LYMPHOMA ------------------------------------------------- Received a call today from an oncologist who evaluated a 40 yr old male who had a localized 1 cm area of induration of scalp excised by his GP (good grief). They could find no evidence of systemic involvement. The oncologist (not able to get authorization yet from the patient's HMO GP) called and asked me what to do. Local radiation tx? Nitrogen mustard? PUVA? No treatment until new lesion? It is not a T cell lesion which was confirmed by appropriate immunotyping etc. Robert M. Peppercorn, M.D. -------------------- x-ray therapy would seem to be the leading candidate for localized B-cell lymphoma on the skin. I dare say you''ll havle difficulty finding anything in print describing success rates with any other modality. Mark Valentine -------------------- Having the experience of seeing two cases of b-cell lymphoma presenting in the skin I would offer the following observations. If the lesion is truly isolated and there can be no nodal involvement demonstrated I have one patient, a local internist by the way, who had the area irradiated. Her workup and radiation was done at the NIH. She is at least 15 years post at this point and disease free as far as I know. My second patient presented when she as about 70 with diffuse nodular involvement of the skin. Her nodules did not respond well to electron beam because of their depth and she did not have demonstrable internal involvement for 10 or more years. When she did get internal involvement it did not seem to slow her down and she died with heart problems at 85 years of age. She also had a few attempts at systemic chemo with very little effect on her disease. Some of her lesions were intensely pruritic and this was resolved by my local injections of triamcinolone 2.5 mg/cc. The nodules also went away after injection so when she was getting them on her face she ask me to inject those because of their rather unsightly appearance. I hope these anecdotes may be of some help. L.J. Gregg,MD, --------------------