Skin Findings in Heme/Lymph Patients

Question 1

cutaneous T cell lymphoma (CTCL) - overview

Answer 1

*most common is mycosis fungoides
*MF is usually indolent and affects older men, black > white affected
*large, ATROPHIC patches and plaques on CLOTHING COVERED areas
*rarely can involve lymph nodes and blood

example of: malignant cells directly deposited in skin

Question 2

cutaneous T cell lymphoma (CTCL) - pathology

Answer 2

*epidermotropism
*pautrier microabscesses
*infiltrate is CD4+ T cells with cerebriform nuclei

Question 3

anagen effluvium

Answer 3

*occurs due to cytotoxic chemotherapy
*characterized by loss of hair when hair follicles are damaged during chemotherapy

example of: skin reaction from treatment of malignancy

Question 4

bleomycin-induced pigmentation

Answer 4

*flagellate hyperpigmentation on torso and proximal limbs
*unique to bleomycin (a type of chemo)
*testable side effect of this medication

example of: skin reaction from treatment of malignancy

Question 5

hand-foot syndrome

Answer 5

*aka palmar plantar erythrodysesthesia
*seen with cytotoxic chemotherapy (5-FU) and tyrosine kinase inhibitors
*well-demarcated erythema, pain, fissuring, and peelings of palms and soles
*treated with potent topical steroids and cooling of hands and feet during chemo infusion

example of: skin reaction from treatment of malignancy

Question 6

graft vs. host disease - skin manifestations

Answer 6

*host cells are depleted and replaced by donor lymphocytes
*acute GVHD: RASH + elevated bilirubin + diarrhea
*rash is widespread and involves palms and soles

example of: skin reaction from treatment of malignancy

Question 7

irCAEs (immune related cutaneous adverse events)

Answer 7

*bullus pemphigoid
*oral lichen planus
*discoid lupus

example of: skin reaction from treatment of malignancy

Question 8

Sweet Syndrome

Answer 8

*aka acute febrile neutrophilic dermatosis
*abrupt onset of PAINFUL edematous papules and plaques along with FEVER and sometimes a leukocytosis
*neutrophilic infiltrate in the dermis
*easily confused with infection
*treatment of underlying illness leads to improvement
*rapid response to steroids

example of: skin as paraneoplastic manifestation

Question 9

dermatomyositis

Answer 9

*inflammation of proximal limb girdle muscles plus characteristic skin changes/rash
*up to 40% of patients have underlying malignancy
*s/s: Gottron’s sign (on knuckles); photosensitive rash; heliotrope sign; Shawl sign
*in addition, looks for elevated creatinine kinase and aldolase
*need malignancy screening for first 2 years

example of: skin as paraneoplastic manifestation

Question 10

skin complications from immune system dysfunction

Answer 10

*bacterial infections (S. aureus, pseudomonas aeruginosa, serratia marascens)
*viral infections (herpes zoster)
*fungal infections (candidiasis, aspergillus, fusariosis, crusted scabies)

Question 11

ecthyma gangrenosum

Answer 11

*solitary PAINFUL lesion in groin area or extremity several centimeters in diameter (central ulceration)
*caused primarily by pseudomonas