Details of a Researcher - Nakamura, Yoshio

Papers - Nakamura, Yoshio

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Role of androgen signaling in androgen receptor-positive extramammary Paget's disease: Establishment of organoids and their biological analysis as a novel therapeutic target

Nakamura Y., Mizukami H., Tanese K., Fusumae T., Hirai I., Amagai M., Takamatsu R., Nakamura K., Nishihara H., Takimoto T., Ueno M., Saya H., Funakoshi T.

Journal of Dermatological Science (Journal of Dermatological Science) 112 ( 1 ) 23 - 30 2023.10

ISSN 09231811

Background: Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma that mainly affects the anogenital and axillary regions. Although its etiology has not been fully elucidated, there is evidence that androgen receptors (AR) are expressed in most cases of EMPD. However, the role of androgen signaling in the pathogenesis of EMPD remains unclear. Objective: To evaluate the role of androgen signaling in tumor growth of AR-positive EMPD. Methods: Patient-derived organoids were established and cultured from two AR-positive EMPD patients: one man and one woman. Cultured organoids were treated with androgen agonists and/or antagonists, then subjected to analysis of changes in organoid proliferation, as well as changes in androgen signaling pathway-specific genes. Results: Organoid cultures were established from each EMPD sample. These organoids were immunohistologically and genetically identical to the original tumor. For each organoid sample, viable cell number increased in response to androgen exposure. The mRNA level of Fkbp5, a known AR target gene, increased in a concentration-dependent manner in organoids exposed to the synthetic androgen R1881. Conversely, the AR inhibitor darolutamide suppressed the viable cell number in a concentration-dependent manner. The mRNA expression levels of MKI67 and Fkbp5 were also suppressed by darolutamide. Conclusion: Our results indicate that androgen signaling is a key pathway involved in the growth of AR-positive EMPD. Therefore, androgen signaling inhibition may be a novel treatment option for EMPD patients who require systemic therapy.

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Clinicopathological significance of androgen receptor expression in extramammary Paget disease: An analysis of 92 patients

Kuramoto J., Kobayashi K., Hirai I., Nakamura Y., Funakoshi T., Kanai Y.

Pathology Research and Practice (Pathology Research and Practice) 249 154775 2023.09

ISSN 03440338

Extramammary Paget disease (EMPD) is a rare cutaneous malignant neoplasm arising in apocrine gland-rich areas. Although – like normal apocrine glands – EMPD frequently expresses androgen receptor (AR), the clinical significance of AR expression remains unclear. The present study investigated the clinicopathological impact of AR expression in EMPD. Immunohistochemistry for AR was performed in a retrospective cohort of 92 EMPD patients with 108 EMPD lesions, including 102 primary lesions, five lymph node [LN] metastases and one local recurrence. The total AR staining score was calculated as staining intensity score (IS 0–3) × positive-cell percentage score (PS 1–4). Expression levels were graded as Grade 1 (scores 0 and 1), Grade 2 (scores 2–4), and Grade 3 (scores 6–12). Higher expression grade was correlated with tumor thickness (P = 0.011), LN metastasis (P = 0.008), and higher EMPD stage (P = 0.023). Grade 1 EMPDs did not invade into the dermis and did not generate metastatic and/or recurrent lesions, whereas only Grade 2 or 3 EMPDs did so. AR expression in invasive components was significantly higher (P = 0.023) than in non-invasive components remaining within the epidermis. AR expression was further elevated in metastatic and/or recurrent lesions relative to locally invasive lesions (P = 0.014). These results clearly indicate that increased AR expression is associated with malignant progression of EMPD and that androgen blockade might be an effective therapy. Furthermore, AR expression assessed by immunohistochemistry may have potential for prediction of LN metastasis and local recurrence in EMPD.

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Outcomes in extramammary Paget's disease patients with brain metastasis: a retrospective analysis.

Fusumae T, Fukuda K, Hirai I, Nakamura Y, Tanese K, Iwata T, Funakoshi T

Journal of the American Academy of Dermatology 2020.05

ISSN 0190-9622

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Weekly docetaxel monotherapy for metastatic extramammary Paget’s disease: Retrospective single-institute analysis

Nakamura Y., Tanese K., Hirai I., Fukuda K., Kawakami Y., Amagai M., Funakoshi T.

