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The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQ) were decided based on the important clinical issues. For document retrieval, key words for published work searches were set for each CQ, and work published from 1980 to the end of September 2014 was searched in PubMed, Cochrane Library and Japana Centra Revuo Medicina databases. The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System technique. A total of 33 CQ were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies., (This article has been co-published with the permission of The Journal of Dermatology, Pediatrics International and Japanese Journal of Radiology. All rights reserved. © 2020 The Authors. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.)

A 7-year-old, male, mixed breed dog was referred to the Veterinary Teaching Hospital at Kitasato University because of anorexia, lameness and multiple cutaneous lesions. Observation of bone marrow plasmacytosis, osteolytic bone lesions, serum myeloma protein and cutaneous infiltration of myeloma cells led us to a diagnosis of multiple myeloma (MM) with cutaneous involvement. Polymerase chain reaction and sequence analysis for the rearranged genes of immunoglobulin and T-cell receptor demonstrated that the neoplastic cells found in skin lesions or bone marrow are of B-lymphocyte lineage and share a common original precursor cell. The dog was treated with UW-Madison protocol or melphalan/prednisone protocol and survived 175 days. This is rare case of anaplastic MM with cutaneous involvement in dog.

Tumor promotion potential of diacylglycerol (DAG)-rich edible oil was examined using a two-stage mouse skin carcinogenesis model initiated with 7,12-dimethylbenz[a]anthracene (DMBA). Topical treatment with 75 mg DAG oil once a day for 5 days/week for 35 weeks caused papillomas in 4 of 23 (17%) DMBA-treated female ICR mice, while DMBA initiation alone and DAG treatment without DMBA initiation did not induce any skin tumors. Doubling the daily treatment (twice a day x 5 days/week) at doses of 75 and 30 mg caused both papillomas and squamous cell carcinomas after DMBA initiation, the incidences of tumors being 48% (12/25) and 44% (11/25), respectively, significantly higher than the 4% (1/23) in the DMBA+ 85 mg triacylglycerol group and 0% (0/24) in the DMBA+ vehicle-treated group. The results indicate that DAG-rich oil has promoting potential for skin carcinogenesis, and thus, further investigations of its tumor-promoting potential in other organs are warranted.

Dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous areas (DFSP-FS) is differentiated from ordinary DFSP by its unfavourable prognosis. We carried out sequential analysis of numerical chromosomal abnormalities in two cases of DFSP during their progression to metastatic disease with FS areas (DFSP-M-FS). They were compared with nine cases of ordinary DFSP and three cases of DFSP-FS, but without metastases. Numerical chromosomal changes were examined by fluorescence in situ hybridization (FISH) using alpha-satellite centromeric probes for chromosomes 1, 8, 11 and 17. Numerical imbalances of chromosome 1 were not clarified. A gain of chromosome 8 was demonstrated in the two cases of DFSP-M-FS. A gain of chromosome 11 was observed in one of the two cases of DFSP-M-FS and in one case of DFSP-FS. A gain of chromosome 17 was demonstrated in both metastatic tumours and in recurrent tumours in two cases of DFSP-M-FS, in addition to two cases of DFSP-FS and four cases of ordinary DFSP with recurrent tumours or large tumours. This study raised the hypothesis that a gain of chromosome 17 developed in recurrent or large-sized DFSP, which occurs in high-risk groups with the possibility of a progression to FS.

Bowen's disease is a squamous cell carcinoma in situ that rarely invades into the underlying dermis. In order to evaluate the relationship between the cytological properties of the tumor cells and the host immune response, we have examined the expression of p53 and proliferating cell nuclear antigen (PCNA), and the number of mitotic cells, clumping cells, koilocytes, Langerhans cells (LCs) and dermal lymphoid cell infiltration in 18 cases of anogenital Bowen's disease. When compared with normal anogenital skins (n = 10), a statistically significant number of p53-positive cells, PCNA-positive cells, mitotic cells, clumping cells, koilocytes and dermal lymphoid cells was observed in the cases of Bowen's disease. Importantly, there existed a very strong correlation between the number of PCNA-positive tumor cells and the number of infiltrated dermal lymphoid cells. Moreover, the number of mitotic cells significantly correlated with the number of intratumoral LCs. The in situ hybridization technique for human papilloma virus (HPV) demonstrated that the HPV-infected Bowen's disease showed a similar histological and immunohistological pattern as the HPV-non-infected counterparts, except for increased koilocyte formation and decreased p53 positivity. The present data suggest that the proliferative activity of Bowen's disease significantly correlates with the host immune reaction, and that the host immune system may differentially recognize the different cytological properties of tumor cells in the Bowen's disease.

