Taizo Kato

Acral Melanoma in Japan

Clinical records and histologic materials from 81 patients with malignant melanoma at the Department of Dermatology at Tohoku University School of Medicine were reviewed. In addition, a statistical study on 1597 cases of malignant melanoma collected from the Japanese literature from 1961 to 1982 was performed. The annual mortality rate has been increasing almost linearly over the past 20 years. The mortality rate per year for 1980 was 0.21 per 100,000. Five-year survival rate at Tohoku University was 35 percent. The most common site of melanoma was acral, especially the plantar surfaces. The clinical and histologic study of acral melanomas showed that clinicopathologic features are the same as those reported for acral lentiginous melanoma in the United States.

Possible functional impairment of Langerhans' cells in vitiliginous skin. Reduced ability to elicit dinitrochlorobenzene contact sensitivity reaction and decreased stimulatory effect in the allogeneic mixed skin cell lymphocyte culture reaction.

We used patch testing to compare the ability to elicit contact sensitivity to dinitrochlorobenzene (DNCB) of uninvolved with vitiliginous skin of 31 patients with vitiligo. The induction of DNCB contact sensitivity was possible in the vitiliginous skin in the same way as in normal skin. The DNCB contact sensitivity reactions, however, were generally diminished in vitiliginous skin, although the number of cases showing similar DNCB contact reactivity between normal and vitiliginous skin increased when the sensitization procedure was performed in vitiliginous skin instead of normal skin. On the other hand, delayed skin reactions to intradermally injected Candida albicans antigen were not suppressed in vitiliginous skin. The number of Langerhans cells was not decreased in vitiliginous skin as compared with that of normal skin. The epidermal cells derived from vitiliginous skin, however, tended to show a lower stimulatory effect in the allogeneic mixed skin cell lymphocyte culture reaction than those from normal skin. These results suggest a possibility of functional impairment of Langerhans cells in vitiliginous skin.

Acute febrile neutrophilic dermatosis (Sweet’s syndrome) with nodular episcleritis and polyneuropathy

A 56‐year‐old Japanese housewife presented with multiple erythematous lesions in association with ocular hyperemia and pain in the right upper and lower extremities, including the hands and feet. These symptoms were preceded by a sore throat with persistent fever higher than 38.5 °C for about 1 week.

Plantar malignant melanoma. Statistical and clinicopathological studies.

Among 51 cases of malignant melanoma seen at the Department of Dermatology, Tohoku University School of Medicine, from 1966 to 1978, 16 cases had had the primary lesion on the sole. The average age of these 16 cases was 63 and the sex ratio (M:F) was 11:5. The common sites of involvement on the sole were the heel (in 9 cases) and the toes and metatarsal region (in 5 cases). In 14 cases the lesions arose on the right sole; furthermore, 6 cases had had histories of trauma before or after the development of tumor and 7 cases had received insufficient excisions of their lesions, all of which showed a recurrence and/or lymph node metastasis within a year. These data suggest that traumatic stimulation may have some effect up on the pathogenesis of plantar melanoma.

Coexistence of xeroderma pigmentosum with sarcoidosis and adenocarcinoma of the digestive organs.

Xeroderma pigmentosum has not been reported in association with any specific diseases except for skin malignancy. We observed a case of its coexistence with sarcoidosis and adenocarcinoma of the digestive organs, which has been reported only once in the past. A 54-year-old Japanese female with a variant type of xeroderma pigmentosum developed successively multiple lesions of basal cell carcinoma and squamous cell carcinoma on her face. Intensive metastasis studies led to the incidental detection of non-caseating epithelioid cell granulomas in one of the palpable right supraclavicular lymph nodes. Similar granulomas were also revealed in the excised tissue specimen of squamous cell carcinomas of her left cheek. She was also found to have bilateral hilar lymphadenopathy and chronic uveitis. Three years later, she died of colon adenocarcinoma and its liver metastasis.

A case of epithelioid sarcoma showing unique tissue image.

