Shinji Oguchi

Dermoscopy for acral pigmented skin lesions

Acral volar skin is the most prevalent site of malignant melanoma in nonwhite populations. In Japanese, about one half of all cutaneous melanomas are seen on acral skin, and nearly 30% of melanomas affect the sole of the foot.1,2 The rate of acral melanoma is much higher in blacks. Moreover, the incidence and real number of malignant melanoma affecting the acral skin were reported to be almost the same among all races, the incidence being 0.3/100,000 populations per year.3,4 In any race, therefore, early detection and accurate diagnosis of malignant melanoma on acral skin are very important to improve the prognosis. On acral skin, melanocytic nevi are also frequently found. In our data, 8% of Japanese have melanocytic nevi on their soles.1 In addition, we sometimes encounter nonmelanocytic pigmented lesions on acral skin, such as the so-called black heel, which may produce problems in clinical differentiation from early melanoma. In this article, we describe characteristic dermoscopic features of various kinds of pigmented lesions on acral skin and emphasize the diagnostic value of the parallelridge pattern in diagnosing early melanoma at this anatomic site. Using this dermoscopic criterion, we detected several cases of early melanoma in situ, which were difficult to be diagnosed clinically and/or histopathologically.

Docetaxel Induced Durable Response in Advanced Extramammary Paget's Disease: A Case Report

The patient was a 54‐year‐old Japanese man with a seven‐month history of an eroded lesion on the scrotum. Skin biopsy confirmed the diagnosis of extramammary Pagets disease, and a CT scan revealed multiple metastases to the lymph nodes along the iliac artery and aorta. The patient underwent combination chemotherapy with mitomycin C, epirubicin, vincristine, cisplatin, and 5‐fluorouracil. After two courses of the regimen, the primary lesions on the scrotum regressed, however, the lymph node metastases did not respond. A regimen of continuous administration of low‐dose cisplatin and 5‐fluorouracil was not effective for the metastases either. Hence, administration of docetaxel at a dose of 60 mg/m2/every four weeks was started. After two courses, the lymph node metastases decreased by 75% compared to the pre‐treatment size, and the effect was judged a partial response. The major toxicities were neutropenia, alopecia, pitting edema, and facial erythema, but these were tolerable. Five courses of this regimen were followed by four courses of weekly administration of 25 mg/m2 docetaxel. The partial response persisted for more than 12 months and the patient was able to enjoy daily life. Docetaxel may be an effective drug for patients with advanced extramammary Pagets disease.

A case of primary Epstein-Barr virus-associated cutaneous diffuse large B-cell lymphoma unassociated with iatrogenic or endogenous immune dysregulation.

Cutaneous Epstein‐Barr virus (EBV)‐associated B‐cell lymphoma (EBVBL) in non‐immunocompromised patients is very rare. Here, we report a case of cutaneous EBVBL in a 72‐year‐old Japanese woman without any signs of immunosuppression. She showed repeated high fever and skin eruptions on the face, limbs and palms. Histological diagnosis was diffuse large B‐cell lymphoma. EBV infection was detected by in situ hybridization and Southern blotting. Immunostaining for viral proteins showed the patient to be positive for latent membrane protein 1 (LMP‐1) and negative for Epstein‐Barr virus nuclear antigen‐1 (EBNA‐2), indicating that a type II latency EBV infection pattern.

Kaposi’s varicelliform eruption of an elderly patient with multiple myeloma

Kaposis varicelliform eruption (KVE) is characterized by disseminated vesiculopustules and erosions due to a herpes virus infection superimposed on a preexisting dermatosis such as atopic dermatitis. However, the occurrence of KVE in patients with multiple myeloma seems to be very rare; to our knowledge, only one such case has been reported. This report documents a second case of KVE in a patient with multiple myeloma.