Takaki Suetake

Epidemiology and prognosis of subungual melanoma in 34 Japanese patients

The incidence of malignant melanoma is much lower in the Japanese than in Caucasians. However, amongst the various types of malignant melanoma, the subungual and periungual sites are commonly found in the Japanese. One hundred and fifty‐one cases of cutaneous malignant melanoma were seen over a 25‐year period at our hospital. We found that. In 34 patients (23%). the subungual region was involved, a high frequency for one institution. We have analysed these patients and looked at their treatment. The finger nails were affected in 21 cases (62%) and the toe nails in 1 3 cases (38%). The thumb nails or great toe nails were at tecled in 25 of the 34 patients (73%). In 25 patients, histopathological features of acral lentiginous melanoma were found, with four cases of superficial spreading melanoma and five of nodular amelanotic melanoma. Of the latter group, four mimicked tibrous histiocytic tumour, and one was a desmoplastic malignant melanoma. I he proportion of patients presenting with stage III disease decreased after 1982. with a corresponding increase in patients whose tumour thickness was less than 4 mm (stage II). Concurrently, the prognosis for subungual malignant melanoma improved. The 5‐year survival rate in each of the periods 1969–82 and 1981—93 was 5 3 and 87%. respectively. This is similar to that found in plantar malignant melanoma and is fell to be due to a greater public awareness of the condition and to the introduction of effective chemotherapy (the DTIC‐AC nitro surear vincristine (OAV) regimen). Although the frequency of malignant melanoma is rather low in the Japanese, our data indicate that there is a high incidence of subungual malignant melanoma. Public awareness of the early stage of malignant melanoma seems to have improved prognosis.

Epidemiology and prognosis of plantar melanoma in 62 Japanese patients over a 28‐year period

Background The plantar surface is one of the commonest sites of malignant melanoma in the Japanese; however, the biological behavior is not sufficiently clarified, because of the paucity of long‐term studies. We attempted an epidemiologic survey of the cases of plantar melanoma treated in our institute to study the survival rate in the recent period.

Acrokeratosis paraneoplastica (Bazex syndrome) associated with primary cutaneous squamous cell carcinoma of the lower leg, vitiligo and alopecia areata

We report a case of acrokeratosis paraneoplastica (AP; Bazex syndrome), characterized by typical palmoplantar hyperkeratosis and psoriasiform scaly erythema of the acral regions, associated with primary cutaneous squamous cell carcinoma (SCC) on the left lower leg. This 54‐year‐old Japanese man subsequently developed vitiligo, and alopecia areata of the scalp. Serial monitoring of squamous cell carcinoma antigen (SCC‐Ag) demonstrated that the severity of the clinical manifestations of AP paralleled the serum concentrations of SCC‐Ag. We suggest that an immune‐mediated mechanism underlies the development of AP in this patient.

Improvement in survival rate of patients with acral melanoma observed in the past 22 years in Sendai, Japan

While the incidence of malignant melanoma is much lower in Japanese than in Caucasians, the commonest site of melanoma in Japanese has been reported to be the acral regions of the limbs. The survival rate for acral and nodular melanoma observed at the Department of Dermatology, Tohoku University Hospital in Sendai, Japan from 1969 to 1990 was reviewed. Among 150 melanoma patients 125 (83%) and 17(11%) had primary cutaneous melanoma and mucous membrane melanomas, respectively. Frequent sites for cutaneous melanomas were the sole (31%) and subungual regions (15%). Comparison of the stages of plantar melanoma at diagnosis showed that the proportion of stages III and IV decreased after 1980 with a corresponding increase in those with a tumour thickness of less than 4 mm (stage II). Concurrently, the prognosis of plantar melanoma has improved; the 5‐year survival rate in each of the three periods 1969–75, 1976–80 and 1981–85 was 21, 70 and 90%, respectively. This was also the case with subungual melanoma. Such improvements in the prognosis are thought to be mainly due to early detection through the growing public awareness of this life‐threatening disease.

Non-pigmented nodular plantar melanoma in 12 Japanese patients

In the Japanese, melanoma most commonly involves the plantar surface. Among 61 patients with plantar melanoma, we diagnosed 50 patients as acral lentiginous melanoma (ALM), nine as nodular melanoma, and two as superficial spreading melanoma. Partial or complete loss of pigment was observed in four of the nine nodular melanoma cases and in the nodular portions of eight ALM cases.

A simple method to treat an ingrowing toenail with a shape-memory alloy device.

An ingrowing toenail has no definitive treatment. Previously, effective methods were complicated but easy ones had less effect. We show both an easy and an effective way with Cu‐Al‐Mn‐based shape‐memory alloys (SMAs). They have a characteristic shape which patients themselves can detach easily without any pain. But they also have enough corrective force. Cu‐based SMAs cost much less than Ni‐Ti‐based alloys. Despite not being appropriate for all cases of ingrowing toenails, it is an easy, effective and less costly alternative.

