Biomedical subjects
Publications and source records attributed to R JACKSON.
The clinical features of the more commonly seen black tumours of the skin are described. In almost all cases it should be possible to distinguish clinically between malignant melanoma and other black lesions. Black tumours are rarely malignant melanomas; most of these lesions are seborrheic keratoses or pigmented nevi.
The variations in the natural course of skin cancer are discussed in detail. Basal cell carcinoma (when properly classified) and squamous cell carcinoma have a reasonably predictable course; malignant melanoma and mycosis fungoides do not. Histological examination may not provide sufficient evidence on which to base a prognosis concerning a particular tumour; clinical evaluation may be of much greater value. The different rates of growth of any one tumour appear to be more closely related to host factors than to tumour virulence.
Results of treatment of 108 squamous cell carcinomas of the skin are analyzed. Fiftyone were successfully treated by the technique of electrodesiccation and curettage. There were two treatment failures by this method. Large squamous cell cancers showing histologically a marked degree of anaplasia and/or invasion are not suitable for this technique. Small squamous cell carcinomas, well differentiated, with minimal invasion, occurring on the exposed areas, in elderly and infirm patients can be treated successfully by electrodesiccation and curettage.
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The use of ionizing radiation and corticosteroids is discussed, in this third and final part of a review of diseases of the skin. Radiation is being used less extensively because superior methods of treatment are available for many conditions which formerly were frequently treated by this modality. The concept of applying the radiation at the level of the basic pathologic process has been developed into clinical practice by the use of generators which can produce very soft (or superficial) ionizing radiation. Topical or systemic corticosteroids do not cure skin diseases but produce dramatic suppression of signs and symptoms. For best results consideration must be given to the diagnosis, the natural history of the disease to be treated, the method of administration and a search for possible contraindications to the use of these steroids. Basic dermatological principles (removal of offending agents, bland soothing applications, sedation, etc.) must be adhered to. The corticosteroids are not a panacea in the treatment of skin disease.
Many systemic diseases have cutaneous manifestations. In some diseases skin involvement is the predominant factor (Behçet's syndrome, urticaria pigmentosa, discoid lupus erythematosus and pseudoxanthoma elasticum); in others the skin manifestations, when present, are an important part of the condition (sarcoidosis, systemic lupus erythematosus, hypersensitivity angiitis, porphyria). This report includes descriptions of and comments on these cutaneous manifestations. Erythema nodosum and erythema multiforme are reaction patterns of the skin and mucous membrane which may have many causes. The relationship between discoid and systemic lupus erythematosus is discussed. There is little doubt that these are variations of the same basic disease process, even though the prognoses are very different.
Some of the more recent advances and newer concepts about certain dermatological conditions are presented. Untoward reactions to drugs, whether to systemic or topical agents, are discussed in detail; emphasis is placed on their frequency and on the diversity of clinical findings. In the management of certain skin tumours (hemangiomas and melanocytic nevi) it is essential that the natural history of the lesion be considered. It is generally agreed that the answer to the problem of staphylococcal infection of the skin will be found in the host rather than the staphylococcus. Keratoacanthoma is a pseudocarcinoma of unknown etiology and sometimes gives rise to considerable difficulty in diagnosis. Diffuse alopecia in women is now a common dermatological problem, the cause of which is unknown. The hair loss associated with it is not permanent.
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