Fatal squamous cell carcinoma following whole body electron beam therapy and photochemotherapy for mycosis fungoides

The development of fatal metastatic squamous cell carcinoma in a patient with poikiloderma atrophicans vasculare, following treatment with whole body electron beam therapy and photochemotherapy is described. The place of electron beam therapy and photochemotherapy in the treatment of mycosis fungoides is discussed, and the conclusion drawn that the two should be used together only with caution.     

皮肤树突状细胞与蕈样肉芽肿

阐述皮肤树突状细胞在蕈样肉芽肿(MF)皮肤损害中的改变及其与MF的病情发展关系和对MF的致病作用。     

Cutaneous metastatic lymphangitis from squamous cell carcinoma of the cervix

A case of cutaneous metastatic lymphangitis which appeared during the unusual evolution of a cervix carcinoma is reported. DNA sequences of No. 18 human papilloma virus (HPV) were isolated in both vaginal and cutaneous specimens. The hypothesis that a particular evolution of invasive cervix carcinomas might be related to the type of associated HPV is suggested.     

Combination topical nitrogen mustard and photochemotherapy for mycosis fungoides

This is a retrospective review of our experience in the treatment of the cutaneous eruption of mycosis fungoides (MF) with a combination of topical nitrogen mustard (HN₂) and photochemotherapy (PUVA). Our aims were to evaluate the efficacy of the combination in clearing the cutaneous eruption of MF, to establish whether the remissions thus achieved could be maintained by the use of HN₂ alone, and to determine whether the combination with PUVA would inhibit the development of sensitization to HN₂. The regimes employed were found to be an effective means of clearing the plaque lesions of MF. The use of PUVA, either started simultaneously or five to seven treatments prior to HN₂, was not found to significantly inhibit the development of sensitization to topical nitrogen mustard. Nevertheless, topical desensitization in those who sensitized allowed the use of long-term HN₂ in the great majority of patients. Once the cutaneous eruption had cleared, long-term therapy with HN₂ alone was found to be a simple, convenient, and effective means of maintaining the patient in remission. It should not however be regarded as a curative regime, since relapse was common when maintenance therapy was discontinued.     

Multiple squamous cell carcinomas in a patient with mycosis fungoides

A 51-year-old man with type IV skin presented for evaluation of a generalized rash associated with multiple ulcerated, nodular lesions on his legs. The nodular lesions occurred approximately 18 months after the initial onset of generalized rash, which had been diagnosed as plaque/patch stage mycosis fungoides. He continued to develop further nodular lesions on his trunk in the weeks following presentation. The nodular lesions were shown to be squamous-cell carcinoma on histopathology. He had received only topical hydrocortisone prior to the development of the second cutaneous malignancy and had no past exposure to carcinogens. His squamous cell carcinomas were treated with surgical excision and split-skin grafting. He received total skin electron-beam therapy to treat the mycosis fungoides. Second malignancy in mycosis fungoides is a recognized phenomenon and usually occurs after potentially carcinogenic therapy. This case demonstrates the occurrence of second malignancy in the absence of a precipitating factor, suggesting that there are innate, immune-mediated mechanisms in the development of cancer in patients with mycosis fungoides.     

皮肤透明细胞鳞状细胞癌

报告1例面部透明细胞鳞状细胞癌.患者女,90岁.左面颊新生物伴溃疡半年余.组织病理检查示:癌细胞呈巢状,细胞多角形,胞质透明,核明显异形.皮损组织病理检查证实为透明细胞鳞状细胞癌.     

Cutaneous squamous cell carcinoma characteristics

The second most common type of skin cancer, squamous cell carcinoma, carries a higher mortality rate than basal cell carcinoma. This article discusses the incidence, risk, characteristics, and prevention of the disease.     

Squamous cell carcinoma appearing in X-ray-treated mycosis fungoides.

Two patients with mycosis fungoides developed a squamous cell carcinoma of the skin on the neck. Upon verification by routine biopsy testing of material taken from a suppurating infiltrate of the neck, both patients were treated intermittently with X-rays. Both had developed the squamous cell carcinoma on a sun-exposed area. Patient 1 had been treated with Grenz-ray irradiation totalling 10 kilovolt (kV) 4400 rad. and Dermopan step IV (50 kV) 5200 rad.; while patient 2 recieved altogether: Grenz-rays 4600 rad., Dermopan step IV 400 rad., and soft X-rays (150 kV) 800 r. The latency period was, respectively, 3 and 10 years.     

