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1.
Int J Womens Dermatol ; 6(3): 142-151, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32313827

ABSTRACT

Exanthematous diseases are frequently of infectious origin, posing risks, especially for pregnant health care workers (HCWs) who treat them. The shift from cell-mediated (Th1 cytokine profile) to humoral (Th2 cytokine profile) immunity during pregnancy can influence the mother's susceptibility to infection and lead to complications for both mother and fetus. The potential for vertical transmission must be considered when evaluating the risks for pregnant HCWs treating infected patients because fetal infection can often have devastating consequences. Given the high proportion of women of childbearing age among HCWs, the pregnancy-related risks of exposure to infectious diseases are an important topic in both patient care and occupational health. Contagious patients with cutaneous manifestations often present to dermatology or pediatric clinics, where female providers are particularly prevalent; a growing number of these physicians are female. Unfortunately, the risks of infection for pregnant HCWs are not well defined. To our knowledge, there is limited guidance on safe practices for pregnant HCWs who encounter infectious dermatologic diseases. In this article, we review several infectious exanthems, their transmissibility to pregnant women, the likelihood of vertical transmission, and the potential consequences of infection for the mother and fetus. Additionally, we discuss recommendations with respect to avoidance, contact, and respiratory precautions, as well as the need for treatment after exposure.

3.
Cureus ; 11(12): e6462, 2019 Dec 25.
Article in English | MEDLINE | ID: mdl-32025391

ABSTRACT

Chronic graft-versus host disease (cGVHD) occurs in 30% to 70% of patients undergoing allogeneic hematopoietic cell transplantation (HCT). Cutaneous cGVHD affects 75% of cGVHD patients, causing discomfort, limiting the range of movement, and increasing the risk of wound infections. Furthermore, systemic immunosuppression is often needed to treat cGVHD and long-term use can lead to adverse events. Optimal use of skin-directed therapies is integral to the management of cutaneous cGVHD and may decrease the amount of systemic immunosuppression required. This study reviewed English-language articles published from 1990 to 2017 that evaluated the effect of skin-directed treatments for cutaneous cGVHD. A total of 201 papers were identified, 164 articles were screened, 46 were read, and 18 publications were utilized in the review. Skin-directed treatments for cGVHD included topical steroids, topical calcineurin inhibitors, psoralen with ultraviolet A (PUVA) irradiation, ultraviolet A1 (UVA1) irradiation, and ultraviolet B (UVB) irradiation. We report the number of complete remissions, partial remissions, and systemic immunosuppression reduction in each study, as available. Twenty-two out of 30 (73.3%) patients experienced overall improvement with topical calcineurin inhibitors. At least 26 out of 76 patients (34.2%) receiving PUVA experienced complete remission, and 30 out of 76 patients (39.5%) experienced partial remission. In UVA1 studies, 44 out of 52 (84.6%) patients experienced overall improvement. In UVB studies, nine out of 14 patients (64.3%) experienced complete remission and four out of 14 patients (28.6%) experienced partial remission. As more HCTs are performed, more individuals will develop cGVHD. Awareness and optimal use of skin-directed therapies for cutaneous cGVHD may help improve patient outcomes and quality of life.

4.
BMJ Case Rep ; 20182018 Aug 11.
Article in English | MEDLINE | ID: mdl-30100570

ABSTRACT

The association of malignant lymphomas with non-necrotic epithelioid granulomas has been reported rarely since 1977. Hodgkin's disease-associated widespread cutaneous granuloma annulare (GA) has been reported in only eight patients. We report the second case of subcutaneous GA associated with Hodgkin's disease. A 73-year-old man with Epstein-Barr virus-associated Hodgkin's lymphoma and paraneoplastic subcutaneous GA, presented 3 months after the diagnosis of malignancy. Examination revealed a large, broad erythematous, indurated, subcutaneous plaque spanning the majority of the left lower back and flank with no associated symptoms. Initial biopsy was suggestive of morphea. Prompted by positron emission tomography (PET) findings of increased fluorodeoxyglucose (FDG) uptake, a second, deeper biopsy was performed, revealing subcutaneous palisaded granulomatous dermatitis. After complete workup, the diagnosis most strongly suggested subcutaneous GA. This case highlights the importance of deep incisional biopsies, the fluorodeoxyglucose - positron emission tomography (FDG-PET) findings in GA and the rare association of GA with Hodgkin's disease which may signal the presence of malignancy.


