Toshikazu Omodaka

Retrospective evaluation of factors influencing successful skin grafting for patients with skin cancer of the foot

Skin grafting is a simple method for reconstruction of a large defect on the foot. Although skin grafting on the foot sometimes fails, it is not clear what factors influence the success rate of skin grafting. We analyzed data for 71 patients with skin cancer of the foot who underwent reconstruction of defects with skin grafting. The factors we evaluated were success rate of skin grafting, weight‐bearing or non‐weight‐bearing area, immediate or delayed reconstruction, and whether a tie‐over bolster was used or not. The success rates were higher in patients with lesions in non‐weight‐bearing areas than in patients with lesions in weight‐bearing areas and in patients who underwent delayed reconstruction than in patients who received immediate reconstruction. On the other hand, the use of a tie‐over bolster did not improve the success rate. In conclusion, delayed reconstruction is desirable if the lesion is located in a weight‐bearing area.

Nail apparatus melanoma thickness is associated with side and age

Nail apparatus melanoma (NAM) is a rare variant of cutaneous melanoma that arises in the nail unit and typically appears as melanonychia in its early stage.1 Since the factors associated with the progression of NAM are not fully understood, 102 cases of NAM were analysed to identify clinical factors associated with Breslows thickness. This article is protected by copyright. All rights reserved.

Serum 5-S-cysteinyldopa behavior in the early phase of nivolumab treatment of 12 melanoma patients

Along with the expansion of therapeutic options for metastatic melanoma, the development of useful biomarkers is urgently required to predict and monitor treatment response. Serum 5‐S‐cysteinyldopa (5‐S‐CD) has been identified as a diagnostic marker of malignant melanoma, but its utility as a biomarker for emerging therapeutic agents remains unknown. We assessed serum 5‐S‐CD in 12 metastatic melanoma patients (median age, 76 years; six men and six women) who had been treated with nivolumab (Nivo) at Shinshu University Hospital between 2014 and 2016. Serum 5‐S‐CD and lactate dehydrogenase levels before and at 3–6 weeks of Nivo treatment were obtained and their changes were compared with clinical responses as defined by the Response Evaluation Criteria in Solid Tumors criteria (version 1.1). A decrease of 10 nmol/L or more of serum 5‐S‐CD was observed only in partial response patients (2/3 cases, 67%), while an increase of 10 nmol/L or more of serum 5‐S‐CD was witnessed only in progressive disease patients (4/8 cases, 50%). Serum 5‐S‐CD changes were within ±10 nmol/L in the remaining six patients (partial response, one; stable disease, one; progressive disease, four). The results of the four moderately affected progressive disease patients were suspected to have been influenced by small‐sized metastatic lesions, a mixed response that included diminished and enlarged metastatic lesions, prior therapy to Nivo with BRAF inhibitors or radiation, or the development of brain metastasis. Serum 5‐S‐CD in the early phase of Nivo treatment may be helpful to predict therapeutic response in metastatic melanoma.

Type 1 diabetes in a melanoma patient treated with ipilimumab after nivolumab

1 Bowyer S, Prithviraj P, Lorigan P et al. Efficacy and toxicity of treatment with the anti-CTLA-4 antibody ipilimumab in patients with metastatic melanoma after prior anti-PD-1 therapy. Br J Cancer 2016; 114: 1084–1089. 2 Weber JS, Gibney G, Sullivan RJ et al. Sequential administration of nivolumab and ipilimumab with a planned switch in patients with advanced melanoma (CheckMate 064): an open-label, randomized, phase 2 trial. Lancet Oncol 2016; 17: 943–955.

Case of severe ulceration induced by pazopanib.

previously. The PCR products were purified and subjected to direct DNA sequencing and HPV type 3 was detected consequently. We also performed an immunohistochemical analysis using an anti-HPV antibody (K1H8; Dako, Glostrup, Denmark) and observed positive cells in the granular layer and stratum corneum (Fig. 1e). We diagnosed him as having flat warts in an immunocompromised condition. The topical application of imiquimod cream for 4 weeks did not obtain a therapeutic effect and the patient declined further therapy. Flat warts are small flat nodules; however, when they grow extensively and are resistant to treatment, an immunocompromised state may underlie the condition. Our patient suffered from ureteral cancer and received oral prednisolone for interstitial pneumonia. His immunocompromised condition might have been a critical factor in the unusual manifestation; namely, the shape and size of his lesions. It is important to note that atypical flat warts arising in an elderly patient suggest an immunocompromised condition. In our case, HPV type 3 was detected from the lesion. The HPV typing of the flat warts from 36 immunocompetent patients revealed that the most commonly detected type of HPV was HPV type 3 (58.3%), followed by types 28 (11.1%), 29 (8.3%) and 95 (8.3%). Although the clinical diagnosis of flat warts is sometimes difficult due to the unusual manifestations, HPV typing or immunohistochemistry can be useful to establish the correct diagnosis. ACKNOWLEDGMENT: We thank Saki Mizuno (Gunma University, Japan) for technical support.