Palpation of the skin with a robot finger: an attempt to measure skin stiffness with a probe loaded with a newly developed tactile vibration sensor and displacement sensor

Background/aims: Various attempts have been made to measure mechanical properties of the skin quantitatively and noninvasively. However, no attempt has been made to measure a tactile sense of our finger that palpates the skin; when we palpate the skin to search for any change, we at first rub the skin surface softly with a finger tip to detect a surface change and then press the finger against the skin to perceive any alteration in consistency. The problem here is how to record such tactile sense quantitatively, because the palpating examination for smoothness or softness of the skin totally depends on a subjective perception. A new tactile sensor from robot technology is equipped with a fingertip‐like sensing probe oscillating at a resonant frequency of 60 kHz; it is capable of clearly sensing small differences in hardness of solid substances from a change in the oscillating frequency and from a displacement sensor that detects depressability of the skin. We have used this new measuring system to evaluate the hardness and elasticity of skin.

Clinicopathological Study of Acral Melanoma in situ in 44 Japanese Patients

BACKGROUND Acral lentiginous melanoma (ALM) has been a major focus of interest in Japan in the last 2 decades. A remarkable improvement recently made in the prognosis of ALM at our institution may possibly be explained by early detection including melanoma in situ. OBJECTIVE We have retrospectively studied 44 cases of melanoma in situ in the past 25 years from 1970 to 1994, 61% of which have been seen in the last 5 years. RESULTS Of 190 cases of invasive malignant melanoma including 20 melanomas involving the mucous membrane, 96 were ALM. Accordingly, the number of cases of melanoma in situ involving the acral regions was also prominent. Of 44 melanomas in situ, 29 occurred in the acral regions. Eight lesions localized on the face were compatible with lentigo maligna both clinically and histologically. All 6 mucosal lesions occurred on the oral mucosa. The remaining lesion appeared on the back of a psoriatic patient treated with photochemotherapy. Forty-two specimens showed histologically a lentiginous proliferation including atypical solitary cells within the lower portion of the epidermis, especially in the basal layer. The remaining 2 specimens were histologically of the pagetoid type. CONCLUSION Corresponding to the fact that ALM are predominant in the Japanese, the most common sites of melanoma in situ are also the acral regions.

Nodular Melanoma in 62 Japanese Patients: Influence of Initial Surgical Treatment on Local Recurrence and Prognosis

The incidence of malignant melanoma is much lower in Japanese than in Caucasians, and the commonest type of melanoma in Japanese is acral lentiginous melanoma (ALM). In contrast to the improved prognosis noted in ALM, it is now of increasing concern that there is a rise in both the frequency and mortality of nodular melanoma. During the 25 years from 1970 to 1994, we observed 190 patients with melanoma, including 62 nodular melanomas and 96 ALM, at the Department of Dermatology, Tohoku University Hospital, Sendai, Japan. We retrospectively reviewed the recurrence and survival rates of nodular melanoma observed. The proportion of nodular melanoma, once comprising only 24% of all melanomas, showed a sharp increase to 40% after 1982. The anatomical sites of the primary tumor were the hands and feet (29%), extremities excluding hands and feet (27%), head and neck (23%), and trunk (21%). Comparison of the stages of nodular melanoma when diagnosed showed that the proportion of stage III remained highest throughout the whole period, but that of stage II melanomas increased after 1982. After treatment, local recurrence occurred far more frequently in nodular melanoma (19%) than in ALM (1%). The prognosis of nodular melanoma was also less favorable than that of ALM, although it slightly improved after 1982; the 5‐year survival rates before and after 1982 were 34 and 50%, respectively. Twenty‐eight patients with nodular melanoma had underwent simple excision or incisional biopsy of the primary tumor at another institution and were later referred to us for further intensive care or for the treatment of local recurrence and/or metastases. The rate of local recurrence of melanoma in such referred patients was higher than that in those who underwent an initial excision with wide margins in our hospital. Concurrently, the prognosis in the former group was significantly lower than that in the latter group; the 5‐year survival rate for the group of narrow initial margin was 22% in contrast to that of wide margin (56%). Combination therapy including initial surgical excision with wide margins as well as the careful follow‐up apparently result in a better outcome for the Japanese patients with nodular melanoma.

Improvement of photoaged facial skin in middle-aged Japanese females by topical retinol (vitamin A alcohol): A vehicle-controlled, double-blind study

Topical tretinoin formulation is still unavailable in Japan. Because topical retinol, which is less potent but may cause less irritation, is available here, we have performed a randomized, blinded, vehicle-controlled study on the face using a once-nightly regimen for the treatment of mild photoaging in middle-aged Japanese females. First, a 26-week study was conducted in 57 subjects with a 0.075% retinol cream and its vehicle on each half side of the face. Three of the 57 subjects withdrew from the study due to irritation, although this rate was much smaller than that noted in our previous study with topical tretinoin. After 26 weeks, the rates of photoaging improvement were significantly higher on the retinol side: 27 out of 54 (50%) versus 13 (24%) for the fine wrinkling and 15 out of 54 (28%) versus 1 (2%) for deep wrinkling. A similar trial with a 0.04% retinol cream for 13 weeks revealed less prominent improvements in fine wrinkling but minimal irritation. From these data, we think that retinol creams, especially 0.04% cream, are suitable for daily use in the general population because of the low irritancy, even for those with sensitive skin.