1
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Bhat K, Madhudiya R, Elhence PA, Singh S. Waxy papules, infiltrated alopecic plaques, and shin ichthyosis. Int J Dermatol 2024; 63:1036-1038. [PMID: 38501702 DOI: 10.1111/ijd.17087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 03/20/2024]
Abstract
A 38-year-old male presented with waxy papules, plaques over the neck and extremities, and ichthyotic scales over the lower limbs. Skin biopsy revealed a dense medium-sized lymphocytic infiltrate in the dermis, with perifollicular accentuation and focal exocytosis into the follicular epithelium with strong positivity for CD 3, 4, and 5. Considering the clinicopathological correlation, a diagnosis of follicular mycosis fungoides (FMF) was made. It is a variant of classic mycosis fungoides (MF) where atypical cells invade the follicular epithelium.
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Affiliation(s)
- Kriti Bhat
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rinkal Madhudiya
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
| | - Poonam A Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Singh
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
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2
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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3
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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4
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Quaglino P, Scarisbrick J, Roccuzzo G, Abeldano A, Battistella M, McCormack C, Cowan R, Cozzio A, Cury-Martins J, Enz P, Geskin L, Guenova E, Kim YH, Knobler R, Litvinov IV, Miyagaki T, Molgo M, Nicolay J, Papadavid E, Pinter-Brown L, Pujol Vallverdu R, Querfeld C, Ortiz-Romero P, Stadler R, Vermeer MH, Bagot M, Hodak E. Identifying unmet needs and challenges in the definition of a plaque in mycosis fungoides: An EORTC-CLTG/ISCL survey. J Eur Acad Dermatol Venereol 2023; 37:680-688. [PMID: 36606565 DOI: 10.1111/jdv.18852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Consensus about the definition and classification of 'plaque' in mycosis fungoides is lacking. OBJECTIVES To delineate a comprehensive view on how the 'plaque' entity is defined and managed in clinical practice; to evaluate whether the current positioning of plaques in the TNMB classification is adequate. METHODS A 12-item survey was circulated within a selected panel of 22 experts (pathologists, dermatologists, haematologists and oncologists), members of the EORTC and International Society for Cutaneous Lymphoma. The questionnaire discussed clinical and histopathological definitions of plaques and its relationship with staging and treatment. RESULTS Total consensus and very high agreement rates were reached in 33.3% of questions, as all panellists regularly check for the presence of plaques, agree to evaluate the presence of plaques as a potential separate T class, and concur on the important distinction between plaque and patch for the management of early-stage MF. High agreement was reached in 41.7% of questions, since more than 50% of the responders use Olsen's definition of plaque, recommend the distinction between thin/thick plaques, and agree on performing a biopsy on the most infiltrated/indurated lesion. High divergence rates (25%) were reported regarding the possibility of a clinically based distinction between thin and thick plaques and the role of histopathology to plaque definition. CONCLUSIONS The definition of 'plaque' is commonly perceived as a clinical entity and its integration with histopathological features is generally reserved to specific cases. To date, no consensus is achieved as for the exact definition of thin and thick plaques and current positioning of plaques within the TNMB system is considered clinically inadequate. Prospective studies evaluating the role of histopathological parameters and other biomarkers, as well as promising diagnostic tools, such as US/RM imaging and high-throughput blood sequencing, are much needed to fully integrate current clinical definitions with more objective parameters.
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Affiliation(s)
- Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Gabriele Roccuzzo
- Dermatologic Clinic, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alejandra Abeldano
- Hospital Gral. de Agudos Dr. C. Argerich, Ciudad de Buenos Aires, Buenos Aires, Argentina
| | - Maxime Battistella
- Université Paris Cité, INSERM U976 HIPI, Paris, France.,Department of Pathology, AP-HP Saint-Louis Hospital, Paris, France
| | - Chris McCormack
- Surgical Oncology Department, Peter MacCallum Cancer Centre, Parkvile, Victoria, Australia
| | - Richard Cowan
- Department of Clinical Oncology, The Christie Hospital, Manchester, UK
| | - Antonio Cozzio
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jade Cury-Martins
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Paula Enz
- Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Buenos Aires, Argentina
| | - Larisa Geskin
- Columbia University Medical Center, New York, New York, USA
| | | | - Youn H Kim
- Stanford Cancer Institute, Stanford, California, USA
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Ivan V Litvinov
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Tomomitsu Miyagaki
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Montserrat Molgo
- Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Nicolay
- Department of Dermatology, University Medical Center Mannheim, Mannheim, Germany
| | - Evangelina Papadavid
- 2nd Department of Dermatology and Venereology, ATTIKON University Hospital, Athens, Greece
| | | | | | | | - Pablo Ortiz-Romero
- Hospital 12 de Octubre, Institute I+12, CIBERONC, Medical School, Universidad Complutense, Madrid, Spain
| | - Rudolf Stadler
- University Hospitals of the Ruhr-University of Bochum, Minden, Germany
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, RC Leiden, The Netherlands
| | | | - Emmilia Hodak
- Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
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5
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Suggested Guidelines for the Treatment of Mycosis Fungoides in Countries with Limited Resources. Dermatol Res Pract 2023; 2023:1360740. [PMID: 36762366 PMCID: PMC9904957 DOI: 10.1155/2023/1360740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
The treatment options for mycosis fungoides (MF) have been expanding but unfortunately many of the currently used treatment modalities are unavailable in Egypt and other African/Arab countries. In addition, there is a lack of consensus on the treatment of hypopigmented MF (HMF), which is a frequently encountered variant in our population. We aimed to develop regional treatment guidelines based on the international guidelines but modified to encompass the restricted treatment availability and our institutional experience. Special attention was also given to studies conducted on patients with skin phototype (III-IV). Treatment algorithm was formulated at Ain-Shams cutaneous lymphoma clinic through the collaboration of dermatologists, haematologists, and oncologists. Level of evidence is specified for each treatment option. For HMF, phototherapy is recommended as a first line treatment, while low-dose methotrexate is considered a second line. For early classical MF, we recommend Psoralen-ultraviolet A (PUVA), which is a well-tolerated treatment option in dark phenotype. Addition of either retinoic acid receptor (RAR) agonist and/or methotrexate is recommended as a second line. Total skin electron beam (TSEB) is considered a third-line option. For advanced stage, PUVA plus RAR agonist and/or methotrexate is recommended as first line, TSEB or monochemotherapy is considered a second line option. Polychemotherapy is regarded as a final option. All patients with complete response (CR) enter a maintenance and follow-up schedule. We suggest a practical algorithm for the treatment of MF for patients with dark phenotype living in countries with limited resources.