Subject(s)
Back , Granuloma Annulare/diagnosis , Hodgkin Disease , Paraneoplastic Syndromes/diagnosis , Aged , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Clobetasol/administration & dosage , Clobetasol/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Fluorodeoxyglucose F18 , Granuloma Annulare/diagnostic imaging , Granuloma Annulare/drug therapy , Granuloma Annulare/pathology , Humans , Male , Paraneoplastic Syndromes/diagnostic imaging , Paraneoplastic Syndromes/drug therapy , Paraneoplastic Syndromes/pathology , Positron-Emission Tomography , Triamcinolone/administration & dosage , Triamcinolone/therapeutic use
5.
J Am Acad Dermatol ; 79(6): 1133-1140.e3, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30055204

ABSTRACT

BACKGROUND: The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. Although melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy or increased exogenous hormones from oral contraceptive pills and hormone replacement affect MM prevalence and outcome. OBJECTIVE: We sought to examine potential associations between in vitro fertilization (IVF) and melanoma. METHODS: A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk compared with the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients. RESULTS: Eleven studies met our inclusion criteria. Five studies found no increased risk for MM among IVF users compared with the general population. Two studies found an increase in MM in clomiphene users, and 4 studies found an increase in MM among patients who were gravid or parous either before or after IVF. CONCLUSION: The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates a potential increased risk for MM in ever-parous patients treated with IVF. High-quality studies including a large number of MM cases that control for well-established MM risk factors are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.


Subject(s)
Clomiphene/adverse effects , Estrogens , Fertilization in Vitro , Melanoma/chemically induced , Neoplasms, Hormone-Dependent/chemically induced , Ovulation Induction/adverse effects , Female , Fertilization in Vitro/methods , Gonadotropins, Pituitary/adverse effects , Gonadotropins, Pituitary/pharmacology , Humans , Infertility, Female/complications , Melanocytes/drug effects , Melanocytes/pathology , Melanoma/epidemiology , Neoplasms, Hormone-Dependent/epidemiology , Parity , Pregnancy , Receptors, Estrogen/drug effects
6.
Int J Womens Dermatol ; 3(4): 219-224, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29234716

ABSTRACT

Throughout pregnancy, the body undergoes a variety of physiologic changes. The cutaneous findings can be most noticeable and often worrisome to both physicians and patients. Obstetricians and dermatologists must be able to differentiate between changes that are benign and those that may be pathologic. Most physicians recognize benign changes that are commonly described in literature such as hyperpigmentation, melasma, striae gravidarum, and telogen effluvium; however, they may be unaware of changes that tend to be less frequently discussed. This comprehensive review provides a broad overview of the physiologic cutaneous changes that occur during pregnancy as described in the literature over the past 10 years.

8.
Obstet Gynecol ; 129(1): 168-173, 2017 01.
Article in English | MEDLINE | ID: mdl-27926637

ABSTRACT

Changes in melanocytic nevi during pregnancy are frequently attributed to the new hormonal milieu and are dismissed without concern for malignancy. Recent studies suggest that pregnancy itself does not induce significant change in nevi, and delays in the assessment of changing moles may contribute to the often more advanced nature of melanomas diagnosed during or soon after pregnancy. Nevi on the breasts and abdomen can grow as a result of skin expansion, but studies have found no significant changes in nevi located in more stable areas such as the back or lower extremities. There is also insufficient evidence to support the notion that nevi darken during pregnancy. As such, any changing nevus that would raise concern for malignancy in a nonpregnant patient should do so in a pregnant patient as well. Pregnancy can, however, induce physiologic pigmentary changes that are often worrisome to both patients and physicians. These benign changes include melasma, pigmentary demarcation lines, secondary areola, and linea nigra as well as other less common findings. It is important for physicians to recognize these changes as physiologic to provide adequate reassurance to their patients and avoid unnecessary stress.