The lymphocytes isolated from perfused or non-perfused circulations before, during, and after hyperthermic isolated limb perfusion (HILP) in the four patients with malignant melanoma were analysed for the expression of CD54 (ICAM-1), CD58 (LFA-3), CD4, CD8, HLA class I and class II in order to investigate the mechanism(s) of the activation of such immunocompetent cells as natural killer (NK)-cells or T-lymphocytes by HILP. It was thus found that the lymphocyte populations expressing CD54 increased significantly 1 day after HILP in the four patients examined. The lymphocyte populations expressing CD58 apparently increased. It was also found that the NK-cell and T-lymphocyte activities increased during or after HILP in the present four cases as observed previously in the other melanoma patients. These results indicate that our HILP system may augment the immunological activities through the mechanisms of the induction of CD54 or CD58 expression in the peripheral lymphocytes of the melanoma patients who receive HILP.

The expression of intercellular adhesion molecule-1 (ICAM-1) in mouse B16 and human melanoma cell lines was investigated by indirect immunofluorescence using a FACScan analyzer. Mouse B16 melanoma cell lines (B16-F1 and F10) did not express ICAM-1 under ordinary culture conditions. Neither in vitro hyperthermia at 41 degrees C for 3 or 6 hr nor cytokines such as gamma interferon (IFN-gamma) or tumor necrosis factor alpha (TNF-alpha) induced ICAM-1 expression in B16 melanoma cell lines. A combination of IFN-gamma with TNF-alpha caused slight induction of ICAM-1 expression in the B16-F10 melanoma cell line. Hyperthermia at 41 degrees C for 3 hr in combination with the cytokines induced a slight expression of ICAM-1 in the B16-F1 melanoma cell line. Hyperthermia at 41 degrees C for 3 hr or 6 hr did not induce de novo ICAM-1 expression but hyperthermia at 43 degrees C for 6 hr caused rather suppression of the expression of ICAM-1 in the three human melanoma cell lines tested. In contrast, they showed a clear increase in the expression of ICAM-1 after treatment with either with IFN-gamma or TNF-alpha, and the expression was further augmented by a combination of the two cytokines. Treatment with cytokines in combination with hyperthermia at 41 degrees C or 43 degrees C for 3 hr did not augment the expression of ICAM-1 over that in cytokine-treated human melanoma cell lines, at normal temperatures. Thus, it is concluded that mouse B16-F1 and F10 melanoma cell lines are different from human melanoma cell lines in terms of induction of ICAM-1 expression by cytokines and/or hyperthermia.

Kinetics of immunological parameters such as natural killer (NK) cell activity and tritium-thymidine uptake rate of T lymphocytes by phytohemagglutinin stimulation were investigated using peripheral leukocyte fractions of melanoma patients treated with hyperthermic isolated limb perfusion (HILP). Also, serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) were quantified during and after HILP. It was found that NK cell activity was augmented during HILP, and T lymphocyte function was stimulated 24 h and 1 week after HILP with statistical significance. NK cell activities in the cells isolated from perfused and non-perfused circulations were equally augmented during HILP in two patients examined. Serum concentrations of sICAM-1 in the patients who received HILP also increased 24 h or even 1 week after HILP. The stimulation of these immune competent cells and upregulation of sICAM-1 by HILP were independent of the stages of melanoma patients at the time of HILP or the doses of agents which were used for the infusion during HILP. The origin of cells which shed sICAM-1 into the serum of the patients who received HILP remains to be further investigated.

In this study, we analyzed the frequencies of human leukocyte antigen (HLA) class I alleles in 110 Japanese patients with melanoma using serological methods, and compared such frequencies with clinical parameters. As expected, frequencies of HLA allele distribution in patients with melanoma reflected the frequencies observed in the normal Japanese population. Because these are different from populations belonging to other races (e.g., white), it followed that the HLA allele distribution in melanoma patients varies among different races. This differences may have significant implications for T-cell-mediated, HLA-restricted therapeutic modalities. No significant associations between HLA and clinical parameters were noted in this study. This report may help design future clinical trials involving therapeutic approaches based on HLA-restricted mechanisms.