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Roccuzzo G, Mastorino L, Gallo G, Fava P, Ribero S, Quaglino P. Folliculotropic Mycosis Fungoides: Current Guidance and Experience from Clinical Practice. Clin Cosmet Investig Dermatol 2022; 15:1899-1907. [PMID: 36124283 PMCID: PMC9482435 DOI: 10.2147/ccid.s273063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Introduction Folliculotropic mycosis fungoides (FMF) is the most frequent variant of mycosis fungoides (MF), with clinical features which differ from the classic form. As for therapeutic options, the latest guidelines on MF agree on a stage-driven strategy, in consideration of clinical presentation, symptom burden and patient’s comorbidities. Materials and Methods A search on MEDLINE, PubMed, Scopus and Cochrane Library was conducted to gather the latest evidence on FMF clinical management. Manuscripts published in the last five years (January 2017–April 2022) were included. Our single-center experience was also described. Results A total of 15 articles were analyzed, with a total of 432 patients (disease stage from IA to IVA2). The most widely-used treatment was psoralen ultra-violet A (PUVA) in monotherapy or in association with other drugs. Oral retinoid-based therapy was also described as a therapeutic option alone or in combination. Other therapy reported were based on Brentuximab Vedotin, Mogamulizumab, Carmustine, topical steroids, tazarotene and excimer laser, interferon, nitrogen mustard, imiquimod, systemic chemotherapy, extracorporeal photopheresis and stem cell transplantation. Discussion FMF is characterized by specific clinical-pathologic features. Advanced forms assume characteristics more similar to classic MF (infiltrated plaques and nodules), whilst early stages can present in a wide range of clinical forms (acneiform lesions, follicular-like keratoses, erythematous patches). As for therapeutic options, in absence of specific guidelines, a high number of treatments are described in clinical practice, with variable results. Phototherapy in all its forms, especially as PUVA, appears to have the greatest initial therapeutic success. Retinoids, although widely used, appear to be poorly effective in monotherapy, particularly acitretin. Combination treatment with phototherapy seems to be advisable. Ionizing treatments, such as radiotherapy and TSEBT, appear effective, at least in the short term. Overall, an integrated approach is mandatory for the inconstant course of the disease and its multidisciplinary nature.
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Affiliation(s)
- Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Giuseppe Gallo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
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7
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Análisis de supervivencia en pacientes con micosis fungoide foliculotropa de un centro latinoamericano. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:930-937. [DOI: 10.1016/j.ad.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 11/24/2022] Open
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8
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Primary cutaneous lymphoma: the 2018 update of the WHO-EORTC classification. Presse Med 2022; 51:104126. [DOI: 10.1016/j.lpm.2022.104126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
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9
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Gu AK, Shi J, Zhang Y. Folliculotropic Mycosis Fungoides. JAMA Dermatol 2022; 158:316. [PMID: 35107567 DOI: 10.1001/jamadermatol.2021.5181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- An-Kang Gu
- Department of Pathology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Jing Shi
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
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10
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Reiter O, Amitay-Laish I, Oren-Shabtai M, Feinmesser M, Amitai DB, Hodak E. Pediatric mycosis fungoides - characteristics, management, and outcomes with particular focus on the folliculotropic variant. J Eur Acad Dermatol Venereol 2022; 36:671-679. [PMID: 35080278 DOI: 10.1111/jdv.17971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature on pediatric mycosis fungoides (MF) and especially its folliculotropic variant (FMF) is sparse. OBJECTIVES To describe the clinical manifestations, treatments, outcomes and long-term course of pediatric MF, including FMF. METHODS A retrospective analysis was conducted of all consecutive MF patients diagnosed at ≤18 years attending two medical centers in 1995-2015. RESULTS The cohort included 71 patients, all but 2 of whom had early-stage disease: hypopigmented (55%) folliculotropic (42%) and classical MF (39%), alone or in combination. The head and neck area was involved in 43% of patients with early-stage FMF compared to 12% of the non-FMF group (p=0.004). There was no difference in the involvement of other body areas between the groups. Pruritus, although mild, was more often recorded among patients with early-stage FMF compared to non-FMF (58% vs. 29%, respectively, P=0.02). Complete response (CR) was achieved in 60 of the 69 patients with early-stage MF (87%) after an average of 1.8 treatment modalities. NBUVB was the most administered treatment to non-FMF patients with CR rates of 63% versus 29% of FMF patients (P=0.04). Systemic/bath PUVA, or UVA+NBUVB were the most administered treatments to FMF patients with CR rates of 60% versus 81% for non-FMF patients (P=0.17). During a mean follow-up of 9.2 years (range 1-24), stage progression was observed in 4 (6%) of the patients with early-stage disease, 2 of whom (all FMF) to advanced stage. CONCLUSIONS Pediatric MF presents as an early-stage disease with over-representation of hypopigmented and FMF variants. NBUVB and UVA-based therapies yield good response rates in non-FMF and FMF patients, respectively. Disease course is indolent, and even on relatively long follow-up, it has a very low progression rate from early to advanced-stage disease, occurring in patients with FMF. We propose a treatment algorithm for pediatric MF.