Subject(s)
Hyperpigmentation/etiology , Melanoma/pathology , Nevus, Pigmented/pathology , Pregnancy Complications, Neoplastic/pathology , Skin Neoplasms/pathology , Female , Humans , Melanoma/diagnosis , Pregnancy
10.
J Am Acad Dermatol ; 76(4): 639-647.e2, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27876302

ABSTRACT

BACKGROUND: The risk of melanoma and hematologic cancers in patients with psoriasis is controversial. OBJECTIVE: We sought to assess the risk of melanoma and hematologic cancers in patients with psoriasis, and the association with different treatments. METHODS: We used case-control and retrospective cohort designs to determine melanoma or hematologic cancer risk in patients with psoriasis. Risk with treatment type was assessed using Fisher exact test. RESULTS: Patients with psoriasis had 1.53 times greater risk of developing a malignancy compared with patients without psoriasis (P < .01). There were no significant differences in malignancy risk among patients treated with topicals, phototherapy, systemics, or biologic agents. Patients with psoriasis and malignancy did not have significantly worse survival than patients without psoriasis. LIMITATIONS: It is possible that patients developed malignancy subsequent to the follow-up time included in the study. CONCLUSION: Patients with psoriasis may experience an elevated risk of melanoma and hematologic cancers, compared with the general population. The risk is not increased by systemic or biologic psoriasis therapies.


Subject(s)
Hematologic Neoplasms/epidemiology , Melanoma/epidemiology , Psoriasis/epidemiology , Skin Neoplasms/epidemiology , Aged , Biological Products/adverse effects , Biological Products/therapeutic use , California/epidemiology , Case-Control Studies , Comorbidity , Dermatologic Agents/adverse effects , Dermatologic Agents/therapeutic use , Female , Hematologic Neoplasms/etiology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , Melanoma/etiology , Middle Aged , Neoplasms, Radiation-Induced/epidemiology , Neoplasms, Radiation-Induced/etiology , PUVA Therapy/adverse effects , Proportional Hazards Models , Psoriasis/drug therapy , Psoriasis/radiotherapy , Retrospective Studies , Risk , Skin Neoplasms/etiology , Survival Analysis , Ultraviolet Therapy/adverse effects
12.
J Am Acad Dermatol ; 75(4): 661-666, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27646736

ABSTRACT

Changes in the moles of pregnant women are frequently attributed to pregnancy, but recent studies suggest that pregnancy does not induce significant physiologic changes in nevi. It is common for nevi on the breasts and abdomen to grow with normal skin expansion, but studies that have examined melanocytic nevi on the backs or lower extremities have found no significant changes in size during pregnancy. Several studies have also investigated the belief that moles darken during pregnancy and have found insufficient evidence to support this idea. Dermoscopically, transient changes have been identified, but none are suggestive of melanoma. Results vary in terms of histologic changes seen in samples taken from pregnant women, but all authors agree that any histopathologic features consistent with melanoma should be viewed as melanoma and not attributed to pregnancy. Biopsy specimens should be obtained promptly from any changing mole that would raise concern for malignancy in a nonpregnant patient. Such procedures can be performed safely during pregnancy.


Subject(s)
Nevus, Pigmented/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Outcome , Skin Neoplasms/diagnosis , Adult , Biopsy, Needle , Dermoscopy/methods , Female , Humans , Immunohistochemistry , Monitoring, Physiologic/methods , Nevus, Pigmented/therapy , Pregnancy , Pregnancy Complications, Neoplastic/therapy , Prenatal Diagnosis , Prognosis , Risk Assessment , Skin Neoplasms/therapy
13.
J Am Acad Dermatol ; 75(4): 669-678, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27646737

ABSTRACT

Malignant melanoma is the most common malignancy during pregnancy, and is diagnosed during childbearing age in approximately one-third of women diagnosed with melanoma. The impact of hormonal changes during pregnancy and from iatrogenic hormones on melanoma is controversial. Women undergo immunologic changes during pregnancy that may decrease tumor surveillance. In addition, hormone receptors are found on some melanomas. In spite of these observations, the preponderance of evidence does not support a poorer prognosis for pregnancy-associated melanomas. There is also a lack of evidence that oral contraceptives or hormone replacement therapy worsens melanoma prognosis.