Percutaneous injection of absolute ethanol was found to cause rapid destruction of murine and human melanoma nodules. It took only 24-48 hr after the ethanol injection to form ulcers or scars on the lesions. Massive necrosis of murine and human melanoma nests and interstitials and infiltration of mononuclear cells into the demaged tissue were observed histopathologically after ethanol injection. The melanomas recurred approximately 1 week after the destruction of the melanoma nodules by ethanol. Biological response modifiers such as levamisole or interleukin (IL)-2 were effective in preventing the recurrence of murine melanoma after ethanol injection. IL-2 injection caused massive infiltration of NK cells, T cells, and macrophages into the damaged melanoma tissue. The therapeutic modality of a combination of ethanol and IL-2 injections could definitely be useful for the local treatment of human metastatic melanoma, but other modalities such as local hyperthermia or radiation should be considered in combination to attain a permanent cure.

Two cases of metastatic malignant melanoma of the lower limb who were treated successfully with hyperthermic isolated limb perfusion are reported. One patient was infused with cisdiammine (1.1-cyclobutanedicarboxylate) platinum (II) (carboplatin, Paraplatin, Bristol-Myers Squibb Company, New Jersey, USA), and the other was infused with human natural beta-interferon (Feron, Toray, Tokyo, Japan), via the external iliac artery. The first case showed a remarkable suppression of the growth of multiple metastatic melanoma nodules associated with numerous melanophage infiltrations, as shown histopathologically after the operation. The patient's serum level of 5-S-cysteinyl dopa decreased for the two months following the treatment. In the second case, new formation of metastatic melanoma nodules was completely suppressed for up to 12 months following the operation. Analysis of immunological parameters showed that the number of peripheral CD8+ lymphocytes gradually and constantly increased after the operation, while that of CD4+ lymphocytes transiently increased and then returned to the pre-operative level. Natural killer activity transiently decreased to a slight degree 4 days after the operation and then returned to the pre-operative level 21 days after the operation. Side effects, such as nausea, vomiting and leg discomfort, were seen in the patient (Case 1) treated with carboplatin, but were completely reversible. These results suggest that hyperthermic isolated limb perfusion with concomitant infusion of carboplatin or beta-interferon is effective in suppressing the growth of metastatic malignant melanomas of the lower limb.

A rare case of cutaneous skin metastasis from an intracranial chordoma is presented. A large nodule developed in the left thigh of a 22-year-old woman who had been previously diagnosed to have a chordoma at the base of her skull. Sections from the biopsied specimens of the nodule showed proliferations of physaliphorous cells and stellate cells in cords and in nests in a myxoid stroma. Immunohistochemically, neoplastic cells were stained positively with antibodies to S-100 protein and cytokeratin. The results of the histopathological and immunohistochemical studies of the nodule were interpreted as pointing to a diagnosis of metastatic chordoma based on their similarity to the results of studies of the primary neoplasm in the cranial region. Based on the number of cases of skin metastasis from chordoma reported in the literature, skin should be kept in mind as one of the target organs, although such metastases are still rare.

Our experiences of hyperthermic isolated limb perfusion with administration of carboplatin, interferon-beta or a combination of both are reported. Administration of high doses of these reagents was well tolerated by patients with melanoma without severe complications after the treatment. A total of 8 patients underwent this therapeutic modality. Remarkable clinical improvement was seen in the first patient, who was in Stage III at the time of the perfusion. Histopathological findings indicated severe damage to the melanoma cells after the operation. Prophylactic hyperthermic perfusion was performed in 6 other patients with Stage II-III melanoma of the lower limb. None of them have shown any signs of recurrence 1-10 months later. The activities of natural killer cells or T lymphocytes appeared to be increased when the perfusion was carried out with concomitant administration of both carboplatin and interferon-beta. These results suggest that hyperthermic isolated limb perfusion with carboplatin and/or interferon beta administration is effective in patients with advanced stage melanoma.

