Metastatic Skin Tumors Research Articles

Expression of TRPS1 in Metastatic Tumors of the Skin: An Immunohistochemical Study of 72 Cases

TRPS1 (Tricho-rhino-phalangeal syndrome 1) is a GATA transcriptional activator gene encoding for a protein used as a sensitive immunohistochemical marker of breast carcinomas. In dermatopathology, TRPS1 is used as a marker of mammary and extramammary Paget’s disease and is also expressed by a variety of primary cutaneous tumors, mostly of adnexal origin. So far, very limited data exist on the expression of TRPS1 in metastatic skin tumors. We studied the immunohistochemical expression of TRPS1 in 72 cutaneous metastatic tumors from the breast (n: 19) and other origins (n: 53) in order to assess its diagnostic usefulness. The intensity of TRPS1 immunostaining was expressed as a histoscore: the product of the percentage of positive cells (scored semi-quantitatively 0–4) and the staining intensity (scored 0–3). In normal skin, nuclear TRPS1 expression was predominantly observed in cells of adnexal structures (pilosebaceous follicles and sweat glands). Eighteen (18/19, 94.7%) metastatic breast carcinomas showed diffuse and strong TRPS1 positivity (histoscore 12). Lower reactivity was found in some other metastases, including from the lung (11/22), the female genital tract (3/4), and the kidney (2/4), whereas most (20/22) metastases from the digestive system and peritoneum, along with a case of metastatic prostate carcinoma, were negative. These results suggest that a high histoscore for TRPS1 is in favor of the mammary origin of metastatic cutaneous carcinoma. Although TRPS1 is not absolutely specific or sensitive to a particular primary, we consider that it can be added to a panel of other markers when investigating the origin of a cutaneous metastasis, namely when this is the first manifestation of the neoplastic disease.

A Case of Metastatic Skin Tumor Arising from Bilateral Ureterocutaneous Fistula Associated with Bladder Cancer

A Case of Metastatic Skin Tumor Arising from Bilateral Ureterocutaneous Fistula Associated with Bladder Cancer

A Case of Metastatic Skin Tumor of the Glans Penis with Paget-like Appearance Originating from Primary Ureteral Carcinoma

A Case of Metastatic Skin Tumor of the Glans Penis with Paget-like Appearance Originating from Primary Ureteral Carcinoma

Does Preventive Negative Pressure Wound Therapy (NPWT) reduce local complications following Lymph Node Dissection (LND) in the management of metastatic skin tumors?

Axillary and inguinal lymph node dissection (LND) are performed in metastatic skin tumors with several local complications, such as lymphorrhea, lymphoceles, and lymphedema. The purpose of this study is to determine whether negative pressure wound therapy (NPWT) applied as a preventive measure could improve outcomes. A monocentric study included patients who underwent axillary or inguinal LND from May 2010 to March 2020, with a retrospective evaluation of prospectively collected data. Patients were divided into two groups: the conventional wound care (CWC) and the NPWT groups. Patients were systematically reviewed at D7, D30, and at 1 year postoperative, and data regarding lymphorrhea, lymphoceles, and lymphedema were collected. A total of 109 axillary and inguinal LND were performed. NPWT was applied on 68 LND and CWC on 41 LND. The variables, diabetes, smoking, gender, associated treatments, and primary pathology (melanoma, squamous cell carcinoma, or Merkel tumors) were similar in both groups. Analyses have shown a significant difference in the rate of scar disunion during the first month between the two groups (p=0.045 between D1 and D7; p=0.011 between D8 and D30), as well as the presence of lymphorrhea (p=0.000 between D1 and D7; p=0.002 between D8 and D30). The rate of lymphoedema was significantly reduced in the NPWT group versus CWC (p=0.000 between D8 and D30; p=0.034 between D31 and 1 year). NPWT reduces local complications (scar disunion, lymphorrhea, and lymphedema) during the first year following LND in the management of node metastatic skin tumors.

Exploration and validation of metastasis-associated genes for skin cutaneous melanoma

