Saburo Kishimoto

Dendritic cell vaccination in human melanoma: relationships between clinical effects and vaccine parameters

Eleven years have passed since the start of the first trial of dendritic cell (DC) vaccination for melanoma. A review of 54 trials was performed to evaluate the relationship between clinical effects and vaccine parameters. Significant differences were found between use of immature and mature DCs with regard to progressive disease (PD), between stage III and IV for clinical response, between use and non‐use of adjuvants with regard to stable disease (SD) in treatment with tumor/tumor lysate‐pulsed DCs, between positive and negative delayed‐type hypersensitivity (DTH) for PD, and between increased and unchanged interferon (IFN)‐γ‐secreting T cells for clinical response. These results are consistent with the partial efficacy of vaccination with mature DCs in early stage melanoma and the partial correlation of efficacy with positive DTH and increased IFN‐γ‐secreting T cells. DC vaccination alone had a limited clinical effect and a modified regimen is needed to enhance antigen‐specific cytotoxic T cells and decrease immunosuppression.

Granulomatous mycosis fungoides presenting as poikiloderma

Granulomatous mycosis fungoides (MF) is a rare subtype of MF, characterized by the histological presence of a granulomatous reaction, but distinct clinical characteristics are not present. A 41‐year‐old healthy man presented with poikiloderma, ichthyosis and erythematous scaly plaque. Histological examination of a biopsy taken from poikilodermic skin showed a granulomatous reaction to epidermotropic atypical lymphocytes. However, in other areas there were only findings of conventional MF without granuloma. Granulomatous MF may be associated with poikiloderma.

Immunohistological analysis of in-transit metastasis in a patient with advanced melanoma treated with combination therapy of cytosine guanine dinucleotide oligodeoxynucleotide, dacarbazine and beta-interferon: a case report.

cal “congenital pattern features’’ could be seen. The nodule at the margin of the plaque was confirmed as MM because of characteristic dermoscopic and histological findings. An epidermal melanoma was supposed to occur at the margin of a medium-sized CMN. Although the pathogenesis of malignant transformation is not clear, two possibilities are supposed. The first is the chance theory in which the risk is thought to be increased by the innumerable melanocytes in CMN. The second is a genetic predisposition. Activating mutations within the kinase domain of the BRAF gene are a common somatic event in MM as well as in melanocytic nevi. Small CMN and acquired nevi are inclined to demonstrate BRAF mutations, while giant CMN possess NRAS mutations. MM occasionally have NRAS mutations in addition to the frequent BRAF mutations. Although the contribution to malignant transformation is not verified, medium-sized CMN sometimes demonstrate NRAS mutations. Giant CMN and associated proliferative nodules are suggested to be derived from a common precursor because there are similar features of frequent NRAS mutations and infrequent BRAF mutations. However, Bastian et al. reported genetic differences between proliferative nodules and MM in giant CMN. These genetic analyses have been mostly reported in giant CMN to our knowledge. In conclusion, we describe an NRAS-mutated MM arising from an NRAS-mutated medium-sized CMN, which was rather small.