Yoshitaka Kai

Applicability of radiocolloids, blue dyes and fluorescent indocyanine green to sentinel node biopsy in melanoma

Patients with primary cutaneous melanoma underwent sentinel node (SN) mapping and biopsy at 25 facilities in Japan by the combination of radiocolloid with gamma probe and dye. Technetium‐99m (99mTc)‐tin colloid, 99mTc‐phytate, 2% patent blue violet (PBV) and 0.4% indigo carmine were used as tracers. In some hospitals, 0.5% fluorescent indocyanine green, which allows visualization of the SN with an infrared camera, was concomitantly used and examined. A total of 673 patients were enrolled, and 562 cases were eligible. The detection rates of SN were 95.5% (147/154) with the combination of tin colloid and PBV, 98.9% (368/372) with the combination of phytate and PBV, and 97.2% (35/36) with the combination of tin colloid or phytate and indigo carmine. SN was not detected in 12 cases by the combination method, and the primary tumor was in the head and neck in six of those 12 cases. In eight of 526 cases (1.5%), SN was detected by PBV but not by radiocolloid. There were 13 cases (2.5%) in which SN was detected by radiocolloid but not by PBV. In 18 of 36 cases (50%), SN was detected by radiocolloid but not by indigo carmine. Concomitantly used fluorescent indocyanine green detected SN in all of 67 cases. Interference with transcutaneous oximetry by PVB was observed in some cases, although it caused no clinical trouble. Allergic reactions were not reported with any of the tracers. 99mTc‐tin colloid, 99mTc‐phytate, PBV and indocyanine green are useful tracers for SN mapping.

Three cases of 'mechanic's hands' associated with interstitial pneumonia: possible involvement with foot lesions.

We describe three cases of the rare combination of lateral erythema and hyperkeratosis of the fingers that typify a condition known as ‘Mechanics Hands’. The first and the third cases were unusual in that the condition was associated with cutaneous involvement of the feet and interstitial pneumonia but not with myositis, or with only mild muscular involvement, while the second case was typical, being accompanied by myositis and detectable antibodies against histidyl transferase. We propose that Mechanics Hands can occur in association with foot lesions and interstitial pneumonia, even if it is not accompanied by myositis.

Pustular-type drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms due to carbamazepine with systemic muscle involvement

Drug‐induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe reaction usually associated with maculopapular eruptions and systemic involvement. Here we report the first case, to our knowledge, of DIHS/DRESS due to carbamazepine with acute generalized pustular bacterid‐like (AGPB‐like) eruptions and skeletal muscle involvement. Reviewing our case and the published work, we discuss pustular‐type DIHS/DRESS which, in most cases, involves acute generalized exanthematous pustulosis (AGEP)‐like skin eruptions in response to carbamazepine. Pustular eruptions may appear in relatively few cases of DIHS/DRESS, in particular, when the causative drug is carbamazepine and, even in cases of intractable pustular bacterid‐like eruptions, a reaction to a drug should be suspected. Skeletal muscle involvement may be associated with DIHS/DRESS as one of its systemic manifestations.

A case of fulminant type 1 diabetes mellitus, with a precipitous decrease in pancreatic volume, induced by nivolumab for malignant melanoma: analysis of HLA and CTLA-4 polymorphisms.

Nivolumab is a monoclonal antibody directed against PD1 (programmed cell death 1) that can improve survival in patients with metastatic melanoma. Such immune checkpoint inhibitors have been known to induce type 1 diabetes mellitus (T1D) [1, 2].A 54-year-old woman reported enlarging black nodules on her left sole, which had been present for seven months (figure 1A). CT imaging revealed swollen lymph nodes in the left inguinal and pelvic regions (figure 1B). After clinical diagnosis of malignant melanoma [...]

Analysis of 256 cases of basal cell carcinoma after either one‐step or two‐step surgery in a Japanese institution

Basal cell carcinoma (BCC) is a common skin cancer that arises from the cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. In the present report, 256 cases treated surgically between 1999 and 2008 in our department were retrospectively analyzed. The most frequent BCC locations included the face (77.8%), especially the nose (26.9%) and eyelids (21.5%). Incomplete excisions occurred in 21 cases. Two patients experienced local recurrence; one of these patients exhibited a bone metastasis while the other had a metastasis of the parotid gland without the local recurrence. The rate of local BCC recurrence was 0.78%, which is lower than that described in previous reports. We categorized BCC into four histological types: superficial, solid, adenoid and infiltrative. The solid type was the most frequent histological type (62.1%). For preventive recurrence, we treated BCC patients with two‐step surgery when the tumor was large or histologically invasive. At the first step, we excised the tumor with a sufficient safety margin, and at the second step, we performed reconstruction after the histological confirmation that no remnant malignant cells were in the tumor margins. In the present report, no local recurrence occurred in patients following the two‐step surgery. Therefore, two‐step surgery is recommended for tumors at locations and with histological types related to frequent recurrence.

