Concomitant hypertrophic lichen planus and squamous cell carcinoma: Clinical features and treatment outcomes.

BACKGROUND: Patients with hypertrophic lichen planus (HLP) and squamous cell carcinoma (SCC) diagnoses present clinicians with diagnostic and disease management challenges. OBJECTIVE: To better define the clinical and treatment outcomes of patients with concomitant diagnoses of HLP and SCC. METHODS AND MATERIALS: A retrospective review was performed from January 1, 2008, to July 31, 2015, at Mayo Clinic. Patients with a histologic diagnosis of HLP and SCC were included. Patient demographics, associated comorbidities, histopathologic characteristics, treatment, and outcomes were evaluated. RESULTS: Thirty-three patients were identified; 79% were female, and mostly the lower extremities were involved. Most of the SCCs were well-differentiated and in situ with the majority treated with destruction or excision. There were no cases of local recurrence, metastasis, or disease-specific death during the follow-up period (mean 55.8 months). CONCLUSION: Patients with diagnoses of both HLP and SCC appear to be a distinct population that is predominantly female with lesion predilection for the lower extremities. However, regardless of treatment modality or tumor size, there were no adverse outcomes. An initial trial of more conservative treatment measures with close follow-up may be reasonable with biopsy of lesions unresponsive to conventional treatment.

Acquired lymphangiectasia (lymphangioma circumscriptum) of the vulva: Clinicopathologic study of 11 patients from a single institution and 67 from the literature.

BACKGROUND: Acquired lymphangiectasia of the vulva (ALV) is a rare condition thought to be secondary to pelvic lymphatic obstruction. Although benign, this entity often occurs after previous malignancy and can be confused with conditions such as genital warts. We sought to clarify the clinicopathologic features of ALV by studying affected patients from our institution and from the existing literature. METHODS: We reviewed retrospectively the clinical and histopathologic characteristics of patients with ALV from our institution and performed an extensive literature search to identify all published cases of ALV. RESULTS: Eleven patients with ALV were identified from our institution. Three patients had Crohn disease, three had malignancies involving the pelvic region (rectal adenocarcinoma, cervical carcinoma, endometrial carcinoma), and three (two with pelvic malignancy) had previous radiation therapy. One patient had Proteus syndrome. Of 67 distinct cases of ALV identified in the literature, 41 (61%) had a history of malignancy. CONCLUSIONS: In any acquired or clinically unusual lymphatic process in the skin and soft tissues, a lesion or obstructive process of the draining lymphatics should be investigated.

Incidence of Merkel cell carcinoma in Olmsted County, Minnesota: a population-based study.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive, often cutaneous malignancy. The incidence has been estimated from national registries in the USA and elsewhere, and data indicate variations depending on the region studied. The objective of this study was to determine the incidence of MCC in Olmsted County (MN, USA). METHODS: Using the Rochester Epidemiology Project, which contains health records for all the residents of Olmsted County, we retrospectively reviewed the records for all cases of MCC from 1976 to 2011. RESULTS: The overall annual age- and sex-adjusted incidence of MCC in Olmsted County during 1976-2011 was 0.35 per 100,000 person-years (95% CI, 0.14-0.57). The incidence tended to be higher among men than women with 0.69 per 100,000 (95% CI, 0.24-1.14) and 0.10 per 100,000 (95% CI, 0-0.24), respectively. CONCLUSIONS: These data are within the range of previous MCC incidence reports, and the incidence of MCC in Olmsted County is consistent with rates reported in the remainder of the USA.

Cutaneous microemboli from hydrophilic polymer after endovascular procedures.

BACKGROUND: Multiple devices and coatings assist with endovascular insertion of sheaths, catheters, and guide wires. Hydrophilic polymer coatings, a common component of endovascular surgical devices, reportedly cause microvascular obstruction and embolization, with various sequelae in organs and soft tissue. OBJECTIVE: We sought to describe clinical and histopathologic features of cutaneous manifestations of hydrophilic polymer gel emboli. METHODS: We evaluated the clinical and histopathologic characteristics of 8 patients with cutaneous complications of hydrophilic polymer gel emboli who presented in May 2013 through February 2015. RESULTS: Sudden onset of lower extremity livedo racemosa, purpuric patches, or both, occurred hours to days after endovascular procedures involving the aorta. Histopathologic evaluation showed basophilic lamellated material, consistent with hydrophilic polymer gel emboli, within small dermal vessels. LIMITATIONS: This was a retrospective study with small sample size and not controlled for all similar procedures in this population. CONCLUSION: Hydrophilic polymer gel coatings in endovascular devices can embolize to skin and cause microvascular occlusion, presenting as livedo racemosa, purpura, or both. Given the number of patients observed over a short period, this phenomenon may be underappreciated. Hydrophilic polymer gel emboli should be considered in differential diagnosis of livedo racemosa and purpura after endovascular procedure.

Cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia: clinical characteristics, temporal relationships, and survival data in a series of 14 patients at Mayo Clinic.

BACKGROUND: We examined the course of cutaneous T-cell lymphoma (CTCL), which has been associated with chronic lymphocytic leukemia (CLL) in patients with CLL. MATERIALS AND METHODS: A search was conducted of the master diagnosis index at our institution to identify patients with both CLL and CTCL from 1980 to 2010. A retrospective chart review was then conducted. RESULTS: Of the 14 patients with CTCL and CLL, eight had mycosis fungoides (MF; two with patch stage, two with plaque stage, two with tumor stage, and two with erythrodermic stage), four had Sézary syndrome, one had natural killer cell lymphoma involving the skin, and one had peripheral T-cell lymphoma involving the skin. Eight had concurrent diagnoses, five received a CLL diagnosis first, and one received a CTCL diagnosis first. Ten patients were deceased at the time of data abstraction due to unknown causes (n = 4), lymphoma (n = 2), pneumonia (n = 2), MF (n = 1), or respiratory failure (n = 1). Of the nine patients with concurrent or prior CTCL, seven were deceased, with a median time to death of 10.2 months (range, 6-89 months). Of the five patients with CLL prior to CTCL, three were deceased at 18, 27, and 47 months, respectively, after the CTCL diagnosis. The median survival for the two groups was 12 and 47 months, respectively. CONCLUSIONS: Patients with CTCL concurrent with or prior to CLL have a worse overall survival than patients with CLL in whom CTCL later develops. Larger studies are needed.

Mycobacterium fortuitum infection following adalimumab treatment for psoriasis and subsequent complication-free treatment with alternate TNF-a blockers.

Tumor necrosis factor-a (TNF-a) inhibitors, such as adalimumab, are often used to treat psoriasis and psoriatic arthritis. While it is well known that these agents increase the risk of reactivation tuberculosis, recent evidence suggests that the risk of other nontuberculous mycobacterial (NTM) infections is on the rise. We report cutaneous Mycobacterium fortuitum in a 60-year-old woman with psoriasis who had been receiving adalimumab therapy for psoriatic arthritis for six months. No other risk factors were identified. M. fortuitum was cultured from a lesion on the right leg. Following resolution of the lesion, the patient has been successfully treated with infliximab infusions and subsequently certalizumab without complication for the past three years. To our knowledge, this is the first report of M. fortuitum occurring in a patient receiving adalimumab with successful subsequent treatment without complication while on another TNF-a inhibitor.