结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

We reviewed all studies since 1940 on the prognosis of squamous cell carcinoma (SCC) of the skin and lip. The following variables are correlated with local recurrence and metastatic rates: (1) treatment modality, (2) prior treatment, (3) location, (4) size, (5) depth, (6) histologic differentiation, (7) histologic evidence of perineural involvement, (8) precipitating factors other than ultraviolet light, and (9) host immunosuppression. Local recurrences occur less frequently when SCC is treated by Mohs micrographic surgery. This local recurrence rate differential in favor of Mohs micrographic surgery holds true for primary SCC of the skin and lip (3.1% vs 10.9%), for ear SCC (5.3% vs 18.7%), for locally recurrent (previously treated) SCC (10% vs 23.3%), for SCC with perineural involvement (0% Ys 47%), for SCC of size greater than 2 cm (25.2% vs 41.7%), and for SCC that is poorly differentiated (32.6% vs 53.6%).

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip : implications for treatment modality selection

The tissue photosensitizer protoporphyrin IX (PpIX) is an immediate precursor of heme in the biosynthetic pathway for heme. In certain types of cells and tissues, the rate of synthesis of PpIX is determined by the rate of synthesis of 5-aminolevulinic acid (ALA), which in turn is regulated via a feedback control mechanism governed by the concentration of free heme. The presence of exogenous ALA bypasses the feedback control, and thus may induce the intracellular accumulation of photosensitizing concentrations of PpIX. However, this occurs only in certain types of cells and tissues. The resulting tissue-specific photosensitization provides a basis for using ALA-induced PpIX for photodynamic therapy. The topical application of ALA to certain malignant and non-malignant lesions of the skin can induce a clinically useful degree of lesion-specific photosensitization. Superficial basal cell carcinomas showed a complete response rate of approximately 79% following a single exposure to light. Recent preclinical studies in experimental animals and human volunteers indicate that ALA can induce a localized tissue-specific photosensitization if administered by intradermal injection. A generalized but still quite tissue-specific photosensitization may be induced if ALA is administered by either subcutaneous or intraperitoneal injection or by mouth. This opens the possibility of using ALA-induced PpIX to treat tumors that are too thick or that lie too deep to be accessible to either topical or locally injected ALA.

Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy.

A study of tumor progression: The precursor lesions of superficial spreading and nodular melanoma

ContextLarge-scale studies are needed to determine if cancers other than Kaposi
sarcoma, non-Hodgkin lymphoma, and cervical cancer occur in excess in persons
with human immunodeficiency virus (HIV) infection or acquired immunodeficiency
syndrome (AIDS).ObjectivesTo examine the general cancer pattern among adults with HIV/AIDS and
to distinguish immunosuppression-associated cancers from other cancers that
may occur in excess among persons with HIV/AIDS.Design, Setting, and SubjectsAnalysis of linked population-based AIDS and cancer registry data from
11 geographically diverse areas in the United States, including 302 834
adults aged 15 to 69 years with HIV/AIDS. The period of study varied by registry
between 1978 and 1996.Main Outcome MeasureRelative risks (RRs) of cancers, calculated by dividing the number of
observed cancer cases by the number expected based on contemporaneous population-based
incidence rates. We defined cancers potentially influenced by immunosuppression
by 3 criteria: (1) elevated overall RR in the period from 60 months before
to 27 months after AIDS; (2) elevated RR in the 4- to 27-month post-AIDS period;
and (3) increasing trend in RR from before to after AIDS onset.ResultsExpected excesses were observed for the AIDS-defining cancers, but non–AIDS-defining
cancers also occurred in statistically significant excess (n = 4422; overall
RR, 2.7; 95% confidence interval [CI], 2.7-2.8). Of individual cancers, only
Hodgkin disease (n = 612; RR, 11.5; 95% CI, 10.6-12.5), particularly of the
mixed cellularity (n = 217; RR, 18.3; 95% CI, 15.9-20.9) and lymphocytic depletion
(n = 36; RR, 35.3; 95% CI, 24.7-48.8) subtypes; lung cancer (n = 808; RR,
4.5; 95% CI, 4.2-4.8); penile cancer (n = 14; RR, 3.9; 95% CI, 2.1-6.5); soft
tissue malignancies (n = 78; RR, 3.3; 95% CI, 2.6-4.1); lip cancer (n = 20;
RR, 3.1; 95% CI, 1.9-4.8); and testicular seminoma (n = 115; RR, 2.0; 95%
CI, 1.7-2.4) met all 3 criteria for potential association with immunosuppression.ConclusionAlthough occurring in overall excess, most non–AIDS-defining cancers
do not appear to be influenced by the advancing immunosuppression associated
with HIV disease progression. Some cancers that met our criteria for potential
association with immunosuppression may have occurred in excess in persons
with HIV/AIDS because of heavy smoking (lung cancer), frequent exposure to
human papillomavirus (penile cancer), or inaccurately recorded cases of Kaposi
sarcoma (soft tissue malignancies) in these persons. However, Hodgkin disease,
notably of the mixed cellularity and lymphocytic depletion subtypes, and possibly
lip cancer and testicular seminoma may be genuinely influenced by immunosuppression.