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Affiliation(s)
- O Reiter
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Amitay-Laish
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Oren-Shabtai
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | - M Feinmesser
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Ben Amitai
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, 49420235, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Hodak
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wen P, Xie Y, Wang L. The Role of microRNA in Pathogenesis, Diagnosis, Different Variants, Treatment and Prognosis of Mycosis Fungoides. Front Oncol 2021; 11:752817. [PMID: 34966672 PMCID: PMC8710607 DOI: 10.3389/fonc.2021.752817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023] Open
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL), accounting for approximately 50% of all CTCLs. Although various molecular changes in MF have been described in existing studies, no obvious disease-specific changes have been found thus far. microRNAs (miRs) are short, noncoding RNA molecules that play roles in the post-transcriptional regulation of oncogenes and tumor suppressor genes in various diseases. Recently, there has been rapidly expanding experimental evidence for the role of miRs in the progression, early diagnosis, prognosis prediction for MF. Efforts to improve early diagnosis and develop personalized therapy options have become more important in recent years. Here, we provide an overview and update of recent advances regarding miRs associated with MF. Furthermore, we provide insights into future opportunities for miR-based therapies.
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Affiliation(s)
- Pengfei Wen
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Wang
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
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12
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Myers E, Kheradmand S, Miller R. An Update on Narrowband Ultraviolet B Therapy for the Treatment of Skin Diseases. Cureus 2021; 13:e19182. [PMID: 34873522 PMCID: PMC8634827 DOI: 10.7759/cureus.19182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/25/2022] Open
Abstract
The objective of this review is to provide an update on narrowband ultraviolet B (NB-UVB) as a treatment for various skin conditions. NB-UVB works by suppressing the cutaneous cell-mediated immune response and has been shown to be an efficacious and clinically tolerable treatment for a range of inflammatory dermatoses. A literature search was conducted by advanced searches of PubMed for NB-UVB treatment of dermatologic skin diseases with a focus on reports from 2010 to 2021, including both office-based and home-based phototherapy (HBPT). Data were prioritized based on studies with a high level of evidence using the Oxford Evidence-Based Medicine guidance. We found that NB-UVB continues to serve as an effective form of therapy for several cutaneous conditions, including vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, and other inflammatory dermatoses. The recent introduction of Janus kinase inhibitors in combination with NB-UVB suggests future promise in the treatment of vitiligo. Despite its rise in popularity, a decline was seen in office-based NB-UVB treatment during the coronavirus disease 2019 pandemic. Options are available to deliver NB-UVB at home with comparable efficacy to office-based treatments. In conclusion, for a select group of patients and conditions, NB-UVB continues to serve as an effective treatment modality with minimal side effects, with HBPT serving as an option to improve patient compliance.
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Affiliation(s)
- Elisha Myers
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Shiva Kheradmand
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
| | - Richard Miller
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
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13
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Prag Naveh H, Amitay-Laish I, Zidan O, Leshem YA, Sherman S, Noyman Y, Taieb J, Didkovsky E, Hodak E. Real-life experience with chlormethine gel for early-stage mycosis fungoides with emphasis on types and management of cutaneous side-effects . J DERMATOL TREAT 2021; 33:2364-2370. [PMID: 34427536 DOI: 10.1080/09546634.2021.1967266] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Real-life efficacy data on the recently approved once daily application of chlormethine gel (CG) for mycosis fungoides (MF) is limited, and detailed characterization of the side effects and their management are strikingly sparse. OBJECTIVE To evaluate the efficacy and particularly the side effect profile of CG in early-stage MF patients in a real-life setting. METHODS We performed a single-center retrospective analysis of 66 early-stage MF adult patients treated with CG in 2016-2019. RESULTS Treatment with a once-daily application (52%), or at lower frequencies (48%), in some with topical corticosteroids (TCS) (40%), resulted in an overall response rate of 50%, with no significant difference between stage IA and IB. Cutaneous side effects (56%) included irritant or allergic contact dermatitis (36%, mostly mild/moderate and manageable by reducing application frequency and/or adding TCS or interrupting treatment), unmasking effect (9%), hyperpigmentation (14%), and pruritus (9%). Withdrawal due to side effects occurred in 19.6% of patients (15% for contact dermatitis). CONCLUSION In real-life management, flexible regimens of CG sometimes with TCS, show efficacy in early-stage MF and may reduce the rate of contact dermatitis, the main treatment-limiting side effect. Practical recommendations with emphasis of the types, time of appearance, and management of side effects are provided.
