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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 histiocytosis (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.

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.

Natural killer (NK) cell activity and NK-related surface markers in peripheral blood mononuclear cells (PBMC) in thirty-three patients with adult type atopic dermatitis (AD) were investigated. NK cell activity, detectable by cytolysis of erythroleukemic cell line K562 cells, was reduced in patient PBMC as compared with healthy controls. Imbalances in the lymphocyte populations reactable with the monoclonal antibodies, anti-HNK-1, and anti-CD16 were found in the patient PBMC. Some positive correlations between these cell populations and the NK cell activities were recognized. In most cases, high levels of serum IgE were inversely correlated with NK cell activity. Depletion of the macrophages from patient PBMC had no effect on NK cell activities. These activities were enhanced by culture with β-interferon for 18 hours, as were the NK cell activities of healthy controls. These results suggest that reduced numbers or imbalances in the lymphocyte population with NK cell activity, are responsible for the pathogenesis and the prognosis of adult type atopic dermatitis.