Granuloma annulare – is it a paraneoplastic condition for malignant lymphoma?

In den vergangenen Jahren wurden mehrfach Assoziationen des Granuloma anulare mit malignen kutanen Lymphomen im Sinne einer fakultativen Paraneoplasie beobachtet. Ziel der vorliegenden Arbeit ist es, einen Überblick über die aktuelle Literatur zum Granuloma anulare zu geben sowie seine Assoziation mit kutanen Lymphomen zu prüfen. Am Beispiel zweier Patienten mit Granuloma anulare und kutanen Lymphomen möchten wir klinisch tätige Dermatologen sowie Dermatopathologen für die mögliche Koinzidenz dieser beiden Erkrankungen sensibilisieren. Es werden charakterisierende Merkmale und klinisch-pathologische Warnsignale genannt, die den Verdacht auf ein malignes Lymphom lenken können. Es wird empfohlen, bei ungewöhnlichen klinischen Konstellationen (zum Beispiel Verteilungsmuster, subjektive Beschwerden, Alter bei Erstmanifestation, fehlendes Ansprechen auf konventionelle Therapie) an ein zugrundeliegendes kutanes und/oder extrakutanes Lymphom zu denken, insbesondere bei Fehlen anderer bekannter klinischer Auslöser des Granuloma anulare wie Insektenstiche, Traumata oder Varizella-Zoster-Infektionen. Trotz umfangreicher Literaturrecherche und Untersuchung der bekannten Fälle von Granuloma anulare und malignen Lymphomen lässt sich weiterhin nicht abschließend feststellen, ob das Granuloma anulare paraneoplastisch bei Lymphomen vorkommt oder ob es sich um eine Koexistenz handelt. Jedoch können im Einzelfall die oben genannten Faktoren ein Lymphom-Screening rechtfertigen.SummaryIn recent years, an association between granuloma anulare and the occurrence of malignant cutaneous lymphomas in the sense of a facultative paraneoplasia has been observed several times. The aim of the present work is to provide an overview of the currently available literature on granuloma anulare as well as an analysis of the pos-sible association between cutaneous lymphomas and granuloma anulare. Using the example of two patients with granuloma annular and associated cutaneous lympho-mas, we would like to sensitize clinically active dermatologists and dermatopatholo-gists to the possible association between these two diseases.Characteristic features and clinicopathological signs are discussed, which should lead the suspicion of an associated malignant lymphoma. It is recommended to rule out an underlying cutaneous and/or extracutaneous lymphoma in unusual clinical constellations (e.g. distribution pattern, subjective complaints, age at first manifestation, lack of response to conventional therapy), especially in the absence of other known clinical triggers of granuloma anulare such as Insect bites, trauma or varicella-zoster infections, among others. However, in individual cases the criteria mentioned here justify lymphoma screening

Current concepts of ectopic nodal inclusions with special emphasis on nodal nevi

Nodal inclusions of ectopic tissue within lymph nodes are seen comparatively often in dermatopathology and general pathology. Glandular and nonglandular epithelium, as well as melanocytic nevi can be observed within lymph nodes and represent mostly incidental findings without any relevance. The main challenge in reporting these morphologic features is to differentiate such benign inclusions from metastatic settlements of distinct organ tumors. As sentinel node biopsy and lymph node dissection have become standard procedure in clinical oncology and have an immense clinical impact, the correct evaluation of these nodal inclusions is indispensable to avoid undertreatment or overtreatment of patients. In addition, the genesis of these inclusions has not yet been satisfactorily clarified. Two concepts have been laid out: the theory of benign metastases and the migration arrest theory. However, neither theory has so far been able to answer the following questions: Why do we find more nodal nevi in patients with melanoma who had a sentinel node biopsy than in patients without melanoma, and why do we not find nodal nevi in deep visceral lymph nodes? We present a comprehensive review of the current knowledge on nodal inclusions, proposing a concept for the pathogenesis of nodal nevi, to answer these questions

S1‐Guideline: Microscopically controlled surgery

Microscopically controlled surgery (MCS) comprises various methods allowing histologically proven complete resection of malignant tumors while at the same time sparing the tumor-free tissue in the immediate vicinity as much as possible. All procedures subsumed under MCS have in common the marking of the excised tissue for topographical orientation, which provides an assignment of remaining tumor remnants. Indications for MCS are malignant skin tumors in problem localizations as well as aggressive subtypes of skin tumors. Established indications for MCS include basal cell carcinoma, cutaneous squamous cell carcinoma, Bowen’s disease as well as Bowen’s carcinoma, dermatofibrosarcoma protuberans, melanoma in chronically light-damaged skin as well as acral lentiginous melanoma and Merkel cell carcinoma. For other tumors such as extramammary Paget’s disease and various cutaneous sarcomas, evidence exists that MCS has demonstrated benefits, such as local recurrence rates. In addition, MCS is indicated when it is foreseeable that a complex closure technique is required and complete resection of the tumor must be assured. Various methods of MCS have been described, including 3D histology, horizontal method and Mohs surgery. A close cooperation of qualified surgeons and (dermato)pathologists as well as laboratory staff is essential for the successful application of MCS

HPV-47-Induced and Tattoo-associated Verrucae Planae: Report of a Case and Review of the Literature

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