Journal of Dermatology (Journal of Dermatology) 47 ( 4 ) 418 - 422 2020.04

ISSN 03852407

© 2020 Japanese Dermatological Association Monthly docetaxel (DTX) monotherapy is the first-line regimen that is preferably used for metastatic extramammary Paget’s disease (EMPD). However, the high-dose DTX regimen frequently causes severe hematological adverse events (AE). To overcome such safety concerns, a weekly low-dose DTX monotherapy has been proposed for use in the treatment of various cancer types. In this study, we aimed to evaluate the feasibility and efficacy of weekly DTX (25 mg/m2) monotherapy for metastatic EMPD by retrospectively analyzing the clinical courses of 14 patients treated with this regimen. Weekly DTX monotherapy was well tolerated and all patients completed the treatment schedule without treatment withdrawal, dose reduction or treatment-related death. While five cases (35.7%) experienced hematological AE, their severity was mild. The response rate was 35.7% (5/14 cases), which included five partial responses. The mean progression-free survival (PFS) and overall survival were 7.1 (95% confidence interval [CI], 5.1–9.1) and 26.4 months (95% CI, 16.7–36.1), respectively. Furthermore, the median PFS was 7.3 months (95% CI, 4.5–10.0) in patients aged 65 years and younger and 7.1 months (95% CI, 4.4–9.9) in patients older than 65 years. These results suggest that weekly DTX monotherapy may be a useful regimen that has a high treatment continuation rate with low levels of hematological toxicity, regardless of the patient’s age for metastatic EMPD.

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Metastatic cutaneous squamous cell carcinoma in liver successfully treated with partial hepatectomy and adjuvant irinotecan chemotherapy

Asahina Y., Nakamura Y., Tanese K., Hirai I., Fukuda K., Amagai M., Funakoshi T.

In Vivo (In Vivo) 34 ( 2 ) 825 - 828 2020

ISSN 0258851X

© 2020 International Institute of Anticancer Research. All rights reserved. Background: The management of distant metastatic cutaneous squamous cell carcinoma (cSCC) relies mainly on chemotherapies and radiotherapy. Management of patients with cSCC with surgically resectable distant metastatic lesions is not clear. Case Report: A 59-year-old male had 4×10 cmsized cSCC on the perianal skin with inguinal lymph node metastasis. Surgical resection was performed followed by radiation and adjuvant carboplatin and farmorubicin combination therapy. Six months later, 25 mm-sized solitary metastatic nodule arose on the liver. Base on his favorable overall condition fulfilling the criteria of tumor resectability for the treatment of tumors in liver and having good performance status, laparoscopic partial hepatectomy and six courses of adjuvant irinotecan therapy were performed. The surgical margin was negative and the patient has maintained complete remission for over 3 years. Conclusion: The clinical course of the present case suggests that surgical approaches should also be considered as candidate additional therapy for resectable distant metastatic cSCC.

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Serum cytokeratin 19 fragment 21-1 and carcinoembryonic antigen combination assay as a biomarker of tumour progression and treatment response in extramammary Paget disease

Nakamura Y., Tanese K., Hirai I., Amagai M., Kawakami Y., Funakoshi T.

British Journal of Dermatology (British Journal of Dermatology) 181 ( 3 ) 535 - 543 2019.09