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Affiliation(s)
- Hadas Prag Naveh
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Iris Amitay-Laish
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Zidan
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Yael A Leshem
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shany Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Noyman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Joseph Taieb
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Elena Didkovsky
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Furukawa F, Makino T, Torai R, Mori S, Terada Y, Seki T, Shimizu T. Effectiveness of combined bexarotene and excimer laser treatment for folliculotropic mycosis fungoides. Eur J Dermatol 2021; 31:ejd.2021.4085. [PMID: 34405813 PMCID: PMC8572682 DOI: 10.1684/ejd.2021.4085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fumina Furukawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Teruhiko Makino
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ryotaro Torai
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shuichi Mori
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yoshiyuki Terada
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Taiki Seki
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Tadamichi Shimizu
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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15
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Grandi V, Baldo A, Berti E, Quaglino P, Rupoli S, Alaibac M, Alberti-Violetti S, Amerio P, Brazzelli V, Bruni PL, Calzavara-Pinton P, Parodi A, Cozzani E, Burlando M, Fargnoli MC, Gambini D, Iacovelli P, Pacifico A, Longo C, Monfrecola G, Motolese A, Mozzicafreddo G, Cota C, Pigatto P, Pileri A, Savoia P, Simonacci M, Venturini M, Offidani A, Molinelli E, Pellegrino M, Trovato E, Piccinno R, Lawrence K, Pimpinelli N. Italian expert-based recommendations on the use of photo(chemo)therapy in the management of mycosis fungoides: Results of an e-Delphi consensus. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:334-342. [PMID: 33458864 DOI: 10.1111/phpp.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/26/2020] [Accepted: 01/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Phototherapy is a mainstay for the treatment of MF. However, there is scarce evidence for its use, mostly due to the lack of a unified schedule. AIMS The primary aim of this study was to establish the first structured, expert-based consensus regarding the indications and technical schedules of NB-UVB and PUVA for MF. The secondary aim was to determine the consensus level for each specific item. MATERIALS & METHODS E-delphi study. Item-specific expert consensus was defined as the number of "Totally Agree" results to ≥80% of the panelists. Cronbach alpha index ≥0.7 was used as a measure of homogeneity in the responses among questions related to the same topic. RESULTS Overall, there was a high homogeneity among responders (0.78). On specific topics, the highest grade was observed for technical items (0.8) followed by indications for early (0.73) and advanced stages (0.7). CONCLUSIONS Items related to the most canonical indications of phototherapy and to treatment schedules showed the highest agreements rates. There is consensus about the use of standardized treatment schedules for the induction and consolidation phases for NB-UVB and PUVA in MF.
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Affiliation(s)
- Vieri Grandi
- Dip. Scienze della Salute, sezione Dermatologia, Universita' degli Studi di Firenze, Firenze, Italy.,St John's Institute of Dermatology, GSTT NHS Foundation Trust, London, UK
| | - Antonello Baldo
- Clinica Dermatologica Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Emilio Berti
- Dipartimento di Medicina Interna, UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Dipartimento di Medicina, Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milano, Italy
| | - Pietro Quaglino
- Clinica Dermatologica AOU Città della Salute e della Scienza, Università degli Studi di Torino, Torino, Italy
| | - Serena Rupoli
- SOD Clinica Ematologica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mauro Alaibac
- Clinica Dermatologica, Università degli Studi di Padova, Padova, Italy
| | - Silvia Alberti-Violetti
- Dipartimento di Medicina Interna, UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Dipartimento di Medicina, Fisiopatologia medico-chirurgica e dei trapianti, Università degli Studi di Milano, Milano, Italy
| | - Paolo Amerio
- Clinica Dermatologica Università degli Studi G. D'Annunzio, Chieti, Italy
| | - Valeria Brazzelli
- Clinica Dermatologica, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
| | - Pier Luigi Bruni
- Struttura Complessa di Clinica Dermatologica, Azienda Ospedaliera S. Maria, Terni, Italy
| | | | - Aurora Parodi
- Clinica Dermatologia, DISSAL, Ospedale Policlinico IRCSS San Martino, Genova, Italy
| | - Emanuele Cozzani
- Clinica Dermatologia, DISSAL, Ospedale Policlinico IRCSS San Martino, Genova, Italy
| | - Martina Burlando
- Clinica Dermatologia, DISSAL, Ospedale Policlinico IRCSS San Martino, Genova, Italy
| | - Maria Concetta Fargnoli
- UOSD di Dermatologia Generale ed Oncologica, Ospedale San Salvatore, e Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi dell'Aquila, L'Aquila, Italy
| | | | | | | | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | | | - Alberico Motolese
- S.C. Dermatologia, Azienda USL di Reggio Emilia - IRCCS, Presidio Ospedaliero Provinciale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Carlo Cota
- UO Dermatologia, INRCA-IRCSS, Ancona, Italy
| | - Paolo Pigatto
- Dermatologia, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Alessandro Pileri
- UO Dermatologia, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Università degli Studi di Bologna, Bologna, Italy
| | - Paola Savoia
- Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - Marco Simonacci
- Unità Operativa Dermatologia, Ospedale di Macerata, Macerata, Italy