Differential diagnosis of trabectedin extravasation: A case report

Dear Editor, Trabectedin is an alkylating antitumor agent. Studies have reported that trabectedin causes serious tissue injury. However, there is no report of the utility of skin biopsies in the diagnosis of trabectedin extravasation. A 51-year-old man with multiple metastases from a malignant solitary fibrous tumor of the thigh received trabectedin. A central venous port (CVP) was implanted in the left subclavian subcutaneous fat the day before chemotherapy. We noticed that the patient’s clothes were wet 18 h after administration; however, redness, swelling and pain were not noted. Therefore, the needle was reinserted and trabectedin administration was continued. The patient developed redness around the CVP and visited the emergency room 4 days after chemotherapy (Fig. 1a). Hematological examination showed slight inflammation. We suspected CVP infection or trabectedin extravasation. We removed the CVP and administrated cefazolin for an infection. However, redness, swelling and pain persisted. We performed a skin biopsy from erythema 9 days after chemotherapy. The histopathological findings showed alteration of collagen fibers and fat necrosis without an inflammatory infiltrate (Fig. 1b,c). The wound, blood, biopsy and

Translocation of the MAML2 gene in hidradenocarcinoma

Dear Editor, Mastermind-like transcriptional coactivator 2 (MAML2) translocation is known as a molecular marker unique to mucoepidermoid carcinoma (MEC), which is the most common malignant tumor of the salivary gland. However, there is no report on the translocation of the MAML2 gene in hidradenocarcinoma. A 54-year-old woman was referred to our department for a tumor on the right axilla, which had appeared more than 10 years prior. Physical examination revealed a granular, pale pink, 61 mm 9 45 mm 9 21 mm hard tumor (Fig. 1a). Computed tomography revealed no distant metastasis but several swollen right axillary lymph nodes. A skin biopsy was

Effective treatments for paronychia caused by oncology pharmacotherapy

Cutaneous adverse events are relatively common in patients being treated with molecular‐targeted drugs. Paronychia is one of the cutaneous adverse events that influences the patients quality of life because of pain, and it often affects anticancer treatments in severe cases. However, there are few effective treatments, especially for severe paronychia. Here, we present our experiences of treatment for paronychia due to oncology pharmacotherapy. Although we treated paronychia with various methods, only corticosteroid ointment and phenol chemical matricectomy significantly improved the paronychia. Dermatologists must perform appropriate and effective treatments for paronychia in order to enable patients to continue anticancer drug treatment without impairing their quality of life.

Palliative surgical treatment for cutaneous metastatic tumor is a valid option for improvement of quality of life

A cutaneous metastatic tumor is relatively rare, and patients with such a tumor usually have a poor prognosis. Even if the metastases can be treated, the treatment cannot improve the prognosis. However, neglecting metastatic lesions sometimes results in a great deterioration of quality of life. Cutaneous metastatic foci are generally treated with chemotherapy and/or radiotherapy. On the other hand, surgical treatment is sometimes chosen for cutaneous metastases. In this study, we analyzed data for 40 patients with cutaneous metastatic tumors who received surgical treatment at Shizuoka Cancer Center between January 2009 and August 2014. Among these cases, lung cancer was the most common primary cancer and the craniocervical region was the most frequent metastatic site. Among the patients who died, the average duration to death after the operation was 186 days. We consider that resection of cutaneous metastatic tumors as palliative therapy is an appropriate therapeutic option if the patients condition permits resection. Such treatment can improve quality of life for both the patients and their families.

Two cases of squamous cell carcinoma of the lower leg treated with a pasteurized bone graft

Squamous cell carcinoma (SCC) is a common skin cancer that may be associated with ultraviolet ray exposure, scarring due to a trauma or burn, or chronic osteomyelitis [1, 2]. SCC is usually treated by surgery. However, for SCC of the lower legs, surgery is sometimes problematic; indeed, tumour cells easily infiltrate the tibia due to a lack of protective fat buffer layer at the front of the lower leg. Amputation may be a safe method for resecting the tumour, and management of the wound after the [...]