Keratin 19-positive cutaneous squamous cell carcinoma with elevated serum cytokeratin 19 fragment 21-1 level: A case report.

cytokeratin 19 fragment 21-1 (CYFRA21-1) is a marker of lung cancer useful for evaluating clinical diagnosis and prognosis. To the best of our knowledge, there have been no reports of cutaneous squamous cell carcinoma (SCC) with high levels of CYFRA21-1 to date. We herein report a case of a 79-year-old man with a large subcutaneous tumor of the left shoulder, which was diagnosed as primary cutaneous poorly differentiated SCC. The tumor nests were composed of poorly differentiated atypical squamous cells exhibiting high-grade malignancy and mitotic figures; multinuclear cells were also identified inside lymph vessels. Keratin 19 (K19) was intensely expressed in tumor cells. A significantly elevated level of CYFRA21-1 (33 ng/ml) was observed preoperatively. After surgery, the level of CYFRA21-1 was significantly decreased (from 33 to 5.0 ng/ml). Our case demonstrated that K19-positive primary cutaneous undifferentiated SCC induced high levels of CYFRA21-1 in the serum. Thus, CYFRA 21-1 may be a marker indicative of poorly differentiated cutaneous SCC exhibiting K19 expression.

New technique of decompressive skinplasty with artificial dermis for severe brain swelling: technical note.

In cases of severe uncontrollable brain swelling, simple skin closure often increases intracranial pressure. This study examined the efficacy of a new technique of decompressive skinplasty to decrease intracranial pressure following decompressive craniectomy in cases of severe traumatic brain injury with uncontrollable brain swelling. In our technique, we use artificial dermis to avoid elevation of intracranial pressure. After performing decompressive craniectomy and duraplasty with artificial dura, decompressive skinplasty with artificial dermis was performed in 5 patients for whom simple skin closure caused the intracranial pressure to elevate under intracranial pressure monitoring. Artificial dermis was grafted onto the region to cover the skin defect and sutured to the skin with 4-0 nylon sutures. Two weeks after surgery, the silicone layer of the artificial dermis was removed and ointment treatment was continued until complete epithelialization was achieved. In all cases, decompressive skinplasty contributed dramatically to decreasing the intracranial pressure in patients with uncontrollable brain swelling. The technique of decompressive skinplasty with artificial dermis contributed to dramatically decreasing the intracranial pressure. More cases are required to investigate the indications for this technique.