Subject(s)
Melanoma/diagnosis , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Outcome , Skin Neoplasms/diagnosis , Biopsy, Needle , Female , Humans , Immunohistochemistry , Incidence , Melanoma/epidemiology , Melanoma/therapy , Monitoring, Physiologic/methods , Neoplasm Invasiveness/pathology , Neoplasm Staging , Postpartum Period , Pregnancy , Pregnancy Complications, Neoplastic/epidemiology , Pregnancy Complications, Neoplastic/therapy , Prenatal Diagnosis , Prognosis , Risk Assessment , Skin Neoplasms/epidemiology , Skin Neoplasms/therapy , Melanoma, Cutaneous Malignant
15.
J Cutan Pathol ; 43(11): 1041-1044, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27433975

ABSTRACT

Lymphomatoid papulosis (LyP) is classified as a CD30+ primary cutaneous lymphoproliferative disease. The phenotypic variability along the spectrum of CD30+ lymphoproliferative diseases is highlighted by the distinct histologic subtypes of LyP types A, B, C, and the more recently described types D, E, and F. We report the case of an elderly woman with a clinical presentation and histopathologic findings consistent with LyP, whose atypical CD30+ infiltrate uniquely demonstrated a spindle-cell morphology. To our knowledge, this is the first reported case of LyP characterized by CD30+ spindle-shaped cells, and may represent a new and distinct histologic variant of LyP.


Subject(s)
Ki-1 Antigen/metabolism , Lymphomatoid Papulosis/diagnosis , Skin Neoplasms/diagnosis , Aged, 80 and over , Female , Humans , Lymphomatoid Papulosis/immunology , Skin Neoplasms/immunology
16.
JAMA Dermatol ; 152(12): 1365-1371, 2016 12 01.
Article in English | MEDLINE | ID: mdl-27262160

ABSTRACT

Importance: There is limited information regarding the influence of patient demographics, tumor characteristics, and treatment type on the survival of patients with dermatofibrosarcoma protuberans (DFSP). Objective: To assess prognostic factors and to evaluate the influence of treatment modality on overall survival of patients with DFSP. Design, Setting, and Participants: We examined DFSP using data for 3686 patients with histologically confirmed cases of DFSP diagnosed between 1972 and 2012 from the 18 US regional registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, with linkage to demographic data from the US Census Bureau for median household income (MHI). The analysis was performed in February 2016. Main Outcomes and Measures: The primary outcome measures were tumor characteristics, prognostic factors, and overall survival in months. Results: There were 3686 cases of DFSP examined. Older age (hazard ratio [HR], 1.08; 95% CI, 1.06-1.10; P < .001), male sex (HR, 1.97; 95% CI, 1.09-3.55; P = .03), and tumor size (HR, 1.09; 95% CI, 1.01-1.18; P = .04) were significantly associated with poorer overall survival in a controlled analysis. Older age (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P = .01), male sex (OR, 1.95; 95% CI, 1.57-2.42; P < .001), and black race (OR, 1.78; 95% CI, 1.37-2.32; P < .001) were associated with larger (≥3.0 cm) tumors at presentation. Treatment modality did not influence overall survival; however, differences in patient characteristics affected the treatment received. Older age at presentation (OR, 1.02; 95% CI, 1.01-1.03; P =.01), black race (OR, 1.82; 95% CI, 1.13-2.92; P = .01), large tumor size (OR, 1.15; 95% CI, 1.09-1.21; P < .001), and head or neck location (OR, 4.63; 95% CI, 2.66-8.07; P <.001) increased the likelihood of a patient receiving surgery and radiation over surgery alone. In addition, white patients (OR, 0.51; 95% CI, 0.30-0.87; P=.01), women (OR, 0.53; 95% CI, 0.36-0.78; P <.001), and patients with a higher MHI (OR, 1.27; 95% CI, 1.11-1.46; P <.001) were more likely to receive Mohs micrographic surgery (MMS) over excision. Conclusions and Relevance: Age at diagnosis, male sex, and DFSP tumor size appear to be important prognostic factors. Treatment modality did not significantly influence survival; however, patient and tumor characteristics influence treatment modality.