| | - Marina Venturini
- Clinica Dermatologica Università di Brescia e U.O. Dermatologia, ASST Spedali Civili, Brescia, Italy
| | - Annamaria Offidani
- SOD Clinica di Dermatologia, Azienza Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elisa Molinelli
- SOD Clinica di Dermatologia, Azienza Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Emanuele Trovato
- Dermatologia, Ospedale Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Roberta Piccinno
- Sezione Fotoradioterapia, UOC Dermatologia, Dipartimento di Medicina Interna e Specialità Mediche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Karl Lawrence
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College of London, London, UK
| | - Nicola Pimpinelli
- Dip. Scienze della Salute, sezione Dermatologia, Universita' degli Studi di Firenze, Firenze, Italy
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16
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Sławińska M, Sokołowska-Wojdyło M, Olszewska B, Nowicki RJ, Sobjanek M, Zalaudek I. Dermoscopic and trichoscopic features of primary cutaneous lymphomas - systematic review. J Eur Acad Dermatol Venereol 2021; 35:1470-1484. [PMID: 33710688 DOI: 10.1111/jdv.17219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/25/2021] [Indexed: 01/24/2023]
Abstract
Dermoscopy and trichoscopy are non-invasive methods used as auxiliary tools in diagnostics of different dermatoses. To date, no systematic review concerning the utility of dermoscopy and trichoscopy in the diagnostics of primary cutaneous lymphomas has been published. The aim of this study was to summarize the current state of knowledge on this topic based on systematic search of PubMed database and related references published before 8th of August 2020. Besides dermoscopic features, type of dermoscope, polarization mode, magnification, number of cases and histopathological correlation were analysed. A total of 34 records were included into the final analysis, evaluating 141 patients diagnosed with primary cutaneous T-cell lymphomas and 70 patients with primary cutaneous B-cell lymphomas. Most of the analysed records evaluated dermoscopic features (n = 206); trichoscopy was analysed in only 5 cases. Structures most commonly observed in classical mycosis fungoides (n = 108) were fine short linear vessels/linear vessels, spermatozoa-like vessels and orange-yellow patchy areas. In folliculotropic mycosis fungoides (n = 12), most frequently observed were comedonal lesions/comedo openings/central keratotic plugs and white halo around hair follicles/perifollicular accentuation. Primary cutaneous marginal zone B-cell lymphoma (n = 42) and primary cutaneous follicle centre lymphoma (n = 20) most commonly presented with salmon-coloured background and fine short/linear irregular/serpentine vessels. For other PCL, with less than 10 cases reported in the analysed records, details have been provided in the article. Most observations analysed in this systematic review rely on findings from case reports/case series (with the level of evidence V) and lack a control group. A few studies provided information concerning technical aspects of dermoscopic/trichoscopic examination. The role of dermoscopy/trichoscopy in diagnostics of cutaneous lymphomas requires further studies, especially in entities where dermoscopic features have been described in only single or a few cases. However, it seems that this practical, accessory tool in future may provide additional clues during clinical assessment.
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Affiliation(s)
- M Sławińska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sokołowska-Wojdyło
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - B Olszewska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - R J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
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17
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Quaglino P, Prince H, Cowan R, Vermeer M, Papadavid L, Bagot M, Servitjie O, Berti E, Guenova E, Stadler R, Querfeld C, Busschots A, Hodak E, Patsatsi A, Sanches J, Maule M, Yoo J, Kevin M, Fava P, Ribero S, Zocchi L, Rubatto M, Fierro M, Wehkamp U, Marshalko M, Mitteldorf C, Akilov O, Ortiz-Romero P, Estrach T, Vakeva L, Enz P, Wobser M, Bayne M, Jonak C, Rubeta M, Forbes A, Bates A, Battistella M, Amel-Kashipaz R, Vydianath B, Combalia A, Georgiou E, Hauben E, Hong E, Jost M, Knobler R, Amitay-Laish I, Miyashiro D, Cury-Martins J, Martinez X, Muniesa C, Prag-Naveh H, Nikolaou V, Quint K, Ram-Wolff C, Rieger K, Stranzenbach R, Szepesi Á, Alberti-Violetti S, Felicity E, Cerroni L, Kempf W, Whittaker S, Willemze R, Kim Y, Scarisbrick J. Treatment of early-stage mycosis fungoides: results from the PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study. Br J Dermatol 2021; 184:722-730. [PMID: 32479678 PMCID: PMC7704558 DOI: 10.1111/bjd.19252] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is a prospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) in patients with newly diagnosed mycosis fungoides (MF). OBJECTIVES To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB) staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures. METHODS In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centres in 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review. RESULTS The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smaller percentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariate analysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA, 20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs. T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%, while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improved significantly both in patients with responsive disease and in those with stable disease. CONCLUSIONS Disease characteristics such as presence of plaques and FMF influence physician treatment choices, and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, future treatment guidelines for early-stage MF need to address these issues.
