Eccrine porocarcinoma is a rare cutaneous neoplasm that mainly affects elderly people and grows slowly over a long period of time but often experiences an accelerated growth phase. Eccrine porocarcinoma may arise de novo or evolve from a pre-existing benign eccrine poroma. We reported a 86-year-old Japanese woman presenting with two reddish-colored pendulated lesions on a keratotic light brown plaque on the right thigh. Dermoscopic examination of the light-brown plaque demonstrated many whitish globular structures in a light-brown background. At the two reddish-colored pendulated lesions, polymorphous and prominent vessel proliferation was observed together with irregularly shaped whitish negative network. Immunohistochemical study demonstrated a positive CEA staining at ductal structures and atypical clear cells of reddish nodules. A diagnosis of eccrine porocarcinoma arising in a pigmented hidroacanthoma simplex was eventually established, and the dermoscopic features of eccrine porocarcinoma from hidroacanthoma simplex was described for the first time.

A 61-year-old female received intravenous injection of calcium chloride after common iliac artery bypass surgery. A red flare appeared at the site of the intravenous infusion on the left forearm and gradually progressed to induration. Seven weeks later, she was referred to the Department of Dermatology for management. Physical examination showed an indurated plaque measuring 13 × 65 mm in size, with linearly distributed ulcers covered by yellowish-white substance, surrounded by reddish skin. Laboratory tests showed no significant abnormalities including serum calcium, phosphate and thyroid hormones. Cultures were negative for microorganisms. Histopathological examination showed calcium deposition confined to the dermis. The lesion healed spontaneously within 2 months with scar formation. A review of the Japanese literature showed confinement of calcium deposits to the dermis in most of the reported cases. We speculate that the pathomechanism of dermal calcinosis includes needle-induced tissue injury with capillary destruction, leading to release of excess calcium between collagen fibers, and its binding to phosphate in the dermis and deposition as calcium phosphate crystals.

Key words：calciphylaxis, end-stage renal disease, warfarin, vitamin K 〈Abstract〉 Calciphylaxis is a rare but fatal disorder characterized by systemic medial calcification of the small arteries and ischemia of the subcutaneous tissues, often leading to necrosis of the subcutaneous fat and skin. This condition most commonly affects patients with end-stage renal disease （ESRD）and the pathogenesis is poorly understood. At present, there is no established treatment. We recently encountered three cases of calciphylaxis. The first case involved a 66-year-old man with ESRD who had been maintained on peritoneal dialysis(PD）for 7 years. The patient was admitted with painful ulcers on his thighs, hip, waist and wrists. Skin biopsies demonstrated calciphylaxis. Treatment with bisphosphonate and sodium thiosulfate hydrate had no effect and he died of peritonitis and DIC soon after admission. The second case involved a 53-year-old woman with ESRD who had