Using immunohistochemical technique and Western blot analysis, we demonstrated the increased expression of the c-fos oncogene in the infiltrative type of solid basal cell carcinoma (BCC), but low or no expression in the circumscribed type of solid BCC. The infiltrative type is called aggressive BCC and had been shown to exhibit a higher rate of recurrence than the circumscribed type. Our results indicate that increased expression of the fos oncogene is closely related to the invasive ability of the tumor cells.

Local microwave hyperthermia in combination with local injections of interleukin 2 (IL-2) was found to exert a remarkable suppressive effect on murine melanoma growth. Both of these therapeutic modalities caused marked tumour infiltration with natural killer cells. After microwave hyperthermia or IL-2 injection alone there was minimal T-cell infiltration, but T cells were more in evidence following combination therapy.

The effects of PSK on tumorigenesis in mouse skin were investigated either when mouse skins were initiated by benzo(a)pyrene and promoted by 12-O-tetradecanoyl-phorbol-13-acetate (Group I, two-stage carcinogenesis) or when both initiated and promoted by benzo(a)pyrene (Group II, complete carcinogenesis). Twelve mice in each group were fed chow with or without 0.4% PSK. This concentration of PSK was determined by calculation to give mice enough PSK to exert antitumorigenic activity without cytotoxicity. By the end of the experimental periods (26 weeks), two carcinoma-burdened mice in Group I without PSK were dead, but no carcinomas at all were identified in the mice fed with PSK, although considerable numbers of papillomas developed in both groups. In Group II, carcinomas started to evolve at the 15th week of the experiment regardless of PSK feeding. The number of carcinomas observed in the mice fed with PSK in Group II was statistically significantly lower than that in the mice fed without PSK. Histologically, mild inflammatory infiltrations were seen around the papillomas, and moderate to dense infiltrations, mainly composed of neutrophils, T lymphocytes, and macrophages, were observed in squamous cell carcinomas. There were apparently no significant differences in the number of the infiltrating cells around carcinomas in PSK (+) and PSK (-) groups in both early and fully developed lesions. However, considerable numbers of cells infiltrating into the nests were observed in the early lesions of elicited carcinomas in the mice fed with PSK, while such cells were rarely seen in carcinoma nests in the group without PSK at that stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Murine B16-F10 melanoma was treated with local microwave hyperthermia, local injection of murine recombinant interferon-beta (rIFN-beta) or a combination of both in order to investigate the augmentation of anti-proliferative effects with this combination treatment. Concerning the local modulation of immunological reactions of the host, local hyperthermia at 43 degrees C for 15 min on murine melanoma caused remarkable infiltration of natural killer cells and local injection of rIFN-beta led to considerable infiltration of T cells. When these two modalities were combined, the infiltration of NK cells completely disappeared and, instead, remarkable augmentation of T cell infiltration occurred. Synergistic suppressive effects on melanoma growth with occasional scar formation were seen with this combined modality. These results indicate that local hyperthermia with a combination of rIFN-beta modulates local immune reactions of the host, and probably this immune reaction is partly involved in the course of the suppression of tumor growth.

Fidler's B16-F10 melanoma was locally treated either with recombinant interleukin-2 (rIL-2) or microwaval hyperthermia, and immunological responses of the host to the melanoma after each treatment were investigated by immunofluorescent staining of the tissue. It was found that the local injection of rIL-2 either into the base of the tumor or into the upper part of the tumor directly caused infiltration of mainly NK cells and macrophages in the interstitials and/or in the tumor nests. T cells were also observed but the extent of infiltration was less in both treatments. Local microwaval hyperthermia of melanoma at 42 degrees C for 30 min or at 43 degrees C for 15 min also caused infiltration of NK cells and macrophages. Positive staining of the melanoma tissue with anti-ICAM-1 antibody after hyperthermia was seen in the interstitials adjacent to melanoma nests containing necrotic melanoma cells caused by hyperthermia. Based on the results, the rationality of combination of hyperthermia with local injection of rIL-2 will be discussed.

