10.5826/dpc.1301a47
text/xml
2160-9381
2521
en
Sebastian Giebel
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
allogeneic hematopoietic stem cell transplantation
Dermoscopic Evolution of Mycosis Fungoides After Allogeneic Hematopoietic Stem Cell Transplantation: a Case Series
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-04-07
2023-01-31
2023-02-27
e2023047
Dermatol Pract Concept
Sebastian Giebel
2023/01/31
10.5826/dpc.1301a47
e2023047
Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice Branch, Poland
2160-9381
allogeneic hematopoietic stem cell transplantation
en
e2023047
Errichetti E., Apalla Z., Lallas A, et al. Dermoscopic spectrum of mycosis fungoides: a retrospective observational study by the International Dermoscopy Society. J Eur Acad Dermatol Venereol. 2022, 36(7), 1045-1053. doi: 10.111/jdv.18078
Dermoscopic Evolution of Mycosis Fungoides After Allogeneic Hematopoietic Stem Cell Transplantation: a Case Series
https://dpcj.org/index.php/dpc/article/download/2521/1954
         Dermoscopic Evolution of Mycosis Fungoides
          After Allogeneic Hematopoietic Stem Cell
                Transplantation: a Case Series
     Grażyna Kamińska-Winciorek1, Anastazja Szlauer-Stefańska1, Włodzimierz Mendrek1,
                                   Sebastian Giebel1


1 The Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute
  of Oncology (MSCNRIO), Gliwice Branch, Poland



Key words: dermoscopy, cutaneous T-cell lymphomas, allogeneic hematopoietic stem cell transplantation, lymphoma, hematologic
neoplasms
Citation: Kamińska-Winciorek G, Szlauer-Stefańska A, Mendrek W, Giebel S. Dermoscopic Evolution of Mycosis Fungoides After
Allogeneic Hematopoietic Stem Cell Transplantation: a Case Series. Dermatol Pract Concept. 2023;13(1):e2023047. DOI: https://doi.
org/10.5826/dpc.1301a47
Accepted: September 22, 2022; Published: January 2023
Copyright: ©2023 Kamińska-Winciorek et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Grażyna Kamińska-Winciorek, Department of Bone Marrow Transplantation and Onco-Hematology, Maria
Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice Branch, Poland; Wybrzeże Armii Krajowej 15, 44-101
Gliwice, Poland. Telephone: +48604070208 E-mail: dermatolog.pl@gmail.com




Introduction                                                             dermoscopists (G.K-W, A.SZ-S), blinded to the clinical
                                                                         status of the disease. The progression was determined as
Allogeneic     hematopoietic       stem    cell   transplantation        new MF lesions were confirmed in the histopathologic
­(alloHSCT) is a potentially curative treatment in patients              examination.
with mycosis fungoides (MF) and may be used in selected                       The details of the disease, alloHSCT procedure and der-
patients with advanced disease [1]. The differentiation of MF            moscopic assessment are presented in Table 1. Treatment
relapse from other skin diseases that occur after transplanta-           was tolerated well, and there was no case of transplant-­
tion is challenging. In this case series we present the dermo-           related mortality.
scopic observation of MF lesions after alloHSCT.                              In active MF, red and orange color of the background
                                                                         was found with the presence of numerous dotted and/or
Case Presentation                                                        linear vessels, distributed unspecifically, uniformly, or in
                                                                         clusters. In one case increased white and yellow scaling was
We have performed a dermoscopic follow-up of MF skin                     noted in patchy distribution. In cases of disease regression, a
lesions in 3 patients before and after alloHSCT. Dermo-                  visible change in background color was noted (from red to
scopic images were captured using the DermLite Cam with                  skin-colored or light brown) (2/3), with the disappearance of
polarized light and independently analyzed by two certified              the previously described vessels.


Research Letter | Dermatol Pract Concept. 2023;13(1):e2023047                                                                         1
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                                                                         Table 1. Dermoscopic assessment of skin lesions in the course of allogeneic hematopoietic stem cell transplantation for mycosis fungoides.
                                                                 Patient case number; Gender
                                                                 1; M                                                              2; F                                                              3; F
                                                                 Conditioning regimen; Donor; Immunosuppression
                                                                 Fludarabine+Melphalan; MUD; CsA+Mtx                               TSI+TLI+ATG; MUD; CsA+MMF                                         Fludarabine+TBI; MUD; CsA
                                                                 Overall response (time after alloHSCT)
                                                                 PR, then PD (treated with DLI), then PR (5,5 years)               CR (3 years)                                                      PD (100 days)
                                                                 Day (alloHSCT is day 0)
                                                                 -1              +14              +41             +696             -1              +14              +27             +87              -1              +14              +56             +100
                                                                 Scale (color and distribution)
                                                                 White and       -                -               -                -               -                -               -                -               -                -               -
                                                                 yellow
                                                                 patchy
                                                                 Other structures (color and morphology)
                                                                 -               -                brown           brown            grey            grey             white diffuse   white diffuse    white           whitefocal       white focal     white focal
                                                                                                  parallel        parallel         dots and         dots and        structureless   structureless    focal           structureless    structureless   structureless
                                                                                                  lines           lines            globules;       globules;        areas; grey     areas;           structureless   areas; brown     areas;          areas
                                                                                                                                   white           white            dots and        brown dots       areas; brown    lines            brown focal
                                                                                                                                   angulated       angulated        globules        and globules     globules                         globules
                                                                                                                                   lines           lines
                                                                 Vessels distribution and morphology
                                                                 unspecific      clustered        -               -                uniform         uniform          peripheral      -                unspecific      unspecific       unspecific      unspecific
                                                                 dotted          dotted                                            dotted          dotted           dotted                           linear          linear           linear          dotted and
                                                                                                                                                                                                                                                      linear
                                                                 Color of the background
                                                                 red, orange     orange           skin-colored    skin-colored     red and         orange           orange          light brown      skin-colored    skin-colored     skin-colored    skin-colored
                                                                 (salmon)        (salmon)                                          purple          (salmon)         (salmon)