ISSN 00070963

© 2019 British Association of Dermatologists Background: Extramammary Paget disease (EMPD) is a rare intraepithelial adenocarcinoma affecting the genitals and axillary regions. As metastasis of these tumours is itself rare, solid disease management strategies have not been established. Serum carcinoembryonic antigen (CEA) and cytokeratin 19 fragment 21-1 (CYFRA 21-1) levels have been identified as candidate biomarkers for tumour progression in EMPD. Objectives: To determine the accuracy of and the correlation between these markers in patients with EMPD. Methods: Serum CEA and CYFRA 21-1 levels were examined in 30 patients with EMPD treated at Keio University Hospital, and compared against clinical information. Both assays were performed at the time of diagnosis, during the postoperative observation period, and following systemic treatment in those with confirmed metastasis. Serum levels were then correlated with tumour progression status and treatment responses. Results: Normal levels for both assays were observed in all 11 patients with primary localized disease (100%). In patients with metastatic disease the CEA positivity rate was 79% (15 of 19 patients), with a rate of 63% (12 of 19 patients) for CYFRA 21-1. Changes in CEA and CYFRA 21-1 levels were statistically independent; however, using a combined view, elevated levels of either marker improved the positivity rate to 95% (18 of 19 patients). Use of both markers also correlated well with treatment responses. Conclusions: The combination of CEA and CYFRA 21-1 is useful for predicting metastasis and treatment response in patients with EMPD, especially in those who only have elevation of a single marker. What's already known about this topic?. Serum levels of carcinoembryonic antigen (CEA) and cytokine 19 fragment 21-1 (CYFRA 21-1) have been shown to be elevated in patients with extramammary Paget disease (EMPD). Elevation of serum CEA levels is associated with tumour progression of EMPD. A single small study reported that serum CYFRA 21-1 levels are elevated in patients with EMPD with lymph node metastasis. What does this study add?. Serum CEA and CYFRA 21-1 were present in 79% and 63% of 19 cases of metastatic EMPD, respectively. Elevations of CEA and CYFRA 21-1 were statistically independent. CEA and CYFRA 21-1 combination assays were positive in 95% of cases of metastatic EMPD. What is the translational message?. Combination assays with CEA and CYFRA 21-1 are useful for monitoring treatment response in patients with metastatic EMPD, particularly in those with elevation of either marker.

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Combination Cisplatin-Epirubicin-Paclitaxel Therapy for Metastatic Extramammary Paget's Disease

Hirai I., Tanese K., Nakamura Y., Ishii M., Kawakami Y., Funakoshi T.

Oncologist (Oncologist) 24 ( 6 ) e394 - e396 2019.06

ISSN 10837159

© AlphaMed Press 2019 Extramammary Paget's disease (EMPD) is a rare cutaneous adenocarcinoma that clinicopathologically resembles breast cancer. The prognosis of metastatic EMPD is poor. Although several chemotherapies have been tried, the effects are temporary; better drugs and combinations are required. In the present study, we retrospectively analyze the efficacy and safety of combination of cisplatin, epirubicin, and paclitaxel in five metastatic EMPD cases. The efficacy was better than that for previously reported regimens: 80% partial responses, including two patients who were refractory to taxane- and/or platinum-based regimens. In terms of safety, four patients who were able to continue treatment exhibited acceptable tolerability. This is the first regimen to combine taxane and anthracycline. When treating breast cancer, anthracycline is regarded as the key cytotoxic agent, and anthracycline in combination with taxane constitutes a key chemotherapeutic regimen. Given our results, we speculate both drugs are critical chemotherapeutic agents for the treatment of metastatic EMPD.

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Investigation of clinical factors associated with longer overall survival in advanced melanoma patients treated with sequential ipilimumab

Muto Y., Kitano S., Tsutsumida A., Namikawa K., Takahashi A., Nakamura Y., Yamanaka T., Yamamoto N., Yamazaki N.

Journal of Dermatology (Journal of Dermatology) 46 ( 6 ) 498 - 506 2019.06

ISSN 03852407

© 2019 Japanese Dermatological Association Melanoma is one of the most serious form of skin cancer. Nowadays, ipilimumab is used for advanced melanoma refractory to first-line anti-programmed death 1 (PD-1) antibodies. Thirty patients (male : female ratio, 18:12; median age, 60.5 years) sequentially treated with ipilimumab after anti-PD-1 antibody (nivolumab or pembrolizumab), while 58 (male : female ratio, 27:31; median age, 66.5 years) with anti-PD-1 antibody only. The kind of therapy and schedules were as follows: nivolumab, 2 mg/kg at 3-week intervals or at 3 mg/kg every 2 week; pembrolizumab, 2 mg/kg every 3 weeks; ipilimumab, 3 mg/kg at 3-week intervals for four doses. The sequential therapy was selected for the patients with disease progression and/or recovered from severe (immune-related [ir]) adverse events (AE) after PD-1 blockade monotherapy. We evaluated multiple parameters and analyzed their relevance to overall survival (OS). The best objective response rate was 6.7% in sequential ipilimumab treatment. Median OS was 163 days (range, 16–489). Baseline absolute lymphocyte count (ALC) and performance status (PS) before sequential ipilimumab were associated with OS in univariate analyses. Baseline PS and irAE within 6 weeks after ipilimumab administration showed significant differences on multivariate analysis. Prior to first-line PD-1 blockade, these parameters were not associated with OS. The other factors (i.e. age, sex, number of doses, absolute neutrophil counts, neutrophil : lymphocyte ratio, lactate dehydrogenase and C-reactive protein) were not associated with OS. [Correction added on 17 April 2019, after first online publication: ‘not related to OS' has been amended to ‘not associated with OS’.] Ipilimumab as sequential therapy did not appear to improve OS and was associated with more severe irAE than PD-1 blockade monotherapy. We need to carefully consider treating patients with poor PS and low ALC.