Cutaneous malignant melanoma in association with mycosis fungoides

We retrospectively analyzed the first 461 cases entered into our cutaneous lymphoma database and found 285 cases of mycosis fungoides. We also identified 6 cases of malignant melanoma, all of which were found in patients with mycosis fungoides. The crude rate of melanoma in the general population in England, United Kingdom, in 1998 was 8.8/100,000 in men and 11.4/100,000 in women. The incidence of melanoma found in our cohort of patients with mycosis fungoides was far higher, and in 4 of the 6 patients cannot be explained on the basis of prior therapy. The reason for this association is unclear, but this report emphasizes the risk of second malignancies for patients with cutaneous T-cell lymphoma and melanoma.     

Treatment of patch-stage mycosis fungoides with topical corticosteroids

Experience at the University of California, San Francisco (UCSF), in the management of patch-stage mycosis fungoides (MF) with topical, predominantly high-potency, corticosteroids is reviewed. The technique of applications is discussed in detail. Approximately 200 patients have been treated. The results are very favorable. The response rate is over 90%. Side-effects are minor. Topical clobetasol is the first-line treatment for early stage MF at UCSF.     

Management with topical nitrogen mustard in mycosis fungoides

Topical nitrogen mustard (mechlorethamine, NM) has been used as primary therapy for management of patients with mycosis fungoides (MF) since the 1950s. Many investigators have demonstrated the efficacy of topical NM in patch and/or plaque disease of MF. Updated results from Stanford also confirm the clinical efficacy. The complete response (CR) rates reported are 76-80% for patients with limited patch/plaque (stage IA), and 35-68% for those with generalized patch/plaque (stage IB) disease. Topical NM can be used as an aqueous (water) or ointment-based preparation. The efficacy results are similar in patients who were treated with aqueous versus ointment preparations. Maintenance regimens used are variable, but there is no data to suggest that a longer maintenance duration results in greater potential for long-term remission. Most patients who achieve initial CR with topical NM tend to require NM-only for disease management. Topical NM is equally effective when used as salvage therapy with disease relapse. The most common toxicity of topical NM therapy is contact irritant or allergic reaction. The potential for allergic reaction is significantly reduced (< 10%) when NM is used as an ointment preparation. The potential for secondary skin cancer development is increased in patients who have used multiple sequential topical skin-damaging therapies or NM in the genital skin, but not in patients who have used NM as monotherapy (avoiding genital skin application). Topical NM is used safely in pediatric patients and there is no evidence of any clinically significant systemic absorption of topically applied NM.     

Treatment of childhood mycosis fungoides with topical PUVA

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma, which is usually observed in mid to late adulthood. We report 5 cases of mycosis fungoides in children, all presenting as patch- and plaque-stage disease most commonly involving the buttocks. Histologic examination showed in every case the typical features of mycosis fungoides. In 4 of the 5 cases, the infiltrating lymphocytes were characterized by the T-cell phenotype CD3(+), CD4(+), CD8(+); and in 3 cases, a monoclonal rearrangement of the T-cell receptor gamma (TCR-gamma) gene was found. Three children received topical PUVA treatment, and the other two were treated with mid-potency topical corticosteroids, resulting in complete clinical remission. A management approach to mycosis fungoides with topical PUVA may be appropriate for children.     

Cutaneous squamous cell carcinoma and human papillomavirus

The relationship between mucosal human papillomavirus (HPV) and cervical carcinoma or anogenital squamous cell carcinoma (SCC) is becoming increasingly evident, whereas a link between HPV and other cutaneous SCCs is less clear. Recent studies have reported links between epidermodysplasia-verruciformis-associated HPV and extragenital cutaneous SCC, particularly in immunosuppressed patients, although immunocompetent patients have also been affected. Mucosal HPV could also be linked to some types of Bowen disease and certain SCCs of the fingers, oropharyngeal mucosa, etc. We review the possible oncogenic mechanisms involving mucosal HPV and epidermodysplasia-verruciformis-associated HPV. Most SCCs could be explained by the combined action of HPV, immunosuppression, and the oncogenic and immunosuppressive effect of UV radiation. HPV might be associated with worse prognosis of SCC, with implications for clinical practice including greater risk of metastasis.     

Cutaneous necrosis associated with the antiphospholipid syndrome and mycosis fungoides

Summary The development of extensive cutaneous necrosis in a patient with tumour-stage mycosis fungoides is described. Skin biopsies showed a lymphomatous infiltrate, and thrombosis of dermal blood vessels. Investigation revealed the presence of anticardiolipin antibodies, a lupus anticoagulant, and low free protein S, which contributed to a prothrombotic state. Antiphospholipid antibodies have been detected in non-Hodgkin's lymphoma, but clinical manifestations are uncommon. Such autoantibodies may be produced by neoplastic lymphoid cells. The frequency with which antiphospholipid antibodies occur in mycosis fungoides is currently unknown.