                                                                Abbreviations: alloHSCT- allogeneic hematopoietic stem cell transplantation; ATG- antithymoglobulin; CsA- cyclosporine A; CR- complete remission; DLI- donor lymphocyte infusion; F- female; M- male;
                                                                MMF- mycophenolate mofetil; Mtx- methotrexate; no- number; MUD- matched unrelated donor; PD- progressive disease; PR- partial remission TBI- total body irradiation; TLI- total lymphatic irradiation;
                                                                TSI-total skin irradiation.




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023047
Figure 1. Patient 1, the skin of the left hand in the course of mycosis fungoides before allogeneic stem cell transplantation (alloHSCT).
(A) Clinical image of skin lesions: numerous juicy red indurated areas covering >80% of the body surface with a tendency to create crusts
can be seen. (B) Dermoscopy: yellow and white scale on juicy red and salmon background is evident. What is more, numerous dotted vessels
in unspecific distribution can be seen.




Figure 2. Day +696 after alloHSCT. (A) Clinical image: Full healing of lesions in the course of MF. (B) Dermoscopy: on skin-colored back-
ground multiple light brown lines are distributed in unspecific arrangement, creating light brown discolorations, no scale.



   Dermoscopy in the setting of alloHSCT may help to                      Background color in MF is red, yellow-orange [5] or a
differentiate between a variety of skin conditions after the          mix of the two colors [2]. The primary red or orange back-
procedure, including relapse of the primary disease, cutane-          ground color, changing to skin-colored or light brown in the
ous graft versus host disease, drug-induced rashes, infectious        case of healing of the lesions was also noted in our patients.
skin disorders, and secondary cutaneous neoplasms. Der-                   The presence of scale seems to be not specific in the
moscopy is an auxiliary tool in the differentiation of inflam-        dermoscopy of mycosis fungoides. The large variation in
matory disorders and MF based on the vessels’ morphology              descriptions of its presence and distribution [2,4,6] may be
and their distribution, color of the background, color and            due to the use of a dermoscope with non-polarized light re-
distribution of the scales [2].                                       quiring immersion vs. polarized light, where scale is more
   Dermoscopic features of MF described in the litera-                easily visualized [2]. In our group, scaling was reported in
ture include short linear and dotted vessels [3,4,5,6] and            active lesions.
spermatozoa-like vascular structures [3,4,5].                             Other noted structures such as white diffuse structureless
   In our cohort, both dotted and linear vessels were noted,          areas, brown lines and globules were present irrespective of
and they were indicative of an active disease process.                disease status.




Research Letter | Dermatol Pract Concept. 2023;13(1):e2023047                                                                          3
Conclusion                                                           2. Bilgic S.A., Cicek D., Demir B. Dermoscopy in differential
                                                                        diagnosis of inflammatory dermatoses and mycosis fungoi-
Our report adds to the information about the dermoscopic                des. Int J Dermatol. 2020, 59(7), 843-850. doi: 10.1111/ijd
                                                                        .14925.3.
characteristics of MF lesions and their evolution. Observa-
                                                                     3. Bosseila M., Sayed Sayed K., El-Din Sayed S.S., Abd El
tions in the case of disease remission included a change of the         Monaem N.A. Evaluation of Angiogenesis in Early Mycosis
background color from initial red-orange to skin-colored or             Fungoides Patients: Dermoscopic and Immunohistochemical
light brown and the disappearance of numerous dotted and                Study. ­Dermatology. 2015, 231(1), 82-86. doi:10.1159/0003​
linear vessels, while the persistence of vessels was indicative         82124
of progressive disease.                                              4. Lallas A., Apalla Z., Lefaki I., et al. Dermoscopy of early stage
                                                                        mycosis fungoides. J Eur Acad Dermatology Venereol. 2013,
                                                                        27(5), 617-621. doi:10.1111/j.1468-3083.2012.04499.x
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