Thirty-eight cutaneous lesions previously diagnosed as spindle cell squamous carcinoma, "atypical fibroxanthoma," or dermal sarcoma are presented. Two patients had two lesions each; thus, there were 36 patients. Cases of spindle cell melanoma (including desmoplastic melanoma), sarcoma of subcutaneous origin, and "neuroid sarcoma" were excluded. On review, the lesions fell into two categories: (1) those with a definite component of invasive squamous carcinoma in addition to sarcoma-like areas (8 cases), and (2) those in which such a squamous component was not identified (30 cases). Cases in the former group were considered proven spindle cell squamous carcinomas, while those in the latter group were designated noncommittally as sarcoma-like tumors. Almost all patients were white and over 40 years of age. Four sarcoma-like tumors (from three patients) arose in areas previously treated with x-ray and all but two (both spindle cell squamous carcinomas) of the remainder in both categories arose in sun-damaged skin. Prognosis did not differ significantly between the two categories but depended primarily on the depth of invasion. Two of two tumors that extended into bone and four of seven that invaded skeletal muscle caused death; all of those involving only dermis (24) or dermis and subcutis (five) were successfully extirpated. Origin in an area that had received x-ray was also an unfavorable prognostic indicator; all three patients whose lesions arose in such areas died of tumor. This may have been related to depth of invasion because the three fatal postradiation sarcoma-like tumors all invaded muscle. It was concluded that the distinction between spindle cell squamous carcinoma and "atyical fibroxanthoma" is of little prognostic import per se, but rather that prognosis is primarily dependent on the depth of invasion and, perhaps, the type of antecedent irradiation.

Of 1810 patients with Hodgkin's disease seen at M. D. Anderson Hospital and Tumor Institute from 1944 to 1977, nine patients developed skin lesions which were histologically specific for the disease, an incidence of 0.5%. The initial manifestations were in the form of small papules and nodules that developed in seven of the nine patients in skin immediately distal to lymph nodes containing tumor, supporting the concept that skin involvement most often results from retrograde lymphatic spread from involved lymph nodes. Because the majority of the patients died within a few months following the development of the skin lesions, skin involvement is considered an indication of stage IV disease. Fifteen additional patients had had skin biopsies that were considered either diagnostic or suggestive of Hodgkin's disease, but were ultimately proven to be a variety of other conditions. Thus, Hodgkin's disease in skin can be simulated by other disease processes, and the diagnosis should be made with caution, particularly in the absence of lymph node involvement.

Two patients had carcinoma arising in eccrine spiradenoma. In both patients, recent changes in a long-standing cutaneous nodule prompted excision, and microscopic examination disclosed carcinoma intimately associated with and apparently arising from typical benign eccrine spiradenoma. One patient had lymph node metastasis.