Case of Merkel cell carcinoma with squamous cell carcinoma possibly arising in chronic radiodermatitis of the hand.

We report a case of Merkel cell carcinoma (MCC) on the dorsal aspect of the right middle finger associated with multiple squamous cell carcinomas (SCC) possibly arising in chronic radiation dermatitis of the hand of an 80-year-old surgeon. In spite of resection of the primary lesion and right axillary lymph nodes, he died of the tumor 5 months after the first visit. Cutaneous and lymph node lesions of MCC were negative for Merkel cell polyoma virus (MCPyV) by immunostaining using monoclonal antibody (CM2B4) and anti-large T antigen of MCPyV polyclonal antibody, and real-time polymerase chain reaction. Several differences in clinicopathological findings have been found between MCPyV-positive cases and negative ones. Several authors have reported that MCPyV-negative cases have a worse prognosis than MCPyV-positive ones. Furthermore, in cases of MCC associated with SCC, most tumors have been reported to be MCPyV-negative. We should pay more attention to the relationship between the carcinogenesis of MCC and ionizing irradiation.

Three-Dimensional Image Fusion of SPECT and CT Scans for Locating Sentinel Lymph Nodes in Malignant Melanomas.

Image fusion software can derive a fusion image from single photon emission computed tomography and computed tomography scans. We applied a three-dimensional fusion image to detect sentinel lymph nodes (SLNs) in 3 patients with malignant melanomas of the lumbar, vulvar and head region, respectively. During each operation, we detected SLNs at the expected site, as indicated by the fusion images. The three-dimensional image fusion could thus be confirmed as a simple and helpful method for precisely localizing SLNs in these patients.

Clinicopathological significance of sentinel node biopsy in Japanese patients with cutaneous malignant melanoma.

Sentinel node biopsy (SNB) for malignant melanoma began to be performed in our department in 1997. A total of 121 patients underwent SNB. Sentinel node (SN) were identified in 39 (83.0%) of the 47 cases in which the blue dye method alone was used, and in 71 (95.9%) of the 74 cases by combination of dye, radioisotope, and γ probe methods. The excised SN was cut through its longest meridian, and the cut surfaces were stained with hematoxylin and eosin (HE) and examined for the presence (SN(+) ) or absence (SN(-) ) of melanoma cells. If no melanoma cells were detected, serial sections were prepared and examined by sequential staining with HE, for S-100 protein, with HE, for HMB-45, with HE, and for Melan-A. In this study minute metastasis (SNm(+) ) was defined as tumor cells newly identified in the immunostained section. The thickness of tumors ranged 0-38.0 mm, and their mean thickness was 4.5 mm. There were 39 SN(+) cases (39/110 [39+71]; 35.5%) and seven SNm(+) cases (7/110 [39+71]; 6.4%). The 5-year survival rate was significantly higher in the SN(-) group than in the SN(+) group and SNm(+) group combined (P=0.0002). The survival rate of the SNm(+) group was not significantly different from that of the SN(+) group (P=0.3848). The 5-year survival rate of the SN(+) group and SNm(+) group combined was significantly higher than that of the group with clinically unequivocal metastatic nodes (P=0.0001). Accurate SNB results will provide important prognostic information for Japanese patients with melanoma.

Bowen's disease with high telomerase activity.

We describe an 81-year-old Japanese woman who had a palm-sized, erythematous plaque with a nodular lesion on the lateral abdomen. The biopsy specimens taken from the erythematous plaque and reddish nodule show that bowenoid changes were present in the epidermis and epidermis to dermis, respectively. A sentinel lymph node biopsy (SNB) was performed with blue dye and radioisotope in her right groin region and two lymph nodes were found to be occupied by many atypical cells. The erythematous plaque with nodular lesion was completely removed with a 3-cm margin under general anesthesia, and complete regional lymph node dissection was also performed. In addition, high telomerase activity was seen in the erythema plaque while using a telomeric repeat amplification protocol assay. In conclusion, some instances of Bowen's disease might have high telomerase activity in the atypical cells and can progress to Bowen's carcinoma. The SNB was regarded as a useful method to detect early lymph node metastases in this case.