Subject(s)
Dermatofibrosarcoma/pathology , Mohs Surgery/methods , Skin Neoplasms/pathology , Adult , Age Factors , Dermatofibrosarcoma/therapy , Female , Humans , Male , Middle Aged , Prognosis , Risk Factors , SEER Program , Sex Factors , Skin Neoplasms/therapy , Survival Rate , United States
17.
Oncology ; 90(2): 79-87, 2016.
Article in English | MEDLINE | ID: mdl-26840790

ABSTRACT

OBJECTIVES: The impact of ethnicity and the socioeconomic status (SES) among Caucasians is not well studied. Here, we examine the impact of income on melanoma presentation and prognosis within a Caucasian cohort, accounting for ethnicity, as some reports suggest increased melanoma incidence in Ashkenazi Jewish (AJ) BRCA mutation carriers. METHODS: We studied prospectively enrolled primary melanoma patients at New York University. SES data were estimated using United States' Census Bureau data and patient zip codes. We evaluated associations between ethnicity, SES, and baseline characteristics using the χ² test and multivariate logistic regression. We compared survival distributions using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard ratios. RESULTS: Of the 1,339 enrolled patients, AJ represented 32% (n = 423). Apart from AJ being older at presentation (p < 0.001), no significant differences were observed in baseline characteristics between ethnic groups. Patients with a median household income (MHI) lower than the median of the cohort were significantly more likely to present with advanced stages (p < 0.001) compared to patients with a higher MHI. Shorter overall (p = 0.016) and post-recurrence survival (p = 0.042) was also observed in patients from lower-income households. CONCLUSION: Data suggest that disparities in melanoma presentation in Caucasians stratify according to income independent of ethnic background.


Subject(s)
Income/statistics & numerical data , Jews/statistics & numerical data , Melanoma/ethnology , Melanoma/pathology , Neoplasm Recurrence, Local/mortality , Skin Neoplasms/ethnology , Skin Neoplasms/pathology , White People/ethnology , Adult , Aged , Delayed Diagnosis/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Male , Melanoma/mortality , Middle Aged , Neoplasm Staging , New York City/epidemiology , Prognosis , Proportional Hazards Models , Prospective Studies , Skin Neoplasms/mortality , Survival Rate
18.
J Am Acad Dermatol ; 74(4): 724-30.e1, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26803347

ABSTRACT

BACKGROUND: Acral lentiginous melanoma has increased mortality compared with other melanoma subtypes and disproportionately affects ethnic minorities. Acral melanocytic lesions have not been well studied in diverse populations of the United States. OBJECTIVE: We sought to assess the prevalence, awareness, and dermoscopic patterns of acral melanocytic lesions in skin-of-color and non-Hispanic white patients. METHODS: We prospectively examined the palms and soles of 1052 patients presenting to dermatology clinics in New York, NY, and Miami, FL, from October 2013 to April 2015. RESULTS: Acral melanocytic lesions were observed in 36% of our cohort. Skin-of-color patients were more likely to have acral melanocytic lesions than non-Hispanic white patients (P < .01). Acral melanocytic lesions correlated with increased mole counts, particularly on non-Hispanic white patients. The majority of lesions demonstrated benign dermoscopic patterns. We observed 2 lesions with the parallel ridge pattern in our cohort, both found to be atypical nevi on biopsy specimen. Patients often lacked awareness of the presence of their lesions. LIMITATIONS: Interobserver variability in assessing dermoscopic patterns is a limitation. CONCLUSIONS: Melanocytic lesions of the palms and soles are common, particularly in a cohort of multiple ethnicities from the United States. Dermoscopy of acral lesions is an important clinical tool for diagnosis and management of these lesions.


