Cutaneous involvement in Hodgkin's disease.

Among 465 patients with Hodgkin's disease seen from 1951 through 1980, there were 16 (3.4%) who had histologically verified "specific" cutaneous involvement with Hodgkin's disease. The most common clinical presentation was of single or multiple dermal or subcutaneous nodules. Three patients had skin lesions at first presentation. In all instances, it was possible to classify the cutaneous histologic pattern using the Rye Classification. In addition, one patient was seen in whom disease was confined to a localized area of skin and subcutaneous tissue. This case was difficult to classify, although there were some histologic features suggestive of lymphocyte-depletion Hodgkin's disease. The findings indicate three mechanisms of cutaneous involvement: (1) retrograde lymphatic spread, distal to involved lymph nodes (11 patients); (2) direct extension from an underlying nodal focus (3 patients); and (3) hematogenous dissemination (2 patients). Cutaneous involvement usually represents, or accompanies, Stage IV disease, and carries an ominous prognosis. The problems inherent in the diagnosis of primary cutaneous Hodgkin's disease are discussed.