Neoplasms

Question 1

Mycosis fungoides (Cutaneous T cell lymphoma)

Answer 1

Not a fungus, but rather a slow progressive neoplastic proliferation of T cells. Disease is chronic and is more common in men than women.

History and exam

1) Early lesion nonspecific, psoriatic-appearing plaque that is palpable and often itches with a predilection for the butt. Later lesion is limited or generalized skin involvement with palpable lymph nodes or 1 or more skin tumors with multicentric, often confluent reddish-brown nodules
2) Patients may have dermatopathic LAD without actual tumor involvement of the node. However, the internal organs can be involved, including the LNs, liver, and spleen
3) Sezary’s syndrome - leukemic phase of cutaneous T cell lymphoma and is characterized by circulating sezary cells in the peripheral blood, erythoderma, and LAD

Dx

1) Diagnosed by clinical features and histo with immunologic characterization and electron microscopy showing typical Sezary or Lutzner cells (cerebriform lymphocytes)
2) Early lesion is clinically inseparable from dermatitis, so histo dx is indicated for any dermatitis that is chronic and resistant to tx***

Tx - phototherapy. For more extensive or advanced disease, radiation is an effective option. Tx modalities, including steroids, chemo, retinoids, monoclonal antibodies and interferons are often combined.

Massive nodular infiltration of face leads to leonine facies

Question 2

Lentigo maligna melanoma

Answer 2

Arises in a lentigo. Usually found on sun-damaged skin of the face

Question 3

Superficial spreading melanoma

Answer 3

Typically younger adults, presenting on the trunk in men and on the legs in women.

Relatively prolonged horizontal growth phase helps identify the disease early when it is still confined to epidermis

Question 4

Nodular melanoma

Answer 4

Lesions have rapid vertical growth phase and appear as a rapidly growing reddish-brown nodule with ulceration or hemorrhage

Question 5

Acral lentiginous melanoma

Answer 5

Begins on the hands and feet as a slowly spreading pigmented patch. Most commonly seen in asians and blacks

Question 6

Amelanotic melanoma

Answer 6

Presents as a lesion without clinical pigmentation. Extremely difficult to identify. This variant can be further classified into any of the other ones.