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We report here six cases of malignant melanoma in which metastatic lesions were detected first. Of these, two cases showed some peculiar features: one exhibited widespread subcutaneous bleeding, probably due to venous rupture, and the other case had a rare primary lesion on the penis. In the Japanese literature, there have been 46 cases of malignant melanoma in which metastatic lesions were detected prior to the initial ones. The preferential site for metastasis was the lymph node (32 cases). The primary lesion was unknown in 35 patients. The outcomes were available for 36 of the 46 patients; 23 died, including 18 who died within two years.

Among the several forms of Langerhans cell histocytosis (LCH), Letterer-Siwe disease is the most acute disseminated multisystemic variant. The course of Letterer-Siwe disease is usually rapid and fatal. We report here a cases of Letterer-Siwe disease which showed a good response to chemotherapy. We also describe the unusual ultrastructural findings in the histiocyte-like cells in this case.

We report a case of toxic epidermal necrolysis-type drug eruption. A 23-year-old man took an oral over-the-counter preparation for the common cold. A few days later, generalized erythema developed with systemic malaise and pain. A multiple blister formation followed, and Nikolsky's sign was noted on each blister. A lymphocyte stimulation test (LST) with the patient's peripheral lymphocytes strongly suggested that the eruption was attributable to lysozyme chloride which was included in the preparation taken. Following an intravenous drip of betamethasone for two weeks, the eruptions improved favorably.

We report an 85-year-old man with squamous cell carcinoma on the right pinna. Two years after the excision of the lesion, metastatic foci were found extending from the right retromandibular to the mastoid region and into the parapharyngeal space. Histopathologically, the primary tumor showed interconnecting nests of atypical cells invading into the dermis from multiple epidermal and infundibular foci. The tumor had both squamous and glandular differentiation. A peculiar finding was the presence of decapitation secretion in the glandular foci. To our knowledge, definite apocrine differentiation in squamous cell carcinoma has not previously been reported.

We report a rare occurrence of adnexal carcinoma in an adolescent. A 17-year-old Japanese girl had a gradually enlarging tumor on the elbow. Histopathologically, the exophytic tumor showed asymmetrical lobules of tumor embedded in a thickened collagenous stroma. The lobules were composed of various patterns of tumor cell nests ranging from tubular to solid forms. Invasive growth patterns were also observed in the stroma. Two types of the cells, cuboidal and elliptically polygonal, were noted. Immunohistochemistry revealed the presence of S-100 protein and cytokeratin 8 and the absence of gross cystic disease fluid protein-15 in the tumor cells. Electron microscopic observation showed a ductal or glandular differentiation and fragmented basal laminae around the nests. Light and electron microscopic findings of this tumor are suggestive of a low-grade sweat gland carcinoma.

A case of cutaneous infection by Exophiala jeanselmei is reported. The patient was a 45-year-old Japanese female. Her skin eruption consisted of a group of erythematous papules on her left cheek to which corticosteroid had been topically applied for nearly 10 years. Histopathologically, a granuloma formation was noted in the dermis within which were many brown spores. The isolated fungus was identified as Exophiala jeanselmei.