Transformation of mycosis fungoides to other types of primary cutaneouslymphoma

(Poster reference number 5270)Roxana del Aguila, MD, Instituto de Oncolog�ıa Angel H. Roffo-Universidad deBuenos Aires Argentina, Buenos Aires, Argentina; Celina Carvajal, MD, Institutode Oncolog�ıa Angel H. Roffo-Universidad de Buenos Aires, Buenos Aires,Argentina; Erica Rojas Bilbao, MD, Instituto de Oncologia Angel H. Roffo-Universidad de Buenos Aires, Buenos Aires, Argentina; Liliana Gimenez, MD,Instituto de Oncologia Angel H. Roffo-Universidad de Buenos Aires, BuenosAires, Argentina; Nora Molinari, MD, Instituto de Oncolog�ıa Angel H. Roffo-Universidad de Buenos Aires, Buenos Aires, Argentina; Romina Cozzani, MD,Instituto de Oncolog�ıa Angel H. Roffo-Universidad de Buenos Aires, BuenosAires, Argentina; Silvana Cugliari, MD, Instituto de Oncologia Angel H. Roffo-Universidad de Buenos Aires, Buenos Aires, Argentina

Background: Usually mycosis gungoides (MF) is an indolent lymphoma but some-times transformation may occur.

Patients:Between1997and2010, above26patientswithdiagnosisofMFwerestudied,three cases developed transformation to anaplastic lymphoma (4 patients) andpleomorphic small T-cell lymphoma (1 patient). Case 1: A 72-year-old woman withtumoral stage MF treated with chemotherapy (CHOP protocol: cyclophosphamide,vincristine, doxorrubicin, and prednisolone) with partial response who developed anerythematous nodule on her right leg, 2.53 2 cm. A skin biopsy revealed a cutaneousCD301 anaplastic T-cell lymphoma. The patient is nowwith oral bexarotene. Case 2: A49-year-old man with patch stage MF treated with three lines who presentederythematous-squamous plaques on his trunk and arms. A skin biopsy revealed acutaneous CD301 anaplastic T-cell lymphoma. Case 3: A 42-year-old man with patch-plaque stage MF treated with topic clobetasol with partial response, developed anerythematous-squamous plaque on his cheek and upper lip including part of themucosa. A skin biopsy revelead a pleomorfic small T-cell lymphoma. Thepatient began8 months ago with oral bexarotene, with a good response. Case 4: A 46-year-old manwith tumoral stageMF treatedwithmultiples lines of chemotherapywithout response,developedmore tumoral lesions. A skin biopsy revealed a cutaneousCD301 anaplasticT-cell lymphoma. The patient had poor outcome and died. Case 5: A 68-year-old manpatient with patch-plaque stage MF treated with PUVA with partial response,developed erythematous-squamous plaques on his right shoulder and crotch. A skinbiopsy revealed a cutaneous CD301 anaplastic T-cell lymphoma. The patient began 2months ago with oral bexarotene, with a good response.

Conclusion: From these patients, we found a rate of transformation of MF similarfrom those reported in the literature. We want to remark the importance of follow-up these patients.

APRIL 20

cial support: None identified.

Commer

MELANOMA & PIGMENTED LESIONS

Anthracosis mimicking metastatic melanoma sentinel lymph node

(Poster reference number 5447)Almudena Nuno-Gonzalez, Hospital Universitario Fundacion Alcorcon, Madrid,Spain; Araceli Sanchez-Gilo, Hospital Universitario Fundacion Alcorcon, Madrid,Spain; Fernando Pinedo-Moraleda, Hospital Universitario Fundacion Alcorcon,Madrid, Spain; Jose Antonio Rueda, Hospital Universitario Fundacion Alcorcon,Madrid, Spain; Jose Luis Lopez-Estebaranz, Hospital Universitario FundacionAlcorcon, Madrid, Spain; Mercedes Mitjavilla, Hospital Universitario FundacionAlcorcon, Madrid, Spain

Introduction: Sentinel lymph node biopsy (SLNB) was introduced in the 1990s formelanoma staging. It provides a pathologic lymph node basin staging in patientswith clinical stage I/II melanoma. Although it is a highly effective prognostic tool, itis debated whether it has any therapeutic value. We present a case of anthracosismimicking macroscopically and microscopically a positive melanoma sentinellymph node.

Case report: We present the case of a 75-year-old woman who had a nodularulcerated melanoma (2.2 mm Breslow, Clark IV) on her left arm. Therefore, sheunderwent SLNB; 99-technetium lymphoscintigraphywas used and it detected threesentinel lymph nodes, two on the left axilla and one on the supraclavicular area; thissupraclavicular lymph node was macroscopically black colored but of a normal size(\1 cm in diameter). The anatomopathologic study revealed an architecturallypreserved node with expanded sinus areas occupied with macrophages containingfine, granular, black pigment intracytoplasmatically. Hematoxylineeosin andinmunohistochemical staining (S-100, Melan-A, and HMB-45) showed negativityfor melanoma metastatic cells.

