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Cardiff, 14 March 1964.

Lymphocytic Lymphoma (Light Sensitive).—Dr. E. WADDINGTON.

A woman aged 44.History.—Since childhood she has had transient urticarial and erythematous rashes

after exposure to sunlight. In 1945 a crop of solid, irritable papnles appeared on theleft cheek during the summer. She was treated with superficial x-ray therapy with.some imjuovement. In 1954 similar lesions developed on the forehead in the early.spring and disappeared in the winter. In lOHfi there were grouj)ed. solid, opalescentpaj)ules on the right cheek varying in size from 1 to li mm. in diameter resemblingmiiiary lymphocytoma (Fig. I). On the left pre auricular area there was a larger,cyanotit;. infiltrated ]>laque. A biopsy from this lesion showed a dense dermal infiltrate(if lympliocytes, small and large reticuhmi cells and an oecasional eosinophil. Super-ficial x-ray therapy produced complete regression.

Fio. 1. Fi.i. 2.

During the last S years she has had a number of attaeks of urticaria, and erythemaon the exposed i)arts after exposure to the sun wlii{-h have been partly controlled withohioroqulne and a sunscre.^ii cream. In addition there has been a more persistenteruption of solid ])apu!es and larger plaques atlecting the forehead, cheeks and thesides and nape of the neck. These have responded to superficial x-ray therapy, onlyto reappear in the summer months.

Examination.—There are closely set solid papules on the right eheek and the fore-head. Larger infiltrated, cyanotic plaques involve the left ])re-auricular area andthe left side of the neck (Fig. 2). No other clinical alnioniiality. Blood examinationnormal.

448 WEST OP ENGLAND AND WALES DBEMATOLOGICAL SOCIETY

Histology.—The appearance is still very similar to that of the previous sections butthere is now a greater number of reticulum cells and the infiltrate extends deeply intothe underlying fat.

Comment.—A 19 years' history of an eruption which, in the beginning, resembledbenign light-sensitive miliary lymphocytoma but over the years has progressed to amalignant lymphoma.

Progressive Symmetrical Sclerodermia, Treated with POTABA.—Dr. E.WADDINGTON.

A man aged 66.History.—Fifteen years ago he developed Raynaud's phenomenon and small ulcers

on the fingertips. Eight years ago he began to lose weight and there was regurgitationof fluid after meals. Six years ago a diaphragmatic hernia was repaired and 3 yearslater a second operation was performed for oesophageal obstruction. Soon afterwardsthe skin of the hands and forearms became stiff and he had difficulty in moving thewrists and fingers.

Examination.—There is marked pigmentation and sclerosis of the fingers, dorsaof the hands and the forearms. The tips of the fingers are fissured. No other abnorma-lity.

Investigation.—Histology (forearm) shows dermal fibrosis with persisting butatrophic appendages and minimal chronic infiammation. The appearance is consistentwith scleroderma.

Badiological examination.—There is atony of the oesophagous with a stricture at thelower end and a small hiatus hernia of the oesophago-gastric type. Stomach and smallbowel normal. There are well marked sacculations involving the transverse and proxi-mal descending colon. No evidence of generalized osteoporosis. No soft tissue calci-nosis. The heart is not enlarged. There is calcification of the aortic arch. There ispleural thickening of the left lung base as a result of the previous thoracotomy. Thelungs are otherwise clear.

Serum proteins—total 7 3, albumin 2-9, globulin 4 4 g./lOO ml.Treatment.—In October, 1963 treatment commenced with potassium para-amino-

benzoate and pyridoxine hydrochloride 24 g. daily. This was reduced after one weekto 12 g. daily because of nausea. There has been a marked subjective and objectiveimprovement over the last few months.

Arsenical Keratoses, Intraepidermal, Squamous-cell and Basal-cellCarcinomata.—Dr. E. WADDINGTON.

A man aged 51.History.—He has had epilepsy since the age of 10 years. Until 1949 he was treated

with a medicine and is now controlled with phenytoin and phenobarbitorie.1955 : Lichen planus was diagnosed and treated with liquor arsenicalis for several

weeks. 1956 : He developed numerous scaly patches on the trunk and limbs and" warts " on the hands and feet. 1959 : Sections taken from the scrotum and groinsshowed intraepidermal carcinomata which were treated with x-ray therapy. 1960 :X-ray therapy to four areas on the abdomen. Two lesions on the scrotum wereexcised. 1962 : Sections taken from the right forearm and left axilla showed intra-epidermal carcinomata.

Examination.—Typical arsenical keratoses on the palms, back of the hands, fingersand soles of the feet. Numerous intraepidermal carcinomata affecting the dorsum ofthe hands, forearms, thighs, back and chest. Superficial basal-cell carcinomata on theright thigh and lumbar region and squamous cell carcinoma on the left side of thescrotum, all confirmed histologically.

Investigations.—Radiological investigation of the lungs and alimentary tractshowed no evidence of neoplasm. Liver function tests normal.

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Comment.—The epidermal changes which develop after ingestion of inorganicarsenic fall into two broad groups. In the first the patients have keratoses of theextremities and the cancers that develop are mainly squamous-cell in type. In theother group there are multiple, superficial basal-cell carcinomata, which often occurwithout keratoses (Sanderson, 1963). This patient is of interest because he has allfour types of arsenical tumours.

REFERENCE.

SANDERSON, K . V. (1963) Trans. St. John's Hosp. Derm. Soc, Lond., 49, 115.