DERMOSCOPY
CASE OF THE MONTH
Dermoscopy of poikilodermatous mycosis fungoides (MF) Ping Xu, MD, and Cheng Tan, MD Nanjing, China Key words: dermoscopy; mycosis fungoides; pigmentation; poikiloderma.
CLINICAL PRESENTATION A 59-year-old man had widespread poikilodermatous patches for 30 years. Physical examination revealed erythematous and scaly patches that were typically atrophic, telangiectatic, and intermingled with mottled hyperpigmentation and hypopigmentation (Fig 1).
Fig 1. Poikilodermatous mycosis fungoides. Clinical presentation: erythematous and poikilodermatous patches and thin plaques on the trunk. The lesions were typically scaly, telangiectatic, atrophic, and intermingled with mottled hyperpigmentation and hypopigmentation.
From the First Clinical College, Nanjing University of Chinese Medicine, and Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine. Supported in part by the National Natural Science Foundation of China (Grant No. 81173400). Conflicts of interest: None declared. Reprint requests: Cheng Tan, MD, Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine,
155 Hanzhong Road, Nanjing, China 210029. E-mail: tancheng@ medmail.com.cn. J Am Acad Dermatol 2016;74:e45-7. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.10.031
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DERMOSCOPIC APPEARANCE Dermoscopically, it showed multiple polygonal structures consisting of lobules of white storiform streaks, studded with fine red dots or hairpin vessels. Between the lobules were septa of pigmented dots that were unevenly and intermittently distributed throughout. In addition, red and yellowish smudges were easily noticed (Fig 2).
Fig 2. Poikilodermatous mycosis fungoides. A, Dermoscopy showed multiple polygonal structures of white storiform streaks, with the highest tone in the center and the lowest in the periphery ( green circles). B, The streak-intersected holes were studded with fine red dots or hairpin vessels ( green arrows). Between the lobules were septa of pigmented dots that were unevenly and intermittently distributed throughout A. In addition, red (red arrows) and yellowish (blue arrows) smudges were noticed.
HISTOLOGIC DIAGNOSIS Skin biopsy specimen showed epidermotropism of atypical lymphocytes. There were vacuolar alterations of the basal layer, scattered melanophages, intermittent fibrosis of the collagen, and lymphocytic infiltration in the papillary dermis. These atypical lymphocytes were positive for CD3, CD4, and CD45RO but were negative for CD8, CD20, CD79, T-cell intracytoplasmic antigen 1 (TIA-1), and granzyme B (Fig 3). All these findings indicated the diagnosis of poikilodermatous mycosis fungoides (MF).
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Fig 3. Poikilodermatous mycosis fungoides. Skin biopsy specimen showed epidermotropism of atypical lymphocytes. There were vacuolar alterations of the basal layer, scattered melanophages, intermittent fibrosis of the collagen, and lymphocytic infiltration in the papillary dermis. (Hematoxylin-eosin stain; original magnification: 3100.)
KEY MESSAGE Poikilodermatous MF is a rare variant of patch-stage MF and is characterized by red or brownish plaques with scaling, mottled dyspigmentation, atrophy, and telangiectasis affecting the trunk and the extremities.1 Researchers have recently identified fine short linear vessels, dotted vessels, and orange-yellow patchy areas in early MF.2 Our dermoscopic observation of poikilodermatous MF revealed multiple polygonal structures consisting of lobule of white storiform streaks with septa of pigmented dots. Because widely accepted criteria for poikilodermatous MF are still lacking, a definitive diagnosis must be based on a combination of clinical demonstrations, histopathologic features, T-cell receptor gene analysis, immunopathologic criteria, and hopefully, in the near future, dermoscopic structures.
REFERENCES 1. Abbott RA, Sahni D, Robson A, Agar N, Whittaker S, Scarisbrick JJ. Poikilodermatous mycosis fungoides: a study of its clinicopathological, immunophenotypic, and prognostic features. J Am Acad Dermatol. 2011;65:313-319. 2. Lallas A, Apalla Z, Lefaki I, et al. Dermoscopy of early stage mycosis fungoides. J Eur Acad Dermatol Venereol. 2013;27:617-621.
