Cutaneous Lymphoma Often Misdiagnosed as Psoriasis
For the retrospective study, the researchers reviewed the charts of patients who were diagnosed with CL during or after the use of anti-TNFα therapies. They identified 20 cases of cutaneous T-cell lymphomas (CTCL) and 2 cases of cutaneous B-cell lymphomas (CBCL).
Among patients with CTCL, 75% had received anti-TNFα therapy for an inflammatory skin condition. Patients often presented with advanced disease (IIB through IVA) at the time of diagnosis and required aggressive therapy, including stem cell transplants (n=3). The most common subtypes were mycosis, fungoides, and Sézary syndrome.
The 2 patients diagnosed with CBCL had an indolent course.
In addition, the researchers identified 31 cases of CL after searching the literature.
“Our findings suggest that most of the identified patients were misdiagnosed as having psoriasis or eczema; therefore, a comprehensive morphological and molecular review of skin biopsies and peripheral blood should be considered prior to initiation of anti-TNFα therapy in patients with poorly defined dermatitis or atypical presentations of “psoriasis,”” the researchers concluded.
Martinez-Escala ME, Posligua AL, Wickless H, et al. Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy [published online January 4, 2018]. J Am Acad Dermatol. http://dx.doi.org/10.1016/j.jaad.2017.12.068