Inability to detect sentinel lymph node metastasis due to an obstruction of the lymphatics by metastatic Merkel cell carcinoma

of life impact and clinical severity on adherence to topical acne treatment. J Cutan Med Surg 2009; 13: 204–208. 3 Bowes LE, Manstein D, Rox Andersen R. Effects of 532 nm KTP laser exposure on acne and sebaceous glands. Lasers Med Sci 2003; 18(Suppl 1): S6–S7. 4 Baugh WP, Kucaba WD. Nonablative phototherapy for acne vulgaris using the KTP 532 nm laser. Dermatol Surg 2005; 31: 1290–1296. 5 Chang SE, Ahn SJ, Rhee DY et al. Treatment of facial acne papules and pustules in Korean patients using an intense pulsed light device equipped with a 530to 750 nm filter. Dermatol Surg 2007; 33: 676–679. 6 Key DJ. Single-treatment skin tightening by radiofrequency and long-pulsed, 1064 nm Nd:YAG laser compared. Lasers Surg Med 2007; 39: 169–175. 7 Roh MR, Chung HJ, Chung KY. Effects of various parameters of the 1064 nm Nd:YAG laser for the treatment of enlarged facial pores. J Dermatolog Treat 2009; 20: 223–228.

Atypical pemphigus with exclusively anti-desmocollin 3-specific IgG antibodies

ejd.2012.1762 Auteur(s) : Yutaka Hatano1, Takashi Hashimoto2, Shunpei Fukuda2, Kazushi Ishikawa1, Mizuki Goto1, Yoshitaka Kai1, Naoko Takeo1, Osamu Okamoto1, Sakuhei Fujiwara1 fujiwara@oita-u.ac.jp 1 Department of Dermatology, Oita University, Idaigaoka1-1 Hasama, Yufu 879-5593, Japan 2 Department of Dermatology, Kurume University School of Medicine, Kurume University, Kurume 830-0011, Japan Antibodies against desmocollin 3 (Dsc3), together with other autoantibodies have been detected in some cases [...]

Fixed drug eruption caused by three unrelated drugs: promethazine, pethidine and omeprazole

We report a case of fixed drug eruption (FDE) caused by three unrelated drugs. A 52‐year‐old woman presented with a diagnosis of FDE after taking a drug to treat a common cold. An oral provocation test and a patch test were carried out, and the patient reacted to promethazine, which is a derivative of phenothiazine. To determine the core structure of the antigen, we performed patch testing and/or an oral provocation testing with six drugs that are similar in structure to promethazine. The patient reacted to five of the six drugs, and the antigenic determinant was identified as a phenothiazine and a tricyclic structure. The patient had similar eruptions at the same sites 3 years later after taking pethidine. Seven months after that reaction, a more severe eruption was caused by oral omeprazole. This is an extremely rare case of FDE caused by three structurally unrelated drugs.

Longitudinal melanonychia caused by unusual subungual keratosis.

hypopigmentation. Br J Dermatol 2001; 144: 188–189. 3 Shim JH, Seo SJ, Song KY, Hong CK. Development of multiple pigmented nevi within segmental nevus depigmentosus. J Korean Med Sci 2002; 17: 133–136. 4 Baba M, Akcali C, Seckin D, Happle R. Segmental lentiginosis with ipsilateral nevus depigmentosus: another example of twin spotting? Eur J Dermatol 2002; 12: 319–321. 5 Davis BR, Candotti F. Genetics. Mosaicism-Switch or Spectrum? Science 2010; 330: 46–47. 6 Oiso N, Amatsu A, Kawada A. Hyperpigmented spots within and partly around a hypopigmented macule. Int J Dermatol 2011; 50: 795–797. 7 In SI, Kang HY. Partial unilateral lentiginosis colocalized with naevus depigmentosus. Clin Exp Dermatol 2008; 33: 337–339. 8 Chen HH, Liao YH. Coexistence of congenital linear punctate keratoderma and nevus depigmentosus with lentigines: a case of twin spotting? Acta Derm Venereol 2004; 84: 408–410. 9 Jagia R, Mendiratt V, Koranne RV, Sardana K, Bhushan P, Solanki RS. Colocalized nevus depigmentosus and lentigines with underlying breast hypoplasia: a case of reverse mutation? Dermatol Online J 2004; 10: 12.

A case of rheumatoid nodulosis successfully treated with surgery.

We report the case of a 76 year‐old male with multiple subcutaneous nodules, but without joint symptoms or deformities, who was diagnosed histopathologically with rheumatoid nodulosis after resection of the nodules. Rheumatoid nodulosis is a disease characterized by multiple subcutaneous nodules that are histopathologically similar to rheumatoid nodules, a high titer of rheumatoid factor, and radiologically detectable cystic bone lesions, but with none or few of the systemic manifestations or joint activity of rheumatoid arthritis (RA). It is considered to be a benign variant of RA. This rare disease must be considered when a case of multiple subcutaneous nodules is encountered, even in aged males without joint symptoms or deformities.