Using a polyclonal antibody to fos oncoprotein and an immunofluorescent technique, we investigated expression of the fos oncogene in chemically-induced mouse tumours and human premalignant and malignant skin lesion. In the chemically induced tumours, the nuclei of almost all carcinoma cells stained uniformly with this antibody, while positive cells were observed in the outermost layers in the benign papillomas. In human tumours, a greater degree of nuclear staining was observed in cases of squamous cell carcinoma than in tissues from patients with Bowen's disease. Basal cell carcinoma and malignant melanoma with histological evidence of invasiveness of the tumour cells showed a higher expression of the fos gene product than that seen in histologically circumscribed tumour nests. Thus, a higher expression of the fos oncogene is closely related to the malignant progression of tumour cells, in particular, the extent of invasiveness.

We investigated populations of the infiltrating cells in Bowen's disease (BD) and squamous cell carcinoma (SCC), both of which arose in the same patient, using the Avidin-Biotin-peroxidase complex method with eight monoclonal antibodies. T lymphocytes were most predominant among infiltrating cells; NK cells, B cells, and monocytes were rarely seen in either BD or SCC. Analysis of subsets of the infiltrating T lymphocytes revealed that the number of suppressor/cytotoxic (s/c) T cells was twice that of helper/inducer (h/i) T cells in BD, while the number of s/c T cells was lower than that of h/i T cells in SCC. The immunohistochemical results in the present case differed from those of predominant infiltration of h/i T cells and of s/c T cells in three other reports of BD and SCC. These results suggest that the population of the cellular infiltrates may be modulated by the nature of tumors and by the immuno-competent state of the hosts.

We investigated the population and pattern of the infiltrated cells in both benign and malignant epidermal tumors which were induced chemically with benzo(a)pyrene (B(a)P) in murine skin. In benign papillomas, which were evolved by a two stage carcinogenesis regimen, a slight to mild inflammatory infiltration around the tumors was observed, and cells infiltrating into the tumor nests were rarely seen. In carcinomas, which were produced by a complete carcinogenesis regimen, a dense inflammatory infiltration was observed around the tumor nests. The infiltrated cells were characterized as T-lymphocytes, macrophages, and neutrophils. Natural killer (NK) cells were found around and in the tumor nests, but their number was small. Both T-lymphocytes and macrophages were found to invade the tumor nests in squamous cell carcinoma whose duration was more than four weeks. This experimental carcinogenesis animal model allows the detailed quantitative and functional analysis of the infiltration of immunocompetent cells into epidermal tumors.

A patient with spindle cell hemangioendotheliomas was followed from 1964 to the present time, allowing the authors the opportunity to examine the lesions in the early, mature, and old phases. Organizing thrombi of different stages associated with slit-like vascular proliferation were always observed, whereas cavernous vascular spaces predominated as the lesions became older. Each spindle cell hemangioendothelioma initially developed relatively rapidly and was sometimes painful but then persisted as a silent nodule for decades. Transmission and scanning electron microscopic studies revealed that endothelial cells tended to digitate into the slit-like proliferating channels, became attached to other cells by means of tight junctions, and thus obstructed the channels at sites where thrombi developed repeatedly. The vascular spaces, ranging in nature from slit-like to cavernous, were outlined further by a relatively sparse mantle of ramified or dendritic interstitial cells that corresponded to spindle cells. Most of the cells appeared simply to be fibroblasts, but they developed the features of pericytes when they were close to the endothelial lining of well-developed vascular lumens. Large vascular spaces and phleboliths were surrounded by smooth muscle cells. Approximately 20% of the interstitial cells were dendritic macrophages characterized by phagocytic activity, presence of many lysosomes, and Factor XIIIa expression. The long and characteristic clinical course, the histologic evidence that thrombosis and its organization was continually occurring within the lesions, and the ultrastructural finding that spindle cell hemangioendotheliomas were composed of different microvascular segments from capillaries to veins, suggest that spindle cell hemangioendotheliomas may develop from a cycle of recanalization after thrombosis that occurs repeatedly because of the unique endothelial growth that was noted. This is in contrast with the previous conception that they were low-grade angiosarcomas.

A 39-year-old man had pseudo-Kaposi sarcoma on his left foot. A biopsy specimen obtained from a cutaneous lesion showed increased numbers of vascular spaces, proliferation of fibroblast-like spindle cells, and deposition of hemosiderin in the dermis. Immunohistochemically, proliferative fibroblast-like spindle cells around the vessels were positive for anti-factor XIIIa antibody. Excessive heat radiation was detected from the skin lesions by thermography.

