Dermatology

Basically, early detection and extensive resection are essential. In our department, we identify sentinel lymph nodes (sentinel lymph node biopsy) in advance using the RI method and surface ultrasound, and perform lymph node resection biopsy after confirming with patent blue, ICG dye method, and fluorescence method before surgery. If there is metastasis, we perform lymph node dissection, and depending on the case, we observe the progress or administer immune checkpoint inhibitors.

For unresectable cases, we first check for BRAF gene mutations. In mutation-positive cases with rapid progression, we administer a BRAF inhibitor + MEK inhibitor, and in mutation-negative cases and mutation-positive cases with slow progression, we monitor the progress with immune checkpoint inhibitors (anti-PD-1 antibodies, anti-CTLA4 antibodies). In this field, new drugs are constantly appearing and the standard of treatment is dynamically changing, so we always strive to provide up-to-date medical care.

A variety of malignancies arise in the skin, including basal cell carcinoma, squamous cell carcinoma, adnexal malignancies, extramammary Paget's disease, angiosarcoma, and malignant lymphoma. In addition to dermoscopy findings and histopathological diagnosis by skin biopsy, we evaluate the general condition according to the disease, and perform a series of treatments including surgery, postoperative therapy, and follow-up.

Basal cell carcinoma, which is said to be the most common, is a malignant skin tumor that rarely metastasizes to lymph nodes or other organs, but it is a tumor that often occurs on the face. It is necessary to resect the wound at least 3 mm apart, and if it is large enough, a skin flap is performed to close the wound by rotating the surrounding skin so as not to leave a disfigured face.

In addition, if a malignant tumor with the possibility of metastasis, such as squamous cell carcinoma, is diagnosed, CT, MRI, and depending on the disease, PET-CT will be used to thoroughly examine the depth of the tumor and whether or not it has metastasized to other organs. Then, surgery and postoperative chemotherapy, radiation therapy, and administration of immune checkpoint inhibitors will be performed according to the stage of the disease.

For mild plaque psoriasis, topical steroids and topical vitamin D3 remain the mainstay of treatment. However, in treatment-resistant cases, cases in which the psoriasis eruption spreads over a wide area, and cases accompanied by joint symptoms, systemic therapy may be indicated. Drug candidates for use include retinoids, cyclosporin, and biologics, each with its own characteristics. We select the most suitable drug while considering the patient's general condition, living environment, acceptable cost, etc. In particular, 10 types of biological agents have been published so far, and their characteristics are slightly different. We will determine the treatment method while fully consulting with the patient on which drug is best.

Atopic dermatitis is a disease whose main lesion is itchy eczema that repeats getting better and worse, and many patients have a family history or medical history of allergic diseases such as bronchial asthma, allergic rhinitis, or conjunctivitis. It is said to have a history and predisposition to produce IgE antibodies. Food allergy is often complicated in infancy, but it is a disease recognized in all ages, and in recent years, the number of elderly people with atopic dermatitis has been increasing.

The main treatments are skin care, topical steroids, and tacrolimus ointment, but in the 2000s, ultraviolet light therapy and in 2008, oral cyclosporine became indicated.

Starting with the launch of dupilumab (Dupixent), an IL-4/13 receptor monoclonal antibody, in 2018, delgocitinib (Collectim) ointment was released as a JAK inhibitor in June 2020, and baricitinib (Olumient tablets) began to be used to treat atopic dermatitis in December 2020. Currently, three oral JAK inhibitors are available.

It is expected that the number of new molecular-targeted drugs will continue to increase in the future, but there is no change in the fact that it is a disease that requires not only drug treatment but also external guidance in daily life, searching for aggravating factors, and dealing with it. We will propose a treatment method based on the individual living situation.

The typical symptom is a slightly raised “wheal” with a well-demarcated border. It is often accompanied by intense itching, which disappears within several 10 minutes to several hours. If food or medicine is the cause, symptoms rarely appear the next day after disappearing, but if not, the wheals will continue to appear the next day or later. There are various types of urticaria in one word, and it is necessary to make an appropriate diagnosis of the disease type and treat it based on that diagnosis.

Irritation-induced urticaria (urticaria that can be induced by a specific stimulus or load) includes allergic urticaria caused by food or drugs, and physical urticaria that causes linear wheals at the scratched site. There are hives, cholinergic urticaria in which small wheals appear when the body is warmed, and aspirin urticaria. A more accurate diagnosis can be made by listening to each case in detail. If the cause can be avoided, guidance is given, and if not, oral anti-allergic drugs and, if necessary, adrenaline self-injection (EpiPen) are prescribed.

Of the urticaria of which the cause cannot be identified, urticaria that repeatedly appears for 6 weeks or longer is diagnosed as "chronic urticaria." If oral administration of anti-allergic agents and oral administration of H2 receptor antagonists does not relieve the symptoms, it is currently possible to treat with subcutaneous injection of Omalizumab (Xolair).

In addition to conventional oral antibiotics, topical antibiotics, and topical adapalene, the use of benzoyl peroxide has recently become possible, and more recently, a combination of clindamycin and benzoyl peroxide, a topical new quinolone, and a combination of adapalene and benzoyl peroxide have become available. It is being published one after another. We will proceed with treatment according to the condition while complying with the guidelines on how to use various drugs properly.