Management of cutaneous T cell lymphoma: new and emerging targets and treatment options

Cutaneous T cell lymphomas (CTCL) clinically and biologically represent a heterogeneous group of non-Hodgkin lymphomas, with mycosis fungoides and Sézary syndrome being the most common subtypes. Over the last decade, new immunological and molecular pathways have been identified that not only influence CTCL phenotype and growth, but also provide targets for therapies and prognostication. This review will focus on recent advances in the development of therapeutic agents, including bortezomib, the histone deacetylase inhibitors (vorinostat and romidepsin), and pralatrexate in CTCL

Jejunal adenocarcinoma with cutaneous metastasis

Small bowel adenocarcinoma (SBA) is a rare primary gastrointestinal malignancy. We present a 60-year old man who developed a cutaneous metastasis of jejunal adenocarcinoma to his neck. This case highlights the clinicopathologic and immunophenotypic features of this uncommon cutaneous metastasis

Jejunal adenocarcinoma with cutaneous metastasis

Small bowel adenocarcinoma (SBA) is a rare primary gastrointestinal malignancy. We present a 60-year old man who developed a cutaneous metastasis of jejunal adenocarcinoma to his neck. This case highlights the clinicopathologic and immunophenotypic features of this uncommon cutaneous metastasis

Clinical and dermoscopic features of keratinizing skin tumors in BRAFi-treated patients

e19052 Background: Development of keratinizing skin tumors (KST), including squamous cell carcinomas (SCC), keratoacanthomas (KA) and verrucae (warts), are common in patients receiving BRAF inhibitors (BRAFi), including vemurafenib (V), XL281 (X) and GSK211846 (G). Dermoscopy is a specialized technique for examining skin lesions. While the clinical characteristics of these lesions are well known, the dermoscopic morphology remains to be elucidated. Methods: Patients on V, X or G who developed biopsy-proven KSTs were included in the study. Clinical and dermoscopic images of the KSTs were evaluated to determine the clinical and dermoscopic features. Frequent and reproducible structures were identified. P values were calculated based on Fisher's exact test. Results: 44 lesions (8 SCC/KAs, 36 verrucae) were identified in 21 patients. Clinically, SCC/KAs presented as scaly papules (75%) or plaques (25%) with a central scale/crust (63%), erythematous halo (63%) and/or scaly rim (63%). Verrucae presented as papules (97%) with an erythematous halo (50%). Dermoscopically, keratinizing pearls were exclusive to the SCC/KAs and keratin “petals”, “domes” or horns were seen exclusively in verrucae (Table). In the verrucae, thrombosed vessels were often observed within keratin structures; vs. vessels seen in the SCC/KAs, which were mainly located outside the keratin, around the center or in the base of the tumor. Conclusions: Although KSTs secondary to BRAFi do not result in drug discontinuation, they can affect dosing and quality of life. The dermoscopic features described herein may aid in the differentiation of benign vs. malignant lesions, with keratinizing pearls appearing to be unique to SCC/KAs. Management strategies for BRAFi KSTs may be tailored based on dermoscopic findings, with more conservative treatment for verrucae vs. SCC/KAs, which may decrease morbidity and cost. [Table: see text

Dermoscopy: an aid to the detection of amelanotic cutaneous melanoma metastases

BACKGROUND: The recognition of amelanotic cutaneous melanoma metastases (ACMM) remains a diagnostic challenge. OBJECTIVES: To describe and analyze the clinical and dermoscopic characteristics of ACMM. PATIENTS AND METHODS: Cases of ACMM were retrospectively selected from the image databases of three dermatology centers. The clinical and dermoscopic images were combined into one database for analysis. RESULTS: Forty-seven ACMM were observed in 18 patients. All lesions were erythematous, symmetric, dome-shaped papules or nodules appearing an average of 17 months after the diagnosis of the primary melanoma. ACMM presented as clinical outliers or as nonspecific papules found by palpation of the skin. The predominant dermoscopic feature was the presence of vascular structures, including serpentine (45%), glomerular (30%), irregular hairpin (23%) and corkscres-like vessels (19%). A few lesions also revealed crystalline (or shiny white lines) when viewed using polarized dermoscopy. CONCLUSION: ACMM should be considered in the differential diagnosis of new or persistent skin-colored or pink papules in patients with a previous history of invasive melanoma, especially if the lesions reveal atypical vessels under dermoscopy. The presence of crystalline structures may be another clue for the detection of some ACMM