We examined alpha-actin and an angiogenic factor, basic fibroblast growth factor (bFGF), by immunohistochemistry and Western blot analysis in four angiofibromas (AFs) and a connective tissue nevus (CTN) obtained from two patients with tuberous sclerosis (TS). There was an increase of alpha-actin-positive microvessels in the papillary and the upper reticular dermis of AFs and a CTN as compared to those in normal skin. The main localization of alpha-actin in the microvessels of AFs was considered to be pericytes. Many microvessels and a few interstitial fibroblast-like cells in frozen sections of AFs and a CTN were positively stained for bFGF, and most of the bFGF-positive microvessels corresponded to those containing alpha-actin as determined by double immunostaining. These data suggested a possible role of increased bFGF in stimulating angiogenesis and/or mainitaining vessels in AFs, although augmentation of mitotic activity was not noted by staining with Ki-67. Further investigations on the identification of the bFGF-producing cells and biological function of bFGF in AFs may be a clue to elucidate pathomechanisms of AFs.

Using immunohistochemical methods, we investigated the distribution of epithelial membrane antigen (EMA) on the normal eccrine gland, eccrine poroma and hidroacanthoma simplex. Granular membrane-associated reaction of EMA was detected on the outer cells of both the intraepidermal and the upper portion of intradermal eccrine ducts, as well as on the luminal surfaces and intercellular canaliculi of eccrine glands. Clear immunolabeling was also present in the tumor cells of eccrine poroma and hidroacanthoma simplex. Thus, it is suggested that the constituent cells of these tumors originate from the outer cells of the intraepidermal and/or the upper portion of the intradermal eccrine ducts. There was no immunolabeling for EMA on the tumor cells of seborrheic keratosis and basal cell carcinoma. Immunohistochemical staining for EMA is a useful tool for the diagnosis of skin appendage tumors.

We report two cases of pilomatrix carcinoma. Wide surgical excision, radiation, and chemotherapy were required for the first patient. The tumor eventually revealed the characteristics of a carcinoma, both clinically and histopathologically, as it recurred. In the second case, although the tumor exhibited the histology of pilomatricoma in the central part of the lesion, there were numerous outgrowing irregular nests of basaloid tumor cells with cellular atypia and frequent mitoses; these are the characteristic features of the pilomatrix carcinoma in its early stages.

We have examined the cytoplasmic distribution of actin and fibronectin in cultured neurofibroma cells (NF cells) derived from a patient with von Recklinghausen's disease by using phase contrast and indirect immunofluorescence microscopy. NF cells were larger in size and more dendritic in shape compared to normal human dermal fibroblasts. NF cells also showed abundant granular staining of actin and a decrease in the linear staining pattern of fibronectin. Furthermore, employing a colony-formation assay on the top of an agar-gel in the presence of fibroblast growth factor (FGF), normal fibroblasts showed a significant number of colonies, whereas NF cells did not demonstrate colony formation even after addition of FGF. These findings suggests that NF cells from patients with von Recklinghausen's disease may have different characteristics when compared with normal fibroblasts, and that NF cells are similar to transformed cells with regard to their actin and fibronectin distribution.

Cutaneous lesions of adult T-cell lymphoma on the bilateral temples in a 74-year-old male were treated either with rINF-gamma and local hyperthermia or rIFN-gamma alone. The size of the tumor on the left temple was reduced by 40% 10 days after the therapy was initiated by the intravenous administration of rIFN-gamma (2 X 10(5) - 4 X 10(5) JRU/day, total 1 X 10(7) JRU) and local hyperthermia (6 times). The tumor had almost disappeared after 21 days (total dose of rIFN-gamma, 3.4 X 10(7) JRU; hyperthermia, 13 times). Two cutaneous tumors on the right temple had rapidly reduced in size 17 days after the therapy of rIFN-gamma was started. The sizes of the lesions had decreased by 79% on day 17 and had further decreased by 91% and 95% on day 21, respectively. All lesions were irradiated with Dermopan for the prevention of recurrence. Local hyperthermia in combination with rIFN-gamma seems to be useful for the treatment of cutaneous lesions of malignant lymphoma.

