosis. However, neglecting metastatic lesions sometimes results in a great deterioration of quality of life. Cutaneous metastatic foci are generally treated with chemotherapy and/or radiotherapy. On the other hand, surgical treatment is sometimes chosen for cutaneous metastases. In this study, we analyzed data for 40 patients with cutaneous metastatic tumors who received surgical treatment at Shizuoka Cancer Center between January 2009 and August 2014. Among these cases, lung cancer was the most common primary cancer and the craniocervical region was the most frequent metastatic site. Among the patients who died, the average duration to death after the operation was 186 days. We consider that resection of cutaneous metastatic tumors as palliative therapy is an appropriate therapeutic option if the patients condition permits resection. Such treatment can improve quality of life for both the patients and their families.