Skin cutaneous melanoma is a malignant and highly metastatic skin tumor, and its morbidity and mortality are still rising worldwide. However, the molecular mechanisms that promote melanoma metastasis are unclear. Two datasets (GSE15605 and GSE46517) were retrieved to identify the differentially expressed genes (DEGs), including 23 normal skin tissues (N), 77 primary melanoma tissues (T) and 85 metastatic melanoma tissues (M). Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were performed to explore the functions of the DEGs. We constructed protein–protein interaction network using the STRING database and Cytoscape software. Using the cytoHubba plugin of Cytoscape, we identified the most significant hub genes by five analytical methods (Degree, Bottleneck, MCC, MNC, and EPC). Hub gene expression was validated using the UALCAN website. Clinical relevance was investigated using The Cancer Genome Atlas resources. Finally, we explored the association between metastasis-associated genes and immune infiltrates through the Tumor Immune Estimation Resource (TIMER) database and performed drug–gene interaction analysis using the Drug-Gene Interaction database. A total of 294 specific genes were related to melanoma metastasis and were mainly involved in the positive regulation of locomotion, mitotic cell cycle process, and epithelial cell differentiation. Four hub genes (CDK1, FOXM1, KIF11, and RFC4) were identified from the cytoHubba plugin of Cytoscape. CDK1 was significantly upregulated in metastatic melanoma compared with primary melanoma, and high CDK1 expression was positively correlated with worse overall survival. Immune infiltration analysis revealed that CDK1 expression negatively correlated with macrophage infiltration (Rho = − 0.164, P = 2.02e−03) and positively correlated with neutrophil cells (Rho = 0.269, P = 2.72e−07) in SKCM metastasis. In addition, we identified that CDK1 had a close interaction with 10 antitumor drugs. CDK1 was identified as a hub gene involved in the progression of melanoma metastasis and may be regarded as a therapeutic target for melanoma patients to improve prognosis and prevent metastasis in the future.

Primary Tumor Suppression and Systemic Immune Activation of Macrophages through the Sting Pathway in Metastatic Skin Tumor.

PurposeAgonists of the stimulator of interferon genes (STING) play a key role in activating the STING pathway by promoting the production of cytokines. In this study, we investigated the antitumor effects and activation of the systemic immune response of treatment with DMXAA (5,6-dimethylxanthenone-4-acetic acid), a STING agonist, in EML4-ALK lung cancer and CT26 colon cancer.Materials and MethodsThe abscopal effects of DMXAA in the treatment of metastatic skin nodules were assessed. EML4-ALK lung cancer and CT26 colon cancer models were used to evaluate these effects after DMXAA treatment. To evaluate the expression of macrophages and T cells, we sacrificed the tumor-bearing mice after DMXAA treatment and obtained the formalin-fixed paraffin-embedded (FFPE) tissue and tumor cells. Immunohistochemistry and flow cytometry were performed to analyze the expression of each FFPE and tumor cell.ResultsWe observed that highly infiltrating immune cells downstream of the STING pathway had increased levels of chemokines after DMXAA treatment. In addition, the levels of CD80 and CD86 in antigen-presenting cells were significantly increased after STING activation. Furthermore, innate immune activation altered the systemic T cell-mediated immune responses, induced proliferation of macrophages, inhibited tumor growth, and increased numbers of cytotoxic memory T cells. Tumor-specific lymphocytes also increased in number after treatment with DMXAA.ConclusionThe abscopal effect of DMXAA treatment on the skin strongly reduced the spread of EML4-ALK lung cancer and CT26 colon cancer through the STING pathway and induced the presentation of antigens.

Characterizing DNA methylation signatures and their potential functional roles in Merkel cell carcinoma

BackgroundMerkel cell carcinoma (MCC) is a rare but aggressive skin cancer with limited treatment possibilities. Merkel cell tumors display with neuroendocrine features and Merkel cell polyomavirus (MCPyV) infection in the majority (80%) of patients. Although loss of histone H3 lysine 27 trimethylation (H3K27me3) has been shown during MCC tumorigenesis, epigenetic dysregulation has largely been overlooked.MethodsWe conducted global DNA methylation profiling of clinically annotated MCC primary tumors, metastatic skin tumors, metastatic lymph node tumors, paired normal tissues, and two human MCC cell lines using the Illumina Infinium EPIC DNA methylation BeadArray platform.ResultsSignificant differential DNA methylation patterns across the genome are revealed between the four tissue types, as well as based on MCPyV status. Furthermore, 964 genes directly regulated by promoter or gene body DNA methylation were identified with high enrichment in neuro-related pathways. Finally, our findings suggest that loss of H3K27me3 occupancy in MCC is attributed to KDM6B and EZHIP overexpression as a consequence of promoter DNA hypomethylation.ConclusionsWe have demonstrated specific DNA methylation patterns for primary MCC tumors, metastatic MCCs, and adjacent-normal tissues. We have also identified DNA methylation markers that not only show potential diagnostic or prognostic utility in MCC management, but also correlate with MCC tumorigenesis, MCPyV expression, neuroendocrine features, and H3K27me3 status. The identification of DNA methylation alterations in MCC supports the need for further studies to understand the clinical implications of epigenetic dysregulation and potential therapeutic targets in MCC.

