Masaki Sawada

Interval sentinel lymph nodes in patients with cutaneous melanoma: A single-institution study in Japan

Interval sentinel lymph nodes (ISLN) are defined as the lymph nodes located between the primary melanoma and anatomically well‐defined lymph nodal basins. It was reported that the ISLN appeared to be at the same metastatic risk as sentinel lymph nodes (SLN) in the traditional nodal basins. This study aimed to examine the incidence and metastatic risk of the ISLN in melanoma patients. Between June of 1999 and December of 2008, 117 patients enrolled at Nagoya University Hospital underwent SLN biopsy for primary cutaneous melanoma with a Breslow thickness of at least 1.0 mm. Triple techniques with lymphoscintigraphy, blue dye injection and gamma probe were used for the biopsy except for 13 cases that underwent lymphoscintigraphy, ultrasonography and blue dye injection, but without gamma probe. Patients who had melanoma of the head and neck were excluded from this analysis. The SLN were identified in 253 nodal basins from 117 patients, and ISLN were found in six patients (5%). We recognized 41 (17%) SLN metastases in 246 conventional nodal basins and one (14%) in seven ISLN. Although ISLN were identified infrequently, the incidence of metastasis into the ISLN was similar to that into SLN in conventional nodal basins. It is therefore recommended that preoperative lymphoscintigraphy and intraoperative recognition of ISLN should be performed.

Proposed classification of longitudinal melanonychia based on clinical and dermoscopic criteria.

For longitudinal melanonychia, clinical and dermoscopic criteria for differentiating malignant melanoma in situ from benign nevus/lentigo/functional melanonychia have not been fully established.

Postoperative DAV-IFN-β therapy does not improve survival rates of stage II and stage III melanoma patients significantly.

Background  DAV‐interferon (IFN)‐β therapy is a combination chemotherapy of dacarbazine (DTIC), nimustine (ACNU) and vincristine (VCR) with local subcutaneous injection of IFN‐β that is widely employed as postoperative adjuvant chemotherapy to treat malignant melanoma in Japan. However, the efficacy of DAV‐IFN‐β therapy has not been confirmed by randomized controlled trials and the benefit of DAV‐IFN‐β therapy has not been established yet. This study evaluated the contribution of DAV‐IFN‐β therapy to improve survival of postoperative patients with cutaneous melanoma.

Spindle cell carcinoma of the breast in a patient with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease characterized by numerous neurofibromas and cutaneous pigmented macules, and its incidence is estimated as 1 in 3500 [1]. Patients with NF1 are often complicated with malignant tumors, especially non-epithelial malignancies [2]. Epithelial malignancies, including breast cancers, are seen in NF1 cases but only infrequently [3]. We report a case with NF1 who developed spindle cell carcinoma of the breast that histologically mimicked a [...]

Clinicopathologic analysis of 66 Japanese thin melanomas with metastasis of sentinel or regional lymph node.

Assessment of sentinel lymph node status is commonly performed in the treatment of cutaneous melanoma. However, there are no definite guidelines for thin melanomas with Breslow tumor thickness <1.0 mm, in part because thin melanomas are relatively infrequently positive for lymph node metastasis.

Lymphatic flow is mostly preserved after sentinel lymph node biopsy in primary cutaneous malignant melanoma

BACKGROUND Knowledge of changes in lymphatic flow after sentinel lymph node biopsy (SLNB) is important for the development of strategies for postoperative adjuvant therapy in malignant melanoma. OBJECTIVES 41 patients (22 males and 19 females; average age: 67.0 ± 24.0 years) with primary cutaneous malignant melanoma (PCMM) participated in the present study. The primary tumor sites were the upper extremities (9 patients), the lower extremities (20 patients), the trunk (11 patients) and the scalp (1 patient). The tumor thicknesses of the PCMM lesions were from 0.5mm to 9.0mm (average: 3.3 ± 2.5mm). All the participants underwent wide local excision and SLNB. METHODS We studied lymphatic flow before and after SLNB by near-infrared (NIR) imaging in all 41 cases. In addition, we performed NIR imaging of lymphatic flow after the lymph node dissection in one case with sentinel lymph node (SLN) metastasis. RESULTS Almost no changes in lymphatic flow were seen in 38 of the 41 patients (92.7%) after SLNB. Only in 3 patients (7.3%), one with SLN metastasis and the other two without SLN metastasis, was apparent alteration in the lymphatic flow observed after SLNB. Of the 16 patients without SLN metastasis, only 3 patients showed recurrence of the tumors. Interestingly, 1 of the 2 patients without SLN metastasis but with lymphatic flow alteration had recurrence (regional lymph node metastasis) of the melanoma, whereas only 2 of the 14 patients without SLN metastasis or lymphatic flow alteration had recurrence, 1 with regional lymph node metastasis and the other with distant lymph node metastasis. In 1 case, we re-examined the lymphatic flow after regional lymph node dissection and the lymphatic flow was found to be dramatically changed. CONCLUSION We clearly demonstrated that SLNB has only a minimal effect on lymphatic flow. The present results suggest that SLNB does not increase the risk of local recurrence/in-transit metastasis and may support the efficacy of post-SLNB local adjuvant injection to prevent local recurrence and in-transit metastasis.

Therapy-related myelodysplastic syndrome after alkylating agents and platinum-based therapy for malignant melanoma.

case expressed Ber-EP4 as seen in nodular BCC. Those findings do not reflect the secretory portion of sweat glands but follicular germinative differentiation of tumor cells, because positive findings were distributed diffusely. CEA was expressed in the luminal cells in apocrine or eccrine duct, and sometimes in the sebaceous duct in a general setting. CA19-9 was expressed in the luminal cells in the apocrine or eccrine duct in a general setting. From conventional microscopic findings, ductal structures in this case should be considered as sweat ductal or sebaceous ductal differentiation. Immunohistochemical findings of CEA and CA19-9 also support those suggestions. Sebocytic differentiation could not be confirmed by conventional microscopic and immunohistochemical findings, therefore, the diagnosis of BCC with sebaceous differentiation was excluded. Ductal structures in this case may be eccrine or apocrine ductal differentiation of neoplastic cells, because sebaceous ductal differentiation is usually observed in the case of BCC with sebaceous differentiation.