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Affiliation(s)
- P. Quaglino
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - H.M. Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R. Cowan
- Christie Hospital, Manchester UK
| | - M. Vermeer
- Leiden University Medical Centre, The Netherlands
| | | | - M. Bagot
- Hospital St Louis, Paris, France
| | - O. Servitjie
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - R. Stadler
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - C. Querfeld
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | | | - E. Hodak
- Rabin Medical Center, Tel Aviv University, Israel
| | - A. Patsatsi
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - J. Sanches
- University of Sao Paulo Medical School, Brazil, South America
| | - M. Maule
- Cancer Epidemiology Unit, Department Medical Sciences, University of Turin, Italy
| | - J. Yoo
- University Hospitals Birmingham, UK
| | - M. Kevin
- University Hospitals Birmingham, UK
| | - P. Fava
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - S. Ribero
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - L. Zocchi
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M. Rubatto
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - M.T. Fierro
- Dermatologic Clinic, University of Turin Medical School, Torino, Italy
| | - U. Wehkamp
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - C. Mitteldorf
- HELIOS Klinikum Hildesheim GmbH, University Medical Center Göttingen, Germany
| | - O. Akilov
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | | | - T. Estrach
- Hospital Clinico, University of Barcelona, Spain
| | - L. Vakeva
- Helsinki University Central Hospital, Finland
| | - P.A. Enz
- Hospital Italiano De Buenos Aires, Argentina, South America
| | - M. Wobser
- University Hospital Wuerzburg, Germany
| | | | - C. Jonak
- Dept of Dermatology, Medical University of Vienna, Austria
| | - M. Rubeta
- Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford UK
| | | | - A. Bates
- University Hospital Southampton, Southampton, UK
| | | | | | | | - A. Combalia
- Hospital Clinico, University of Barcelona, Spain
| | - E. Georgiou
- Aristotle University of Thessaloniki, in Papageorgiou General Hospital, Greece
| | - E. Hauben
- Belgium University Hospitals Leuven, Leuven, Belgium
| | | | - M. Jost
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R. Knobler
- Dept of Dermatology, Medical University of Vienna, Austria
| | | | - D. Miyashiro
- University of Sao Paulo Medical School, Brazil, South America
| | - J. Cury-Martins
- University of Sao Paulo Medical School, Brazil, South America
| | - X. Martinez
- City of Hope National Medical Center and Beckman Research Institute, Duarte, California, US
| | - C. Muniesa
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - K. Quint
- Leiden University Medical Centre, The Netherlands
| | | | | | - R. Stranzenbach
- University Medical Centre, Johannes Wesling, Minden, Germany
| | - Á. Szepesi
- Semmelweis University, Budapest, Hungary
| | | | | | - L. Cerroni
- Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria
| | - W. Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zurich, Switzerland
| | - S. Whittaker
- Kings College London, Guys and St Thomas NHS Foundation Trust, London
| | - R. Willemze
- Leiden University Medical Centre, The Netherlands
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18
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Cutaneous Lymphomas — Part I: Mycosis Fungoides, Sézary Syndrome, and CD30+ Cutaneous Lymphoproliferative Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Pujol R, Gallardo F. Linfomas cutáneos. Parte I: micosis fungoide, síndrome de Sézary y proliferaciones linfoides cutáneas CD30 positivas. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:14-23. [DOI: 10.1016/j.ad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
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20
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Laggis CW, Lamb A, Secrest AM, Ufkes N, Halwani AS, Tao R, Gaffney D, Miles RR, Florell SR, Wada D. Favourable outcomes in folliculotropic mycosis fungoides after multimodality treatment in a single institution. J Eur Acad Dermatol Venereol 2020; 35:e42-e45. [PMID: 32594555 DOI: 10.1111/jdv.16790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- C W Laggis
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - A Lamb
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - A M Secrest
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - N Ufkes
- Medical University of South Carolina School of Medicine, Charleston, SC, USA
| | - A S Halwani
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Oncology, University of Utah, Salt Lake City, UT, USA
| | - R Tao
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - D Gaffney
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - R R Miles
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - S R Florell
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - D Wada
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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21
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Luo Y, Liu Z, Liu J, Liu Y, Zhang W, Zhang Y. Mycosis Fungoides and Variants of Mycosis Fungoides: A Retrospective Study of 93 Patients in a Chinese Population at a Single Center. Ann Dermatol 2019; 32:14-20. [PMID: 33911704 PMCID: PMC7992633 DOI: 10.5021/ad.2020.32.1.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Mycosis fungoides (MF) is the most common types of cutaneous T cell lymphoma. It typically presents with erythematous patches and plaques in the early stage and tumors and extracutaneous involvement with possibly fatal outcomes in the late stage. To facilitate early and accurate diagnosis of MF, it is essential to be knowledgeable of classic and variants of this disease. However, there is limited published data in the Chinese population. Objective To characterize our patient group and to provide additional insight into these malignancies. Methods Patients diagnosed with mycosis fungoides and its variants from October 2012 to January 2018 were retrospectively analyzed. Disease-specific survival (DSS) rate and curve according to early and advanced stages were also calculated. Results The mean age at diagnosis of ninety-three MF patients was 38.9±1.73 years (range: 6~77). Forty-five males (48.4%) and 48 females (51.6 %) were included in this study. The DSS rate of early-stage MF was 98.6%, while that of advanced stage MF was 88.9%. There was a significant difference in DSS rate between early stage and advanced stage MF (p=00.042, log-rank test). The median age of 10 patients with hypopigmented MF (hMF) was 10.5 years (range: 6~28). The age of hMF was younger than that of classical MF patients (p<0.05). Conclusion Early-stage MF has a better prognosis than advanced stage and hMF affects younger people than classic MF among Chinese. This study provides an insight into mycosis fungoides and its variants in a Chinese population.
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Affiliation(s)
- Yixin Luo
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaorui Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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Garcia-Arpa M, Flores-Terry MA, Franco-Muñoz M, de Lara-Simón IM. Spiky follicular mycosis fungoides and hidradenitis suppurativa-like lesions in a patient - complete remission with interferon alpha. An Bras Dermatol 2019; 95:121-123. [PMID: 31899065 PMCID: PMC7058870 DOI: 10.1016/j.abd.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/01/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mónica Garcia-Arpa
- Department of Dermatology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - Miguel A Flores-Terry
- Department of Dermatology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Monserrat Franco-Muñoz
- Department of Dermatology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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23
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Kamijo H, Sugaya M. Two distinct variants of mycosis fungoides (MF): Folliculotropic MF and erythrodermic MF. J Dermatol 2019; 46:1136-1140. [PMID: 31625194 DOI: 10.1111/1346-8138.15114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) is the most frequent type of cutaneous T-cell lymphoma. Folliculotropic MF (fMF) and erythrodermic MF (eMF) are two distinct variants of MF. Both variants have been considered aggressive and most cases are less responsive to standard skin-directed therapies than classical MF. We, however, experienced many cases with fMF or eMF who showed indolent clinical courses. In this article, we reviewed 10 cases with fMF and 13 cases with eMF who came to our department between 2005 and 2017. In patients with fMF, monotherapy with topical corticosteroid was effective in two cases (20%) and ultraviolet phototherapy with oral retinoid controlled disease activity in two cases (20%). Five patients with eMF (38%) responded well to ultraviolet phototherapy. In conclusion, patients with early fMF and a subgroup of eMF patients have an indolent disease course, as was proposed among the specialists. Skin-directed therapies are preferable rather than aggressive treatment in those cases.