Differential expression of lncRNAs and predicted target genes in normal mouse melanocytes and B16 cells.

Melanoma is a highly invasive and metastatic malignant skin tumor with poor prognosis. Although several widely studied pure melanoma cell lines are available, the precise mechanism underlying transformation of melanocyte to melanoma remains unclear. Long non-coding RNAs (lncRNAs) represent a vast category of non-coding RNA molecules, and increasing evidence suggests that lncRNAs are crucial for various biological processes, including those in the skin. Herein, lncRNA sequencing was performed on an Illumina HiSeq platform to identify lncRNAs expressed differently in murine B16 melanoma cells compared to normal mouse melanocytes. Using four computational approaches, 2319 lncRNAs were expressed in both normal melanocytes and B16 cells, with 373 being differentially expressed at a significant level. Of these, 136 lncRNAs were upregulated and 237 were downregulated. KEGG analyses revealed that 467 genes were target genes in the Wnt signalling pathway, TGF-beta signalling pathway, MAPK signalling pathway, NF-kappa B signalling pathway, melanoma and several other cancer-related regulatory pathways. From among the differentially expressed lncRNAs, lnc-13317.1 was found to play a role in the cell cycle in melanoma by targeting BRCA1. Thus, lnc-13317.1 might have therapeutic potential in melanoma treatment. The lncRNA profile described here highlights the importance of elucidating the exact function of these lncRNAs in the transformation of melanoma. Lnc-13317.1 might have therapeutic potential in melanoma treatment by targeting BRCA1.

1103 Functional genomic evaluation of targetable pathways in three metastatic cutaneous squamous cell carcinomas

Cutaneous squamous cell carcinoma (cSCC) is increasing, paralleled by increases in deadly invasive and metastatic primary skin tumors. To date there are neither reliable predictive biomarkers of disease progression nor medical treatments as standard of care. To address these issues, we exposed primary cultured cells from invasive or metastatic cSCC tissues to 118 small molecule inhibitors as single agents and in combination with an EGFR inhibitor, gefitinib. In-house bioinformatics tools were used to cross analyze drug responses and DNA mutations in tumors detected by whole exome sequencing with patient-matched whole blood DNA standards. According to a paradigm that (in)activating mutations may predict sensitivity to targeted inhibitors, we associated drug sensitivities with DNA mutations predicted to be “damaging” by SIFT. Two cases sensitive to AKT inhibitor in combination with gefitinib had mutations in AKT3. One case, the only one with FLT or CSFR mutations, was sensitive to a single agent inhibitor of FLT1 and CSFR1R. Two cases with sensitivity to a PLK1 inhibitor in combination with gefitinib lacked mutations in PLK1. The most sensitive of these cases harbored mutations in p53BP1, which participates in a cell cycle pathway regulated by TBK1 and PLK1 phosphorylation. All three cases had damaging mutations in TP53, two cases had HRAS mutations (G13D and G13R), and two cases had mutations in the DNA damage repair genes FANCD2 and XRCC3. These studies form a plausible foundation for biomarkers of progression to high mortality/morbidity cSCC applicable in dermatopathology and for patient-specific therapeutic options for aggressive cSCC.

Plasma Cancer Therapy In Dermatology

Main topics in cancer treatment in dermatology are melanoma (MM), basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and metastatic skin tumors. Thereof stage IV MM because of fatal outcome is uf utmost importance. Despite some substantial therapeutic progress now in this entity by immunologic treatments alternatives are warranted when disease is progressing under therapy or the tumor basically appears refractory. National guidelines currently recommend ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma but no data exists to guide management of cutaneous and subcutaneous metastases which are very common. Therapeutic options include intralesional electrochemotherapy and Bacillus Calmette-Guerin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation, interferon therapy, and intratumoral interleukin-2 injections. Recent developments include anti-programmed cell death 1 receptor agents (PD-1, nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec), adoptive T cell therapy and dendritic cell vaccines. Regarding BCC and SCC mainly the aggressive variants are of interest for new therapies. A third entity are metastatic tumors of different origin exposing single to field canzerization. Since Cold Plasma (CAP) reacts by different and substantially more complex modes compared to classic drug chemotherapy and also modern antimetabolite and immune therapies like hitherto conventional treatment suffers from limited dosage options to avoid stronger toxicity, combined treatment with CAP offers better efficacy with less adverse effects. By this way substantial add on effects can be shown in vitro for fotemustin, dacarbacin, paclitaxel, and bleomycin. Similar potentiation can be achieved when electrochemotherapy is applied together with CAP in the presence of bleomycin (systemic) and with the squamous cell carcinoma and the actinic keratosis for the first time CAP was also shown to exert effective anticancer efficacy in humans. In metastatic tumors CAP was shown to decelerate tumor growth, defeat microbial superinfection, support pain relief and therewith increasing quality of life. Additionally for some patients CAP proved significantly better outcome together with better tolerability compared with standard treatment. The combination of conventional and physically supported chemotherapy with CAP appears highly beneficial in therapy of human cancer like melanoma and squamous cell carcinoma by enhanced tumor reduction and less drug toxicity of chemotherapeutics thus improving markedly quality of life.