CASE OF THE MONTH
Dermoscopy of poikilodermatous mycosis fungoides (MF) Ping Xu, MD, and Cheng Tan, MD Nanjing, China Key words: dermoscopy; mycosis fungoides; pigmentation; poikiloderma.
CLINICAL PRESENTATION A 59-year-old man had widespread poikilodermatous patches for 30 years. Physical examination revealed erythematous and scaly patches that were typically atrophic, telangiectatic, and intermingled with mottled hyperpigmentation and hypopigmentation (Fig 1).
Fig 1. Poikilodermatous mycosis fungoides. Clinical presentation: erythematous and poikilodermatous patches and thin plaques on the trunk. The lesions were typically scaly, telangiectatic, atrophic, and intermingled with mottled hyperpigmentation and hypopigmentation.
From the First Clinical College, Nanjing University of Chinese Medicine, and Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine. Supported in part by the National Natural Science Foundation of China (Grant No. 81173400). Conflicts of interest: None declared. Reprint requests: Cheng Tan, MD, Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine,
155 Hanzhong Road, Nanjing, China 210029. E-mail: tancheng@ medmail.com.cn. J Am Acad Dermatol 2016;74:e45-7. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.10.031
e45
e46 Xu and Tan
J AM ACAD DERMATOL
MARCH 2016
DERMOSCOPIC APPEARANCE Dermoscopically, it showed multiple polygonal structures consisting of lobules of white storiform streaks, studded with fine red dots or hairpin vessels. Between the lobules were septa of pigmented dots that were unevenly and intermittently distributed throughout. In addition, red and yellowish smudges were easily noticed (Fig 2).
Fig 2. Poikilodermatous mycosis fungoides. A, Dermoscopy showed multiple polygonal structures of white storiform streaks, with the highest tone in the center and the lowest in the periphery ( green circles). B, The streak-intersected holes were studded with fine red dots or hairpin vessels ( green arrows). Between the lobules were septa of pigmented dots that were unevenly and intermittently distributed throughout A. In addition, red (red arrows) and yellowish (blue arrows) smudges were noticed.
HISTOLOGIC DIAGNOSIS Skin biopsy specimen showed epidermotropism of atypical lymphocytes. There were vacuolar alterations of the basal layer, scattered melanophages, intermittent fibrosis of the collagen, and lymphocytic infiltration in the papillary dermis. These atypical lymphocytes were positive for CD3, CD4, and CD45RO but were negative for CD8, CD20, CD79, T-cell intracytoplasmic antigen 1 (TIA-1), and granzyme B (Fig 3). All these findings indicated the diagnosis of poikilodermatous mycosis fungoides (MF).
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Fig 3. Poikilodermatous mycosis fungoides. Skin biopsy specimen showed epidermotropism of atypical lymphocytes. There were vacuolar alterations of the basal layer, scattered melanophages, intermittent fibrosis of the collagen, and lymphocytic infiltration in the papillary dermis. (Hematoxylin-eosin stain; original magnification: 3100.)
KEY MESSAGE Poikilodermatous MF is a rare variant of patch-stage MF and is characterized by red or brownish plaques with scaling, mottled dyspigmentation, atrophy, and telangiectasis affecting the trunk and the extremities.1 Researchers have recently identified fine short linear vessels, dotted vessels, and orange-yellow patchy areas in early MF.2 Our dermoscopic observation of poikilodermatous MF revealed multiple polygonal structures consisting of lobule of white storiform streaks with septa of pigmented dots. Because widely accepted criteria for poikilodermatous MF are still lacking, a definitive diagnosis must be based on a combination of clinical demonstrations, histopathologic features, T-cell receptor gene analysis, immunopathologic criteria, and hopefully, in the near future, dermoscopic structures.
REFERENCES 1. Abbott RA, Sahni D, Robson A, Agar N, Whittaker S, Scarisbrick JJ. Poikilodermatous mycosis fungoides: a study of its clinicopathological, immunophenotypic, and prognostic features. J Am Acad Dermatol. 2011;65:313-319. 2. Lallas A, Apalla Z, Lefaki I, et al. Dermoscopy of early stage mycosis fungoides. J Eur Acad Dermatol Venereol. 2013;27:617-621.