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Affiliation(s)
- Hiroaki Kamijo
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Dermatology, International University of Health and Welfare, Chiba, Japan
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Denis D, Beneton N, Laribi K, Maillard H. Management of mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL): focus on chlormethine gel. Cancer Manag Res 2019; 11:2241-2251. [PMID: 30962713 PMCID: PMC6433101 DOI: 10.2147/cmar.s138661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mycosis fungoides (MF) is a low-grade cutaneous lymphoma accounting for more than half of primary cutaneous T-cell lymphomas (CTCLs). Due to the rarity of CTCL, randomized studies are lacking, and treatment is based mainly on the recent published European Organisation for Research and Treatment of Cancer guidelines. Basically, early-stage MF is treated with skin-directed treatments, whereas advanced-stage MF requires more aggressive therapies. Among the skin-directed therapies, nitrogen mustard has been used for more than 50 years. A gel formulation was developed recently, showing a slight decrease in efficacy, counterbalanced by better tolerance (essentially due to a decrease in delayed hypersensitivity reactions). This review aims to summarize the current management of MF and the role of chlormethine gel in the treatment of the disease.
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Affiliation(s)
- Daphné Denis
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
| | - Nathalie Beneton
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
| | - Kamel Laribi
- Haematology Department, Centre Hospitalier Le Mans, Le Mans, France
| | - Hervé Maillard
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
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25
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Dereure O. [Primary skin lymphomas: Current therapy]. Ann Dermatol Venereol 2019; 146:92-99. [PMID: 30709635 DOI: 10.1016/j.annder.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/16/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
Therapeutic progress in primary cutaneous lymphomas continues to be largely dominated by the T-cell lymphomas, towards which the great majority of recent therapeutic innovations have been directed. The latter include local treatments consisting either of relatively classical but "revamped" approaches involving different pharmaceutical forms (example: chlormethine gel) or else lower but seemingly equally effective dosages (electron therapy), or of more innovative approaches (example: UVA-1, dynamic phototherapy, imiquimod, resimiquimod). However, significant progress has been made chiefly in terms of systemic treatments with the emergence of "targeted" drugs that directly and specifically target tumour cells (monoclonal antibodies directed against CD30, CCR4 or CD158k) and the further development of "small" molecules such as histone deacetylase inhibitors and new cytostatics. Immunotherapies, which have proven so effective in other areas of oncodermatology, are also of great interest, while allogeneic haematopoietic stem-cell transplantation has clearly shown its superiority over autologous transplantation and now constitutes a significant component of the therapeutic arsenal in advanced disease. While the innovations in terms of B-cell lymphomas are certainly less significant, mention must also be made of the value of rituximab combined with polychemotherapy (CHOP) and of lenalidomide (as second-line therapy) in primary cutaneous diffuse large B-cell lymphoma, leg type, along with the development of localized (very) low-dose radiotherapy in unilesional or paucilesional indolent forms.
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Affiliation(s)
- O Dereure
- Unité Inserm U1058, département de dermatologie, université Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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26
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The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019; 133:1703-1714. [PMID: 30635287 DOI: 10.1182/blood-2018-11-881268] [Citation(s) in RCA: 741] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Primary cutaneous lymphomas are a heterogeneous group of T- and B-cell lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. The 2005 World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) consensus classification has served as a golden standard for the diagnosis and classification of these conditions. In September 2018, an updated version of the WHO-EORTC was published in the fourth edition of the WHO Classification of Skin Tumours Blue Book. In this classification, primary cutaneous acral CD8+ T-cell lymphoma and Epstein-Barr virus positive (EBV+) mucocutaneous ulcer are included as new provisional entities, and a new section on cutaneous forms of chronic active EBV disease has been added. The term "primary cutaneous CD4+ small/medium T-cell lymphoma" was modified to "primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder" because of its indolent clinical behavior and uncertain malignant potential. Modifications have also been made in the sections on lymphomatoid papulosis, increasing the spectrum of histologic and genetic types, and primary cutaneous marginal zone lymphomas recognizing 2 different subtypes. Herein, the characteristic features of these new and modified entities as well as the results of recent molecular studies with diagnostic, prognostic, and/or therapeutic significance for the different types of primary cutaneous lymphomas are reviewed. An update of the frequency and survival of the different types of primary cutaneous lymphomas is provided.
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Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas arising in the skin. Mycosis fungoides (MF), the most common variant, is characterised by clonal proliferation of skin residing malignant T-cells. Initially appearing with erythematous patches and plaques it follows a chronic course with progression to cutaneous tumours and extracutaneous involvement in some patients. Phototherapy with ultraviolet A radiation combined with 8-methoxypsoralen (PUVA) and with narrow-band ultraviolet B radiation (NB-UVB) are among the first line options for the treatment of MF and can induce remission in most patients. Sézary syndrome (SS) is a rare and more aggressive CTCL variant with generalized skin involvement. Patients with SS and with erythroderma from MF can benefit from treatment with extracorporeal photochemotherapy (ECP) where peripheral blood is exposed to PUVA. Phototherapy can be safely combined with systemic agents, most notably interferon-alpha and retinoids. Another photoresponsive CTCL variant is lymphomatoid papulosis (LP), a CD30+ lymphoproliferative disease characterised by chronically recurring papules. The disease responds favourably to PUVA but low dose methotrexate might be preferred for long term disease control. Recently updated treatment guidelines have been published to provide evidence-based algorithms for the stage-oriented treatment of MF, SS and LP. Areas of uncertainty are treatment schedules that are currently not optimised for CTCL, the use of phototherapy for maintenance, and the value of ultraviolet A1 radiation, excimer lasers, and photodynamic therapy.