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Updates on the systemic treatment of advanced non-melanoma skin cancer

Tanese K., Nakamura Y., Hirai I., Funakoshi T.

Frontiers in Medicine (Frontiers in Medicine) 6 160 2019

© 2019 Tanese, Nakamura, Hirai and Funakoshi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Non-melanoma skin cancers (NMSCs), which represent a diverse group of cutaneous malignancies, are the most common forms of human neoplasia. The incidence of these diseases is increasing due to a number of factors, including that of increasing human lifespans. The majority of NMSCs are basal cell carcinomas (BCC) and cutaneous squamous cell carcinomas (cSCC), with the remainder being various rare skin cancers, including extramammary Paget's disease (EMPD), Merkel cell carcinoma (MCC), and several skin adnexal carcinomas. Of these, MCC usually shows aggressive behavior with a high mortality rate. On the other hand, BCC, cSCC, EMPD, and skin adnexal tumors usually show an indolent clinical course and metastasize only rarely. Nevertheless, the metastatic forms of these tumors commonly lead to poor patient outcome. A definitive management strategy for the treatment of advanced NMSC has not been established, mainly due to their rarity and lack of reliable information based on well-controlled randomized trials. Chemotherapeutic regimens for treatment of these diseases have been mainly based on the observations of isolated, small case series or clinical trials with a limited numbers of patients. However, accumulating evidence regarding their pathobiological backgrounds as well as recent advances in molecular biotechnology have facilitated the development of novel drugs for treatment of these diseases. Over the past decade, the U.S. Food and Drug Administration has approved several molecular targeting therapies, including Hedgehog inhibitors for BCC, monoclonal antibodies targeting anti-programmed death ligand-1 and anti- programmed cell death 1 (PD-1) for MCC, and anti-PD-1 for cSCC. Here, we review their clinical utility and discuss updated systemic treatment strategies for advanced NMSC.

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Efficacy and safety of weekly docetaxel regimen for advanced extramammary Paget's disease: Retrospective single institute analysis

Nakamura Y., Hirai I., Ishii M., Kawakami Y., Tanese K., Funakoshi T.

ANNALS OF ONCOLOGY 29 2018.11

ISSN 0923-7534

Carboplatin and epirubicin combination therapy for advanced malignant epithetial skin tumors: retrospective study of six patients

Yoshio Nakamura

J Dermatol 45 ( 7 ) 874 - 875 2018.07

Vancomycin Mediates IgA Autoreactivity in Drug-induced Linear IgA Bullous Dermatosis

Yoshio Nakamura

J Invest Dermatol (Journal of Investigative Dermatology) 138 ( 7 ) 1473 - 1480 2018.07

ISSN 0022202X

© 2018 The Authors Vancomycin (VCM) is known to induce linear IgA bullous dermatosis (LAD). However, in contrast to conventional LAD, in which circulating IgA autoantibodies against basement membrane proteins are commonly detected, patient sera from VCM-induced LAD yields negative results in indirect immunofluorescence microscopy, and the targeted autoantigen remains undetermined. By using sera from a typical patient with VCM-induced LAD, we identified that co-incubation of sera with VCM resulted in linear IgA deposition at the basement membrane zone by indirect immunofluorescence. Patient sera reacted with the dermal side of 1 mol/L NaCl-split skin and with the recombinant noncollagenous (i.e., NC1) domain of type VII collagen by both immunoblot and ELISA in the presence of VCM. The investigation of an additional 13 patients with VCM-induced LAD showed that 10 out of the 14 sera (71.4%) reacted with the NC1 domain of type VII collagen by ELISA when spiked with VCM, whereas only 4 (28.6%) tested positive without it. The enhancement of reactivity to NC1 by VCM, as determined by optical density via ELISA, was observed in 10 out of the 14 sera (71.4%). These findings indicate that type VII collagen is a target autoantigen in VCM-induced LAD and that VCM mediates IgA autoreactivity against type VII collagen, providing an insight into mechanisms involved in drug-induced autoimmune disease.