https://jamanetwork.com/journals/jama/articlepdf/193706/JOC01537.pdf

Association of cancer with AIDS-related immunosuppression in adults.

• There is an increased risk of developing cutaneous neoplasms in patients with renal transplants who are receiving immunosuppressive therapy. We studied 523 consecutive white patients who had received renal transplants at a Canadian medical center. Malignant neoplasms developed in 7.5% of these patients, and 72% of these neoplasms were cutaneous in origin. Compared with the general population, the rate of development of all skin cancers, squamous cell carcinoma, and basal cell carcinoma was 3.2, 18.4, and 1.4 times, respectively. In our study the squamous cell carcinoma to basal cell carcinoma ratio was 2.3:1, compared with 0.2:1 in the general population. There was no significant difference in the site of development of skin cancer in patients with renal transplants compared with the general population. There was, however, a propensity for the development of multiple skin cancers at an earlier age, especially on sun-exposed areas. The results of this study have been compared with those of other world medical centers. ( Arch Dermatol 1986;122:1288-1293)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=derm&articleId=547691&pdfFileName=archderm_122_11_015.pdf

Cutaneous Malignant Neoplasms in Patients With Renal Transplants

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/26860/0000425.pdf?sequence=1

The self-inflicted dermatoses: a critical review

• The dermatologic changes in anorexia nervosa and bulimia nervosa may be the first signs to give the clinician a clue that an eating disorder is present, as many of these patients either deny their symptoms or secretly refuse to comply with treatment. The dermatologic signs are a result of (1) starvation or malnutrition, eg, lanugolike body hair, asteatotic skin, brittle hair and nails, and carotenodermia; (2) self-induced vomiting, eg, hand calluses, dental enamel erosion, gingivitis, and a Sjogrenlike syndrome; (3) use of laxatives, diuretics, or emetics and their dermatologic side effects; and (4) other concomitant psychiatric illness, eg, hand dermatitis from compulsive handwashing. Further, as most of the cutaneous signs are not specific to anorexia nervosa and bulimia nervosa, failure to include eating disorders in the differential diagnosis may lead to misdiagnosis of the cutaneous symptoms. ( Arch Dermatol 1987;123:1386-1390)

Dermatologic signs in anorexia nervosa and bulimia nervosa.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/26126/0000202.pdf?sequence=1

Herbert F. Haberman

Papers

Cutaneous Malignant Neoplasms in Patients With Renal Transplants

The self-inflicted dermatoses: a critical review

Dermatologic signs in anorexia nervosa and bulimia nervosa.

Neurotic excoriations: a review and some new perspectives.

A Comparative Study of the Physical and Chemical Properties of Melanins Isolated from Human Black and Red Hair