Discussion: There are some situations in which we can find a black lymph node:anthracosis, as in our patient, people with tattoos, hereditary hemochromatosis,lipofuscin deposits, or after an arthroplastic procedure. Anthracosis can occur aftersoot or smoke inhalation and it was first described on people who worked as coalminers. It is also seen in heavy smokers, secondary to a high level of contamination oreven linked to wood-burning stoves. The most commonly affected lymph nodes aremediastinic, because anthracosis is relatedwith soot inhalation but it can also be foundin cervical and supraclavicular lymph nodes. Our patient only had contamination as arisk factor for anthracosis and she did not have pulmonary symptoms. In this case thehistologic studymade the diagnosis, and hematoxylin eosin and inmunohistochemicalstaining (S-100, Melan-A, and HMB-45) ruled out melanoma metastasis.

Conclusion: To our knowledge, this is the first reported case of an anthracotic lymphnode mimicking metastatic melanoma. We want to highlight the importance ofanatomopathologic study of sentinel lymph node to detect melanoma metastaticcells and avoid unnecessary complete lymph node dissections.

cial support: None identified.

Commer

12

Assessing hairdressers’ knowledge about melanoma and determiningtheir willingness to detect scalp skin lesions and make referrals todermatologists

(Poster reference number 4889)Neda Roosta, University of Southern California Keck School of Medicine, LosAngeles, CA, United States; David Woodley, MD, University of Southern CaliforniaKeck School of Medicine, Los Angeles, CA, United States

Head and neck melanomas (HNMs) are an especially dangerous form of skin canceras they represent 6% of all melanomas yet account for 10% of all deaths frommelanomas and have 2 times the rate of melanoma-specific death than extremitymelanomas. The physical location of these lesions often makes them especiallysensitive to disease initiation and progression because the head and neck sustain thegreatest sun exposure and melanomas in this location are unidentifiable by self-inspection. Widespread public heath protocols are needed to improve earlydetection of HNM, since early detection has been one of the main factors underlyingthe increasing cancer-related survival rates. One innovative approach for early HNMdetection is to target hairdressers, considering they observe the greatest extent ofthe general public’s head, scalp and, neck and thus have unprecedented access fordetecting HNMs. This study addresses the vital role of hairdressers in the detectionof HNMs in the general population. A total of 108 hairdressers from 45 hair salons inSouthern California completed self-administered surveys during work hours.Respondents were mostly female (75%), had a mean age of 37.4 (SD ¼ 13.6) and13.3 months of training in beauty school. Hairdressers’ clients were mainly white(70.4%), followed by Hispanic (14.8%), and were mostly 31 to 40 years old. Resultsindicated 49.1% of hairdressers received at least some training on skin cancer inbeauty school. Even when not requested to do so by their clients, hairdressersreported examining their clients scalp for lesions a few times a month (10.2%), and afew times a week/daily (47.3%). 62% of hairdressers that recognized a lesion toldtheir client to see a doctor every time a lesion was observed. Of the hairdressers whobrought attention to a client’s lesion, 43.8% reported some form of dermatologicaldiagnosis resulting from the referral. The majority of hairdressers (85.2%) were notfamiliar with the ABCDE diagnostic of melanoma detection, and only 12.0% had highconfidence to identify a potential melanoma. The vast majority (91.7%) wanted tolearnmore about skin cancer detection via brochure or Internet modality, and 93.5%said they would be willing to inform clients of skin lesions after proper training.These findings suggest that hairdressers have the willingness to be trained in HNMdetection and referral. Implementing future education efforts targeted at hair-dressers will likely reduce the increasing disease burden of HNM.

cial support: None identified.

Commer

Atypical junctional melanocytic hyperplasia: A study of its prognosticsignificance

(Poster reference number 4709)Abdel Kader El Tal, MD, Wayne State University, Dearborn, MI, United States;Darius Mehregan, MD, Wayne State University, Dearborn, MI, United States; FarahMalick, MD, Wayne State University, Dearborn, MI, United States; MarijanaAtanasovski, MD, Wayne State University, Dearborn, MI, United States

Atypical junctional melanocytic hyperplasia (AJMH) is a poorly defined clinicalentity. For most dermatologists, it represents a melanocytic proliferation thatinsufficient for a definitive diagnosis of melanoma in situ. However, treatmentguidelines for AJMH are not well defined. A review of biopsies between 2003 and2004 from a private dermatopathology laboratory was performed. Fifty-five caseswere coded as atypical junctional melanocytic hyperplasia during that period. Outof the 55 cases identified, 27 fit into the strict criteria of AJMH. A questionnaire wassent to the selected 27 patients and treatment and recurrence rates were assessed.Of the 27 questionnaires that were sent, 21 replies were obtained. Two patientswere lost to follow-up and were excluded accordingly. Of the 19 remainingparticipants, 14 were females and 5 were males. The mean patient age was 53years old. The most common prebiopsy clinical diagnosis was atypical or dysplasticnevus. The most common location was the lower extremity. All 19 patientsunderwent reexcision of their lesions with 5 mm margins with the exception of 3patients who had reexcision with a 1mmmargin. No recurrences occurred. None ofthe 19 patients were treated with other treatment modalities other than excision.Patients were followed up for a period of 2-6 years. In conclusion, AJMH is a poorlydefined entity that is looked at, and treated, by the Dermatologist as an entity closerlinked to melanoma in situ than to a benign melanocytic proliferation. Treatment byexcision appears sufficient in this small sample to prevent recurrence; however,further studies are needed to determine optimal margins.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB141