[Indolent CD8+ lymphoid proliferation on the nose]. / Lymphoprolifération CD8+ indolente du nez.

BACKGROUND: Indolent non-epidermotropic CD8+ lymphoid proliferation of the ear was recently reported in the literature by Petrella et al. This is a distinct entity related to cutaneous T-cell lymphomas. Herein, we report a case of indolent CD8+ lymphoid proliferation of the ear involving the nasal crest and we relate a number of cases recently published in the literature. PATIENTS AND METHODS: An 87-year-old woman consulted for a pigmented papular lesion of the nasal crest present for 9 years that had begun to regress spontaneously. The remainder of the examination revealed nothing of note. The biopsy showed dense lymphoid infiltration within the dermis. Immunohistochemical analysis supported the diagnosis of indolent CD8+ lymphoid proliferation. Treatment with moderate topical corticosteroids was initiated. DISCUSSION: This novel entity is characterised by the presence of relatively non-symptomatic infiltrated lesions in the ear, which can occur bilaterally. Histological findings are frequently worrying with the presence of a dense cellular infiltrate comprising a relatively monomorphous population of CD8+ lymphocytes, although progression is usually indolent.

[Lymphomatoid papulosis in childhood: six case reports and a literature review]. / Papulose lymphomatoïde de l'enfant : six cas et revue de la littérature.

BACKGROUND: Lymphomatoid papulosis (LyP) is a rare lymphoproliferative disorder. It is now included in the World Health Organisation (WHO) classification of cutaneous lymphomas. Although frequently described in adults, there have been only a few reported cases of LyP in children; diagnosis is often difficult in this population and no clear guidelines have been established regarding management or monitoring. In this article we report six new cases of LyP in children. PATIENTS AND METHODS: This is a retrospective study of six children, aged between two and 11 years, seen at the Hôtel-Dieu Hospital in Lyon and at the Grenoble Hospital Centre between 2005 and 2008. Each child underwent skin biopsy for histological and immunohistochemical analysis. RESULTS: All six children presented papulonodular lesions on the limbs and trunk, in some cases necrotic, present for different times and developing in episodes. Histology and immunolabelling announces in all six cases militated in favour of LyP type A, with large CD30+ and CD15- cells dispersed in an inflammatory dermal infiltrate made up for the most part of lymphocytes, polynuclear neutrophils, eosinophils and a small number of histiocytes. DISCUSSION: Only around 60 cases of LyP have so far been reported in children, principally type A. Association with malignant lymphoma occurs, with high risk in relation to the general population of the same age. Clinical diagnosis is confirmed histopathology and immunolabelling. There is currently no consensus regarding therapeutic management. First-line treatment generally comprises therapeutic abstention or dermal corticosteroids. Methotrexate and phototherapy constitute possible alternatives but should be used only in very disseminate or debilitating forms of the disease. CONCLUSION: The presentation and course of LyP of childhood differs very little from the adult form. Cases of associated lymphoma have been reported. Although regular clinical monitoring is recommended, there is no call for routine laboratory testing.

Dermoscopy of fully regressive cutaneous melanoma.

BACKGROUND: Metastatic melanoma of unknown origin is a difficult challenge diagnostically and therapeutically. Diagnosis of the putative primary lesion is difficult. This difficulty increases when the primary lesion has undergone complete regression. OBJECTIVE: To define the dermoscopic features of fully regressed melanoma. PATIENTS AND METHODS: A single-institution, register-based study of an unselected consecutive series of seven cases of metastatic melanoma in the lymph nodes with no known or visible primary lesion was carried out. Skin examination included dermoscopy; when a suspicious area was found, observed dermoscopic features were recorded and a biopsy was performed. Diagnosis of completely regressive cutaneous melanoma was based on clinical-pathological correlation according to widely accepted criteria. RESULTS: Seven dermoscopic features were associated with completely regressive melanoma: scar-like depigmentation (100%); pink coloration of the background (100%); linear-irregular vessels (86%); globular pattern of the vessels (43%); remnants of pigmentation (86%), either macular (43%) or with a peppering aspect (43%); and white lighter transverse bands (43%). The last feature was only observed with polarized light dermoscopy devices. CONCLUSION: Dermoscopy more accurately distinguishes the vascular, pigmentary and scarring changes of fully regressive melanoma. We believe that dermoscopy should be included in the search for a regressive primary lesion in case of metastatic melanoma of unknown origin.