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Affiliation(s)
- Franz Trautinger
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Austria.
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Fertitta L, Fontbrune FSD, Battistella M, De Masson A, Bergeron A, Ranta D, Vignon-Pennamen MD, Bagot M, Bouaziz JD. Folliculotropic mycosis fungoides associated with GATA2 deficiency: a new skin manifestation. Br J Dermatol 2018; 179:1420-1421. [PMID: 30101490 DOI: 10.1111/bjd.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - A Bergeron
- Department of Pneumology, Hôpital Saint Louis, AP-HP, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - D Ranta
- Department of Haematology, CHRU de Nancy, Nancy, France
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Folliculotropic mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:543-557. [DOI: 10.1111/ddg.13514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Christina Mitteldorf
- Department of DermatologyVenereology and AllergologyHELIOS Medical Center Hildesheim Hildesheim Germany
- Department of DermatologyVenereology and AllergologyGöttingen University Medical Center Göttingen Germany
| | - Rudolf Stadler
- Department of DermatologyVenereologyAllergologyand PhlebologyMühlenkreisklinikenJohannes Wesling Medical Center Minden Germany
| | - Christian A. Sander
- Eduard Arning Department of Dermatology and AllergologyAsklepios Klinik St. Georg Hamburg Germany
| | - Werner Kempf
- Kempf und PfaltzDermatopathology Laboratory Zurich Switzerland
- Department of DermatologyVenereology and AllergologyZurich University Hospital Zurich Switzerland
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Die follikulotrope Mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:544-559. [DOI: 10.1111/ddg.13514_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Klinik für DermatologieVenerologie und AllergologieHELIOS Klinikum Hildesheim
- Klinik für DermatologieVenerologie und Allergologie Göttingen
| | - Rudolf Stadler
- Universitätsklinik für DermatologieVenerologieAllergologie und PhlebologieMühlenkreisklinikenJohannes Wesling Klinikum Minden
| | - Christian A. Sander
- Eduard‐Arning‐Klinik für Dermatologie und AllergologieAsklepios Klinik St. Georg Hamburg
| | - Werner Kempf
- Kempf und Pfaltz histologische Diagnostik Zürich
- Universitätsspital ZürichKlinik für DermatologieVenerologie und Allergologie Zürich
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Deonizio JMD, Guitart J, Yazdan P, Mulinari-Brenner F, Sotto MN, Sanches JA. Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression. Int J Dermatol 2018; 57:675-680. [PMID: 29603194 DOI: 10.1111/ijd.13967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/31/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Folliculotropic mycosis fungoides (FMF) is a cutaneous T-cell lymphoma mainly affecting the hair follicle, which seems to represent a place of immune privilege phenomenon. OBJECTIVES To explore a possible role of immune privilege (IP) in FMF analyzing the major histocompatibility complex (MHC) expression. METHODS Immunohistochemistry for HLA-G and MHC-II was performed to formalin-fixed paraffin-embedded cutaneous skin biopsies of FMF patients (n = 43), conventional mycosis fungoides (CMF; n = 13), alopecia areata (AA; n = 13), and normal scalp skin (NS; n = 12). RESULTS HLA-G expression was lower in FMF (34%: 14/41) and CMF (18%: 2/11) groups compared to alopecia areata (92%:11/12) and normal scalp skin group (100%: 12/12). MHC-II expression in hair follicle was greater in the FMF group (18/42: 43%) compared to AA (0%) and NS (0%). HLA-G and MHC-II expression in cellular infiltrate had no difference among FMF and CMF groups and was different compared to the AA group. CONCLUSIONS Our data support the hypothesis of disruption of immune privilege based on the lower expression of HLA-G and higher expression of MHC-II in the follicular epithelium in mycosis fungoides compared to alopecia areata and normal scalp skin. The lack of difference between FMF and CMF groups did not support the role of these molecules as a driver of folliculotropism. The expression of MHC molecules seems to be different between neoplastic and inflammatory infiltrates. The definitive significance of expression of the MHC molecules remains unclear, and more studies are necessary to fully understand the role of these molecules in cutaneous lymphomas.
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Affiliation(s)
- Janyana M D Deonizio
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Joan Guitart
- Department of Dermatopathology, Northwestern University, Chicago, USA
| | - Pedram Yazdan
- Department of Dermatopathology, Northwestern University, Chicago, USA
| | | | - Mirian N Sotto
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - José A Sanches
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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33
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van Santen S, Vermeer MH, Willemze R. Classification and recommended treatment options for folliculotropic mycosis fungoides. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1406796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Suzanne van Santen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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34
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Affiliation(s)
- M. Bagot
- Department of Dermatology and Paris 7 University; Inserm U976; 1 Avenue Claude Vellefaux 75010 Paris France
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35
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Radiation Therapy in Peripheral T-Cell and Cutaneous Lymphomas. Radiat Oncol 2017. [DOI: 10.1007/978-3-319-52619-5_30-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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