Subject(s)
Dermoscopy/methods , Melanoma/diagnosis , Nevus, Pigmented/diagnosis , Skin Neoplasms/diagnosis , Skin Pigmentation/physiology , White People/statistics & numerical data , Aged , Aged, 80 and over , Awareness , Biopsy, Needle , Cohort Studies , Female , Florida/epidemiology , Humans , Immunohistochemistry , Male , Melanoma/ethnology , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Nevus, Pigmented/ethnology , Observer Variation , Prevalence , Prospective Studies , Risk Assessment , Skin Neoplasms/ethnology , United States/epidemiology
19.
Dermatol Online J ; 22(12)2016 Dec 15.
Article in English | MEDLINE | ID: mdl-28329538

ABSTRACT

HTLV-1 is a virus that is endemic in southwesternJapan and the Caribbean and has been implicatedin the development of ATLL. ATLL, which is anuncommon malignant condition of peripheralT-lymphocytes, is characterized by four clinicalsubtypes, which include acute, lymphomatous,chronic, and smoldering types, that are based onLDH levels, calcium levels, and extent of organinvolvement. We present a 52-year- old woman withpruritic patches with scale on the buttocks and withtender, hyperpigmented macules and papules oftwo-years duration. Histopathologic examinationwas suggestive of mycosis fungoides, laboratoryresults showed HTLV-I and II, and the patient wasdiagnosed with primary cutaneous ATLL. We reviewthe literature on HTLV-1 and ATLL and specifically theprognosis of cutaneous ATLL. The literature suggeststhat a diagnosis of ATLL should be considered amongpatients of Caribbean origin or other endemicareas with skin lesions that suggest a cutaneousT-cell lymphoma, with clinicopathologic features ofmycosis fungoides. Differentiation between ATLLand cutaneous T-cell lymphoma is imperative as theyhave different prognoses and treatment approaches.


Subject(s)
Anemia, Refractory, with Excess of Blasts/diagnosis , Leukemia-Lymphoma, Adult T-Cell/diagnosis , Skin Neoplasms/diagnosis , Anemia, Refractory, with Excess of Blasts/pathology , Anemia, Refractory, with Excess of Blasts/virology , Blotting, Western , Enzyme-Linked Immunosorbent Assay , Female , HTLV-I Antibodies/immunology , HTLV-II Antibodies/immunology , Human T-lymphotropic virus 1/immunology , Human T-lymphotropic virus 2/immunology , Humans , Leukemia-Lymphoma, Adult T-Cell/pathology , Leukemia-Lymphoma, Adult T-Cell/virology , Middle Aged , Skin Neoplasms/pathology , Skin Neoplasms/virology
20.
Dermatol Online J ; 22(12)2016 Dec 15.
Article in English | MEDLINE | ID: mdl-28329554

ABSTRACT

We report a 68-year-old woman with chroniclymphocytic leukemia, who developed numerous,pruritic, edematous, and vesicobullous skin lesionsof the face and extremities over the course of severalmonths. The diagnosis of eosinophilic dermatosis ofhematologic malignancy (EDHM) was made basedon the clinical history and histopathologic features.Owing to the possible link between EDHM and amore aggressive underlying CLL, she was startedagain on chemotherapy. This case serves as areminder that, although the precise pathogenesis ofEDHM remains unclear, the paraneoplastic disorderis the result of immune dysregulation. Patientswho develop EDHM should undergo prompthematologic/oncologic evaluation.


Subject(s)
Eosinophilia/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Paraneoplastic Syndromes/diagnosis , Skin Diseases/diagnosis , Aged , Eosinophilia/complications , Eosinophilia/pathology , Facial Dermatoses/complications , Facial Dermatoses/diagnosis , Facial Dermatoses/pathology , Female , Humans , Leg Dermatoses/complications , Leg Dermatoses/diagnosis , Leg Dermatoses/pathology , Paraneoplastic Syndromes/complications , Paraneoplastic Syndromes/pathology , Skin Diseases/complications , Skin Diseases/pathology
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