A 48-year-old Japanese male patient visited us with a 3-year-history of scattered nodules on the right leg and foot. A nodule 2×1cm in size with a cratral scab and ulcer was observed on the swollen right leg and several small nodules ranged from 1 to 3mm in diameter were scattered on the foot. Biopsy specimen obtained from the nodule of the leg showed the histological features of epithelioid sarcoma. In addition to the positive staining for keratin and vimentin, tumor cells were also positive for CD34 and Factor VIII. Patient received an amputation at the right thigh followed by inguinal lymph node dissection. A metastatic lymph node at the distal portion of the saphenous vein was histologically detected. Patient was alive more than 2 years after the surgical procedure. During this period a small metastatic nodule appeared on the occipital region which was excised surgically.

A case of mixed carcinoma.

A 77-year-old Japanese male patient visited us with a 2-year-history of a tender nodule existing at the preauricular portion of the left ear. On physical examination, there was a smooth, brownish, dome-shaped nodule 15×15mm in size with a cratral scab. There were no palpable regional lymph nodes. The lesion was totally excised with more than 1cm safety margin, whose defect was covered by a skin flap made from behind the ear. Histopathological exmanination reveald that a solid feature of BCC adjacent to well differentiated SCC showing marked keratinization. These findings were typical of a collision tumor.

Malignant Melanoma in situ in a Japanese Psoriatic Patient Treated with Phototherapy

aware of the existence of such practices, because tbey could be easily confused with nonaccidental injuries that are frequently seen in both adults and children.- The features characterizing guboow may be summarized according to the following criteria: (1) Location: strictly limited to a well-defined area with a precise and geometric or polygonal appearance; (2) same age of the lesional burns, without further evidence of newer elements; (3) details regarding the cause of the scars are fully explained by the patients and are consistent with their religious Islamic faith; and (4) full cooperation with the medical staff interested in the knowledge of this practice. The religious background and cultural habits may provide useful clues to die origin of such skin lesions. The dermatoses closely linked with these backgrounds include prayer nodules in Shiite Muslim men, turban ear in Sikh men, perichondritis of the tragus in nuns, mudi-chood in girls and young women in South India, and ritual facial markings of Yorubas of western Nigeria. Garlo Enrico Urbani, M.D. Milan, Italy

Stratum corneum-induced chemiluminescence in human neutrophils.

In an in vitro study to examine whether corneocytes stimulate neutrophils to cause a respiratory burst, we found that stratum corneum (SC) homogenates obtained from the sole of healthy individuals induced a substantial respiratory burst in human neutrophils when assessed by lucigenin-dependent chemiluminescence (CL) in the presence of the nontreated fresh human serum (NTS) . Electronmicroscopically the interaction between corneocyte and neutrophils was shown as distinctive deformation of the neutrophils adhering to the surface of the corneo-cytes that suggested a specific binding between them. In contrast, in the heat-inactivated serum (HIS) -supplemented system the peak inensity of SC-induced CL was significantly decreased, being only slightly higher than that noted in the SC-free background. To circumvent the time-consuming preparation of the SC homogenates we measured CL with a sheet of SC obtained by stripping with adhesive cellophane tape. In this case we used plasma because complement in the serum was easily activated by cellophane tape itself. To evaluate the influence of the location of horny tissue in the SC on the induction of CL responses, we used SC sheets stripped with cellophane tape from various levels of the SC. Howeve, there was no significant difference in CL response between SC sheets obtained 1, 2, 3, 5, 10 or 15 strippings.Our findings suggest that, when the SC comes in contact with serum, it is opsonized by C 3 b and that such SC causes a respiratory burst of neutrophils following their physical contact. Extracellular release of the resultant active oxygen species probably causes damaging effects on the surrounding SC and epider_ mal tissue and such an interaction between SC and neutrophils seems to be involved in the formation of subcorneal sterile pustules noted in pustular dermatoses.

A case of fibrosarcoma in a child.

昭和63年1月28日生まれの女児。出生時より, 左臀部の一部に, 多毛とその周囲の皮膚に紅斑, および硬結を触れた。生後5ヵ月を過ぎた頃から, その部分よりもやや前方が, 淡紅色の紅斑を伴って隆起してきた。そして1ヵ月後には, 高さ5cm, 直径12cm大の腫瘤性の病変を形成した。術前の生検よりの診断では, infantile fibromatosisのaggressive typeであったが, 手術標本を検討してinfantile fibrosarcomaと診断した。