BACKGROUNDMost available studies on the efficacy of topical photodynamic therapy
focus on short-to medium-term results. Long-term data are scarce.OBJECTIVETo evaluate the long-term efficacy of photodynamic therapy with topical
methylaminolevulinate to treat Bowen's disease and basal cell
carcinoma in the clinical practice setting of a dermato-oncology
department.METHODSThe study included patients diagnosed with Bowen's disease or basal cell
carcinoma, and who received photodynamic therapy from 2004 to 2008.
Treatment protocol and clinical follow-up were standardized. The
primary endpoint was clinically observed recurrence in a previous
photodynamic therapy-treated area. Descriptive and survival analyses
were performed.RESULTSA total of 31 Bowen's disease lesions and 44 superficial basal cell
carcinoma were treated, with a median follow-up of 43.5 months.
Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in
11 superficial basal cell carcinoma (33.3%). Significantly higher
estimates for recurrence rates were found in patients with Bowen's
disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of
recurrence was higher in patients with Bowen's disease than in those
with superficial basal cell carcinoma and younger patients.CONCLUSIONSRecurrence should be considered when choosing to treat non-melanoma skin
cancer with photodynamic therapy. Younger age and Bowen's disease were
independent predictors for long-term recurrence, suggesting the need
to establish an extended period of follow-up for this subset of
patients.
We report a patient with cutaneous papular xanthomatosis who 4 years later developed a CD3(-/+dim)/CD4(+) T-cell lymphoma. Pruritic xerotic non-erythrodermic skin, eosinophilia and hyper-IgE were present and erroneously classified as atopic dermatitis. Flow cytometry and DNA ploidy analysis of both blood and skin lymphocytes, skin histology and blood T-cell receptor gene rearrangement studies confirmed diagnosis of T-cell lymphoma. Monoclonal CD3(-/+dim)/CD4(+) T-cells were especially prone to the synthesis of IL-13, a cytokine that is involved in IgE-secretion, and comprised both a medium (diploid) and large (hyperploid) sized T-cell populations with a similar immunophenotype. The majority of the normal residual T-cells were large granular lymphocytes, expressed activation-related and natural-killer-associated markers and secreted high levels of interferon gamma, suggesting that they might correspond to active cytotoxic cells directed against the neoplastic T-lymphocytes.
Blastic plasmacytoid dendritic cell tumor is a rare, highly aggressive systemic neoplasm for which effective therapies have not yet been established. We describe a 73-year-old man with multiple nodules and patches emerging on the trunk and limbs. Lesional skin biopsy revealed a plasmacytoid dendritic cell tumor with dense dermal infiltrate of tumor cells with blastoid features. No apparent systemic involvement was identified in the initial stage. The patient was treated with prednisone daily, with notorious improvement of the skin lesions, although no complete remission was obtained. During the six-month follow-up period, no disease progression was documented, but fatal systemic progression occurred after that period of time.
Cytotoxic lymphomas comprise a spectrum of peripheral T-cell lymphomas that can have
a initial or late cutaneous presentation. We describe a 46-year-old man from Cape
Verde, with a dermatosis involving his face and trunk, consisting of monomorphic
papules with a smooth surface and both motor and sensory polyneuropathy.The
hypothesis of leprosy was supported by the clinical and initial hystopathological
findings and the patient was referred to our hospital with suspected Hansen's
disease. In the new skin and lymph node biopsies a lymphocyte population was
identified whose immunohystochemistry study allowed the diagnosis of T-cell lymphoma
with expression of cytotoxic markers. The patient was started on chemotherapy with
initial remission of the skin lesions but, subsequently, progression of systemic
disease.
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