Skin involvement in Hodgkin's disease

Of 1810 patients with Hodgkin's disease seen at M. D. Anderson Hospital and Tumor Institute from 1944 to 1977, nine patients developed skin lesions which were histologically specific for the disease, an incidence of 0.5%. The initial manifestations were in the form of small papules and nodules that developed in seven of the nine patients in skin immediately distal to lymph nodes containing tumor, supporting the concept that skin involvement most often results from retrograde lymphatic spread from involved lymph nodes. Because the majority of the patients died within a few months following the development of the skin lesions, skin involvement is considered an indication of stage IV disease. Fifteen additional patients had had skin biopsies that were considered either diagnostic or suggestive of Hodgkin's disease, but were ultimately proven to be a variety of other conditions. Thus, Hodgkin's disease in skin can be simulated by other disease processes, and the diagnosis should be made with caution, particularly in the absence of lymph node involvement.