Cutaneous lymphomas in African American/Black patients: pitfalls and presentations

Abstract

This review describes and highlights differences in clinical presentations of cutaneous lymphomas (CLs), particularly in darker skin types, i.e., Skin of Color (SOC). We illustrate differences in clinical features on physical exam that can be a diagnostic challenge and suggest ways to recognize and identify these conditions at an early stage through a high level of suspicion. The review includes a summary of the epidemiology of various CLs, specifically highlighting the presentation and incidence in African American/Black patients, where the data are available. We also include a discussion of adult HTLV-1-associated T-cell leukemia/lymphoma (ATLL) which, although a systemic T-cell lymphoma, may present with skin manifestations and mimic MF, other CTCL subtypes, or other inflammatory dermatoses. Finally, this review highlights the possible use of imaging modalities, such as dermoscopy and reflectance-confocal microscopy, in diagnosing and recognizing cutaneous lymphomas in patients with darker skin types. MethodsWe conducted a search with an MSKCC librarian on cutaneous lymphomas and lymphoproliferative disorders using Scopus, Embase, Ovid, and Google Scholar to identify publications in English. Our search term keywords were restricted to Mycosis Fungoides, S ezary syndrome, primary cutaneous anaplastic large-cell lymphoma, lymphomatoid papulosis, subcutaneous panniculitis-like T-cell lymphoma, primary cutaneous follicle center lymphoma, primary cutaneous marginal zone B cell lymphoma, and primary cutaneous diffuse large B-cell lymphoma, leg type, for which MSKCC Dermatology Service has corresponding clinical images. We expanded our search to include literature on dermoscopy and imaging modalities using these search terms and variations, including dermatoscope, imaging, and confocal. The returned publications were reviewed and sorted by relevance to Skin of Color. at the time of diagnosis. 2 Cutaneous T-cell lymphomas (CTCL) are the most common, with a reported incidence of 6.4 per 100,000, according to data from the Surveillance, Epidemiology, and End Results registry (SEER). 3 From the same data, the incidence of cutaneous B-cell lymphomas (CBCL) is estimated at 3.3 per 100,000. 4 While cutaneous lymphomas may occur in patients of all races, the majority of patients with CLs in the United States are White, reflecting the racial make-up of the country in past years.Mycosis fungoides (MF) is the most common type of CTCL, representing about 57% of all CTCL. The ratio of incidence of MF in African American/Black (which we will refer to as Black

Cutaneous T-cell Lymphoma Progression: A Potential Dupilumab Pitfall

“…It is important to note that other documented cases have also reported a paradoxical worsening of skin scaling, lymphadenopathy, severe pruritis, and extension of rash borders one to two months after the initial administration of dupilumab [3,5]. The patient described in this case additionally presented with an acute onset of hyperpigmented plaques, which aligns with the varied morphologies of CTCL in African American patients [6,7]. The discernible erythematous plaques pathognomonic for CTCL in light-skinned individuals often contrast with the varying pigmentations with little erythema presented in darker-colored skin [7].…”

“…The patient described in this case additionally presented with an acute onset of hyperpigmented plaques, which aligns with the varied morphologies of CTCL in African American patients [ 6 , 7 ]. The discernible erythematous plaques pathognomonic for CTCL in light-skinned individuals often contrast with the varying pigmentations with little erythema presented in darker-colored skin [ 7 ]. These variations in clinical presentation, along with the atypical manifestation of a desquamating rash, can further complicate a diagnosis.…”