Three cases of malignant hemangioendotheliomas in elderly individuals are recounted. All of them died shortly after onset of the malignancies in spite of radical surgery in one; radical surgery, chemotherapy, and radiotherapy in another; and chemotherapy and radiotherapy in the third. Findings from studies of specimens of the malignancies by conventional microscopy, histochemistry, and electron microscopy are described.

Dermal melanosis is caused by deposition of melanin in melanophages or by free melanin in the dermis or in dermal melanocytes. Circumscribed dermal melanoses can be congenital or acquired and at times are nevoid in distribution. Bilateral nevus of Ota-like lesions and blue macules recently have been described in association with progressive systemic sclerosis. Macular amyloidosis and friction melanosis are also acquired dermal melanoses. It is important to distinguish dermal melanoses caused by the presence of melanocytes in the dermis from those produced by the presence of melanin free within the dermis. Clinically, the two different processes may have very similar appearances. Treatments for circumscribed dermal melanoses include cosmetics, cryotherapy, dermabrasion, or, rarely, skin grafts.

A case of multiple trichilemmal cysts is presented. After trauma, a large tumor developed on one of the cysts. The histologic features of this tumor were similar to those of proliferating trichilemmal cyst, but some of the tumor cells showed definite nuclear atypicality. The malignant potential of this tumor was confirmed by later development of metastases to the regional lymph nodes.

Under the electron microscope, we studied dermal melanocytes in lesions of six cases of nevus of Ota and also those in common blue nevus and in nevus caeruleus tardus associated with progressive systemic sclerosis. An extracellular sheath surrounded most of the dermal melanocytes in nevus of Ota in four patients ages 21, 22, 25, and 30, but not those in two younger patients ages 9 months and 10 years. Some dermal melanocytes possessed extracellular sheath as well as basal laminae. Some possessed only an extracellular sheath. The thickness of the extracellular sheath varied among dermal melanocytes. Not all dermal melanocytes possessed extracellular sheaths. In particular, only a small number of dermal melanocytes in the two younger patients possessed extracellular sheaths and these were thinner than those of the three older patients. Fibrous long-spacing collagen was recognized in some parts of the extracellular sheaths of dermal melanocytes. In contrast, dermal melanocytes in common blue nevus were not surrounded by either extracellular sheaths or basal laminae. Dermal melanocytes in nevus caeruleus tardus in patients with progressive systemic sclerosis were surrounded by thin extracellular sheaths, but not by basal laminae. The extracellular sheath is composed of fine filaments, 20-40 A in diameter, and appears to be derived from collagen.

Subcellular defects of hypomelanosis in tuberous sclerosis (TS) (28 subjects) were compared by light and electron microscopy with oThere forms of congenital circumscribed hypomelanosis that occur in nevus depigmentosus (ND) (8 subjects) and in piebaldism (PB) (4 subjects), respectively. On the light microscopic level in both TS and ND, the population density of functioning melanocytes was normal but each perikaryon was small, and dopa activity was decreased. On the ultrastructural level, the hypomelanotic skin and hair of TS were associated with a decrease in the synthesis, melanization, and size of melanosomes; the decrease in the size of melanosomes resulted in the aggregation of melanosomes (i.e., a melanosome complex) in the keratinocytes in all the specimens examined. In ND, ther were no obvious changes in the size and melanocytes. the hypomelanosis of ND is related to the decreased synthesis and also, perhaps, abnormal transfer of melanosomes. In PB the hypomelanosis of the skin and hair results from the absence of functional melanocytes. The hypermelanotic areas of PB, however, characteristically contain melanocytes that synthesize abnormal (sperical and granular) as well as normal (ellipsoidal and lamellar) melanosomes.

Frequency of malignant transformation arising in giant congenital nevi is considered to be 4%-5%. More than a half of the patients in which malignant melanoma developed in giant congenital nevi were under the age of 10. It may be hypothesized that dermabrasion of giant congenital nevus may provoke malignant transformation. Some of the cell groups in giant congenital nevus are potentially malignant. Some groups of nevus cells were larger in size than those of other portions of nevus. Electron microscopic observation revealed that nuclei of these larger nevus cells were significantly indented, and melanization of melanosomes was irregular. Coexistence of alpha-like actin with beta- and gamma-actins in giant congenital nevus cells and disappearance of alpha-like actin in malignant melanoma cells were noted.