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Assessment of the methods used to detect HER2-positive advanced extramammary Paget’s disease

Yoshio Nakamura

Med Oncol (Medical Oncology) 35 ( 6 ) 2018.05

ISSN 13570560

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The human epidermal growth factor receptor 2 (HER2) is recognized as an oncogene as well as a therapeutic target in various cancers. Certain patients with advanced extramammary Paget’s disease (EMPD) have also been reported to express HER2, which is therefore considered a therapeutic target for EMPD. However, an accurate methodology to determine HER2-positive EMPD has not been established. To assess the optimal methods for detection of HER2-positive EMPD, 73 EMPD samples were analyzed by immunohistochemical (IHC) staining, fluorescence in situ hybridization (FISH), and the HER2 testing algorithm for breast cancer of the American Society of Clinical Oncology/College of American Pathologists, which combined the results of IHC staining and FISH. The results showed discordance in the rate of positive IHC staining and FISH results. While 68.6% (24/35) of the metastatic samples showed equivocal or positive IHC staining, only 37.1% (13/35) were positive by FISH. To assess the accuracy of these methods, the degree of HER2 expression detected by each method was correlated with the staining profiles of activated downstream signaling pathways involving phosphorylated p44/42 MAPK (Thr202/Tyr204) (p-ERK1/2) and phosphorylated AKT (Ser473) (p-AKT). Among 16 lymph node metastasis samples, all HER2-positive samples as determined by the testing algorithm stained positively for both p-ERK1/2 and p-AKT. On the other hand, 10-14.3% of the samples determined by FISH or IHC showed negative staining for p-ERK1/2 and p-AKT. The results showed that combining the results of IHC and FISH according to the HER2 testing algorithm is a useful method for accurately evaluating HER2-positive EMPD.

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Evaluation of appropriate surgical margin for pigmented basal cell carcinoma according to the risk factor for recurrence: A single-institute retrospective study in Japan

Yoshio Nakamura

J Eur Aca Dermatol Venereol 2018.04

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Retrospective study of advanced melanoma patients treated with ilipomumab after nivolumab: Analysis of 60 Japanese patients

Yoshio Nakamura

J Dermatol Sci 88 60 - 66 2018.01

Retrospective study of advanced melanoma patients treated with ipilimumab after nivolumab: Analysis of 60 Japanese patients

Fujisawa Y., Yoshino K., Otsuka A., Funakoshi T., Uchi H., Fujimura T., Matsushita S., Hata H., Okuhira H., Tanaka R., Nagai K., Ishida Y., Nakamura Y., Furudate S., Yamamura K., Imafuku K., Yamamoto Y.

Journal of Dermatological Science (Journal of Dermatological Science) 89 ( 1 ) 60 - 66 2018.01

ISSN 09231811

© 2017 Japanese Society for Investigative Dermatology Background: Due to resistance and immune-related adverse events (irAE) some melanoma patients require ipilimumab after nivolumab therapy. However, little is known about the result of this switching. Objective: Investigate the outcome of ipilimumab switching in Japanese patients. Methods: We retrospectively collected 60 patients who were treated with ipilimumab after nivolumab from 9 institutes in Japan. Information of the primary tumor, treatment, response, irAE), and survival was collected. Results: In our cohort, acral lentiginous and mucosal melanoma accounted for 53% of the cases. The most common reason for initiating ipilimumab was disease progression (93%). Median interval from the last nivolumab administration to first ipilimumab administration was 29 days. Only 38% of patients completed 4 injections of ipilimumab. The best overall response was 3.6%. IrAE occurred in 78% of patients and 70% of those were of grade 3/4 (G3/4) and 31% of patients experienced 2 or more irAEs. An within interval of 28 days or less between the last nivolumab administration and ipilimumab administration was correlated with the development of G3/4 pyrexia and 3 or more irAEs, but irAE occurrence did not affect survival. Multivariate analysis showed that endocrine irAE (relative risk = 0.22, P = 0.015) and skin irAE (relative risk = 2.78, P = 0.048) were significant factors associated with survival. Conclusion: In our study, the response ratio to ipilimumab after nivolumab was unsatisfactory and associated with a high frequency of severe irAEs. As there are few second-line treatment options for patients with BRAF wild-type advanced melanoma after nivolumab failure, patients should be closely monitored if ipilimumab is initiated.