Retrospective study of 48 cases of metastatic skin tumors, including 4 cases with Sister Mary Joseph nodules

Retrospective study of 48 cases of metastatic skin tumors, including 4 cases with Sister Mary Joseph nodules

A case grafted with polyglycolic acid sheets and fibrin glue for protection after temporary resection of a metastatic cervical skin tumor

The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job. Under local anesthesia, resection was performed, and PGA sheet grafting were used to shield the skin defect. After resection, she was relieved from pain, and could stay home without daily wound treatment. One and half months after resection, the wound was almost epithelialized. The PGA sheets consist of soft, elastic, nonwoven fabric made of PGA. In recent years, PGA sheet grafting has been widely used in the reconstruction and was chosen to shield the skin defect for this case. PGA sheet grafting after resection of cervical skin tumor can be an acceptable method for palliative care to relieve pain, bleeding, offensive smell, and ugly appearance.

Subcutaneous metastasis arising from gastric cancer: A case report.

A 59-year-old man was referred to the Kochi Medical School Hospital due to left shoulder pain. Physical examination revealed a nodular, painful mass lesion in the subcutaneous tissue of the right chest wall, with a diameter of ~2 cm. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower gastric body near the lesser curvature, and biopsy specimens of the gastric and humeral lesions revealed poorly differentiated adenocarcinoma. Abdominal computed tomography revealed multiple low-density lesions in the liver and a well-defined, 2.2-cm mass in the subcutaneous tissue of the right chest wall. The diagnosis was advanced gastric cancer with metastases to the liver, bone and skin, and systemic chemotherapy with radiotherapy for the bone metastasis was recommended. The patient also underwent distal gastrectomy to control bleeding from the primary gastric cancer lesion due to unresolved anemia, not improving by blood transfusion, and a low hemoglobin level. The subcutaneous tumor in the right chest wall was resected at the same time, to alleviate the pain caused by the mass. Macroscopic examination of the resected specimen revealed a well-circumscribed, solid tumor, measuring 2.2×2.1 cm, with a firm consistency. Microscopic examination showed infiltration of poorly differentiated adenocarcinoma cells into the subcutaneous tissue. Subcutaneous metastasis from gastric cancer is a rare manifestation, with a reported incidence of 0.8-1.0%. Cutaneous metastasis of cancer generally appears late in the course of the disease. Surgical resection of metastatic skin tumors is occasionally undertaken as palliative treatment to improve the patient's quality of life by controlling severe symptoms, including pain and hemorrhage.

Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors.

Background: Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu® Surgical Adhesive and ARTISS® fibrin sealant with a control population. Material and methods: We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures. Results: Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000).Conclusion: The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND.(Level of evidence: level IV, retrospective case study)

Evolution of metastasis revealed by mutational landscapes of chemically induced skin cancers.

Human tumors show a high level of genetic heterogeneity, but the processes that influence the timing and route of metastatic dissemination of the subclones are unknown. Here we have used whole-exome sequencing of 103 matched benign, malignant and metastatic skin tumors from genetically heterogeneous mice to demonstrate that most metastases disseminate synchronously from the primary tumor, supporting parallel rather than linear evolution as the predominant model of metastasis. Shared mutations between primary carcinomas and their matched metastases have the distinct A-to-T signature of the initiating carcinogen dimethylbenzanthracene, but non-shared mutations are primarily G-to-T, a signature associated with oxidative stress. The existence of carcinomas that either did or did not metastasize in the same host animal suggests that there are tumor-intrinsic factors that influence metastatic seeding. We also demonstrate the importance of germline polymorphisms in determining allele-specific mutations, and we identify somatic genetic alterations that are specifically related to initiation of carcinogenesis by Hras or Kras mutations. Mouse tumors that mimic the genetic heterogeneity of human cancers can aid our understanding of the clonal evolution of metastasis and provide a realistic model for the testing of novel therapies.

皮膚転移を生じた多発性骨髄腫の1例

皮膚転移を生じた多発性骨髄腫の1例

Dermoscopy of nodular skin metastases from the gastrointestinal primary cancer.

