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Case of spindle cell squamous cell carcinoma with dermoscopic findings of diffuse/discrete scales and predominant white color

(Fig. 1c,d), and CD123and BDCA2-positive plasmacytoid dendritic cells (pDC) (Fig. 1e,f). In addition, melanoma cells were immunoreactive for MART-1 and HMB-45 (Fig. 1g,h). Because of the patient’s history of cancer, she was treated with MTX 6 mg/week and retinoid 30 mg/day, without using biologics. Our patient developed a superficial spreading melanoma on the psoriatic plaque on the thigh. She first developed a pigmented nodule, and psoriatic lesions appeared later. One explanation is that the patient developed a number of psoriatic plaques, one of which involved the melanoma by chance. There are few reports on the incidental relationship between malignant melanoma (MM) and psoriasis, in association with previous therapies such as phototherapy and immunosuppressive drugs. Our patient had been treated with MTX for 4 years prior to presentation, and the total dose summed nearly 800 mg. Previous reports have shown that patients with rheumatoid arthritis who had been treated with MTX at a total dose of 2500–3300 mg developed MM. As compared with previous cases, our patient received a much smaller amount of MTX; thus, the causative effect of MTX on MM was not considered to be significant. Although the total dose of PUVA therapy is uncertain, phototherapy is unlikely to be relevant to melanoma arising because the patient was not treated for many years. Alternatively, recent findings have shown that pDC is detected within the cellular infiltrates around the melanoma, via interaction between CCR6 on pDC and CCL20 on melanoma cells, which may play a role in initiating CD8-positive cytotoxic T cells against melanoma cells. pDC are implicated to play a role in the regression phenomenon of MM, which however was not observed in this case. On the other hand, activated pDC releases a-interferon that stimulates inflammatory dendritic cells toward the interleukin-23/T-helper 17 pathway in psoriasis. Therefore, some underlying pathogenesis may be shared in the lesion of MM and coexisting psoriasis.