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Rapidly developed BRAF inhibitor-induced verrucaus keratosis

Yoshio Nakamura

J dermatol 44 e274 - e275 2017.11

Rapidly developed BRAF inhibitor-induced verrucous keratosis.

Nakamura Y, Mori T, Takae Y, Tsutsumida A, Takahashi A, Namikawa K, Hirai I, Yamazaki N

The Journal of dermatology 44 ( 11 ) e274 - e275 2017.11

ISSN 0385-2407

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Peptide-pulced dendritic cell vaccine in combination with carboplatin and paclitaxel chemotherapy for stage IV melanoma

Yoshio Nakamura

Melanoma Res 27 326 - 334 2017.08

Successful treatment of widespread chronic gluteal hidradenitis suppurativa with combination of recycled skin graft and negative-pressure wound therapy.

Kinoshita-Ise M, Nakamura Y, Kumagai Y, Kubo A, Nagao K, Funakoshi T

The Journal of dermatology 44 ( 8 ) 973 - 975 2017.08

ISSN 0385-2407

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Peptide-pulsed dendritic cell vaccine in combination with carboplatin and paclitaxel chemotherapy for stage IV melanoma.

Fukuda K, Funakoshi T, Sakurai T, Nakamura Y, Mori M, Tanese K, Tanikawa A, Taguchi J, Fujita T, Okamoto M, Amagai M, Kawakami Y

Melanoma research 27 ( 4 ) 326 - 334 2017.08

ISSN 0960-8931

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Nivolumab for advanced melanoma: pretreatment prognostic factors and early outcome markers during therapy

Yoshio Nakamura

Oncotarget 7 77404 - 77415 2016.11

Successful treatment of widespread chronic glutal hidradenitis supprativa with combination of recycled skin graft and negative-pressure wound theraoy

Yoshio Nakamura

J Dermatol 44 973 - 975 2016.09

Metastatic eccrine porocarcinoma successfully treated with carboplatin and epirubicin chemotherapy

Yoshio Nakamura

J Dermatol 42 928 - 930 2015.09

A case of pityriasis rubra pilaris diagnosed after rapid exacerbation

Yoshio Nakamura

臨床皮膚科 67 410 - 415 2013.05

Nodular localized cutaneous amyloidosis complicated with Sjogren syndrome

Yoshio Nakamura

皮膚病診療 35 363 - 366 2013.04

AIDS associated Kaposi’s sarcoma characterized by the frequent occurrence of huge gingival lesions

Yoshio Nakamura

24 1217 - 1220 2012.12

A case of self-healing reticulohistiocytosis

Yoshio Nakamura

臨床皮膚科 66 1085 - 1089 2012.12

Localized multiple neurofibromas on the head & neck

Yoshio Nakamura

皮膚病診療 33 ( 9 ) 933 - 936 2011.09

A case of pedunculated giant aneurysmal fibrous histiocytoma

Yoshio Nakamura

臨床皮膚科 65 530 - 534 2011.05

A case of skin necrosis resulting from transcatheter arterial embolization(TAE) through the internal thoracic artery for the recurrent hepatocellular carcinoma

Yoshio Nakamura

臨床皮膚科 65 265 - 268 2011.03

Nakamura Y, Futei Y: A case of multiple cutaneous B cell pseudo lymphoma. Japanese Journal of Clinical Dermatology 65: 157-160 Japanese Journal of Clinical Dermatology

Yoshio Nakamura

臨床皮膚科 65 157 - 160 2011.02

A case of localized cutaneous synovial sarcoma.

Yoshio Nakamura

臨床皮膚科 65 52 - 56 2001.01

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