Dermoscopy is a useful, sufficient and widely used tool for examining pigmented and non-pigmented lesions [1, 2]. It may be helpful as a diagnostic method in the investigation of non-characteristic skin nodules, occurring as solitary, pale or pinkish lesions, especially those of unknown origin or in the event of dealing with an unclear patient history. In the literature, there are only several case studies which have been published on the subject of dermoscopic images of metastatic nodules from internal malignancies [3–5]. Skin metastases occur in 0.6–10% of all patients with cancer and represent 2% of all skin tumors [6]. Among gastrointestinal tract malignancies, large intestine cancer among women and cancer of the esophagus, pancreas and stomach cancer among men can often metastasize to the skin [6]. Skin metastases from visceral malignancies are important for dermatologists and oncologists because of their variable clinical appearance and presentation as well as frequent delay or even failure to diagnose them correctly [6]. Metastatic skin nodules occur as non-painful, single or multiple, hard or flexible, tiny, pinkish, small nodules, without any specific clinical diagnostic criteria [4]. Clinical diagnosis in such cases is not clear. From a histopathologic point of view, there are 4 main morphological patterns of cutaneous metastases involving the dermis, namely a nodular, diffuse, infiltrative and intravascular pattern [6]. In dermoscopic evaluation of non-pigmented skin nodules, vascular structures have often played a key diagnostic role, also in the diagnostic management of metastatic skin tumors [7, 8].

Co-expression of putative cancer stem cell markers, CD133 and Nestin, in skin tumors.

Cancer stem cells (CSC) are populations of cells responsible for tumor initiation, progression and therapeutic resistance in many cancers. In the present study, we aimed to investigate the expression pattern and clinical significance of two CSC markers, CD133 and Nestin, in a series of skin tumors. One hundred and thirteen paraffin blocks from skin cancers including 16 (14%) cases of melanoma, 37 (33%) of squamous cell cancer (SCC) and 60 (53%) of basal cell cancer (BCC) were collected and assembled in a tissue microarray (TMA). The samples were immunohistochemically examined for the expression of CD133 and Nestin. Expression of these markers was also correlated with clinicopathological parameters. A significant difference was observed in the expression of CD133 and Nestin in melanomas, SCC and BCC (p value=0.001). Furthermore, the level of expression was significantly higher in the melanomas compared to the SCC and BCC tumors. Expression of CD133 in the melanoma was significantly associated with increased tumor invasiveness (p value=0.05), a higher rate of metastasis (p value=0.04) and the presence of ulceration (p value=0.02). Increased expression of Nestin was observed in metastatic melanoma (p value=0.04), while no statistically significant correlation was found with other clinicopathological parameters including Breslow thickness, Clark level and ulceration. Elevated expression levels of CD133 and Nestin in the melanomas are associated with advanced disease, with more aggressive and metastatic skin tumors. Therefore, these markers could be potential therapeutic targets for malignant tumors of the skin.

Metastatic laryngeal carcinoma mimicking eruptive keratoacanthomas: report of keratoacanthoma-like cutaneous metastases in a radiation port

Metastatic skin lesions from a primary squamous cell carcinoma of the head and neck have only been reported in 1%-2% of these patients. Hence, skin metastases from laryngeal carcinoma are uncommon. Also, cutaneous metastases clinically presenting as a keratoacanthoma are rare. We describe cutaneous metastases in a radiation port clinically mimicking eruptive keratoacanthomas. Using the PubMed database, an extensive literature search was performed using the keywords cancer, carcinoma, keratoacanthoma, laryngeal, metastases, metastasis, metastatic, mimicking, port, radiation, radiotherapy, radiation, skin, visceral. We were able to summarize the features of patients with keratoacanthoma-like cutaneous metastases and discuss radiation port cutaneous metastases. Cutaneous metastases can be the initial manifestation of a previously undiagnosed malignancy or can present in a patient with an established diagnosis of cancer. Our patient not only developed skin metastases that mimicked eruptive keratoacanthomas, but to the best of our knowledge, is the first individual to develop radiation port cutaneous metastasis from a primary laryngeal carcinoma. The development of cutaneous metastases in an area of skin that has been treated with radiation therapy may result from the treatment altering and/or injuring the site, thereby making it more susceptible to another condition, such as metastatic skin tumors. In patients with an established diagnosis of visceral malignancy, the appearance of new keratoacanthoma-like lesions should prompt the clinician to consider a biopsy in order to establish or exclude the possibility of a cutaneous metastasis.

転移性皮膚腫瘍に対する Mohs ペーストにより QOL の改善を認めた1例

転移性皮膚腫瘍に対する Mohs ペーストにより QOL の改善を認めた1例