Subject(s)
Carcinoma, Basal Cell/surgery , Ear Deformities, Acquired/prevention & control , Ear Neoplasms/surgery , Plastic Surgery Procedures/methods , Skin Neoplasms/surgery , Surgical Flaps , Carcinoma, Basal Cell/pathology , Ear Auricle , Ear Deformities, Acquired/etiology , Ear Neoplasms/pathology , Humans , Male , Middle Aged , Mohs Surgery/adverse effects , Skin Neoplasms/pathologyABSTRACT
Erythema nodosum is an inflammatory reaction of the skin characterized by tender erythematous patches or nodules, usually located on the lower extremities. This report illustrates an association of erythema nodosum with a rare malignancy and an uncommon infectious agent in humans. There are many diseases associated with erythema nodosum; we propose that hairy cell leukemia and group C streptococcus be considered among this list.
Subject(s)
Erythema Nodosum/pathology , Leukemia, Hairy Cell/pathology , Panniculitis/microbiology , Panniculitis/pathology , Skin Neoplasms/pathology , Streptococcal Infections/diagnosis , Streptococcus/classification , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy, Needle , Erythema Nodosum/complications , Erythema Nodosum/diagnosis , Follow-Up Studies , Humans , Immunohistochemistry , Leg Dermatoses/complications , Leg Dermatoses/diagnosis , Leg Dermatoses/pathology , Leukemia, Hairy Cell/complications , Leukemia, Hairy Cell/drug therapy , Male , Severity of Illness Index , Skin Neoplasms/complications , Skin Neoplasms/drug therapy , Streptococcal Infections/complications , Streptococcus/isolation & purification , Treatment OutcomeABSTRACT
Selective sentinel lymphadenectomy (SSL) following preoperative lymphoscintigraphy is the most significant recent advance in the management of patients with primary melanoma. This study evaluates the prognostic value of sentinel lymph node (SLN) status and other risk factors in predicting survival and recurrence in patients with primary cutaneous melanoma. From October 1993 to July 1998 a series of 412 patients with primary invasive melanoma underwent SSL at the UCSF/ Mt. Zion Melanoma Center. The outcome of 363 evaluable patients is summarized in this study. The factors related to survival and disease recurrence were analyzed by Cox proportional hazard regression models. The overall incidence of patients with positive SLNs was 18%. Over a median follow-up of 4.8 years, the overall mortality rate in patients with primary cutaneous melanoma was 18.7%, and 74 recurrences occurred (20.4%). Mortality was significantly related to SLN status [HR = 2.06; 95% Confidence interval (CI) 1.18, 3.58], angiolymphatic invasion (HR = 2.21; 95% CI 1.08, 4.55), ulceration (HR = 1.79; 95% CI 1.02, 3.15), mitotic index (HR =1.38; 95% CI 1.01, 1.90), and tumor thickness (HR = 2.20, 95% CI 1.21, 3.99). Factors significantly related to disease-free survival included SLN status (HR = 2.09; 95% CI 1.31, 3.34), tumor thickness (HR = 1.89; 95%. CI 1.20,2.98), and age (HR= 1.26 95% CI 1.08, 1.47). SLN status was the most significant factor for melanoma recurrence and death. Other important predictors include tumor thickness, ulceration, lymphatic invasion, and mitotic index.
