A case of radiation-induced bullous morphea/lichen sclerosus overlap in a breast cancer patient.

Radiation induced morphea (RIM) is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical treatment options. In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. In this paper we present a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment.

Diverse types of dermatologic toxicities from immune checkpoint blockade therapy.

Immunomodulatory drugs that leverages host immune mechanisms to destroy tumor cells have been met with great promise in the treatment of cancer. Immunotherapy, targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1) receptor and its ligand (PD-L1) have shown tremendous improvements in the survival of patients with advanced solid tumors. However, the development of dermatologic toxicity (DT) is a consequence to immunotherapy.

Graft-versus-host disease-associated angiomatosis: a clinicopathologically distinct entity.

Background: Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting.

Objective: We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD.

Post-varicella-zoster virus granulomatous dermatitis: a report of 2 cases.

Granulomatous dermatitis (GD) is known to occur following varicella-zoster virus (VZV) infection. Lesions may appear at varying times after the acute eruption in both immunosuppressed and immunocompetent hosts. The etiology of GD is unclear, and findings of VZV in the lesions often are inconsistent.

Annular plaques: An unusual manifestation of graft-versus-host disease.

Chronic cutaneous graft-versus-host disease (GVHD) classically presents with lichenoid papules or sclerotic plaques. This case highlights an unusual clinical manifestation of chronic GVHD and demonstrates that the skin morphology of chronic GVHD and cutaneous lymphoma may be similar. We report for the first time a case of annular scleroderma-like graft-versus-host disease in a patient following allogeneic stem cell transplant for CD30+ anaplastic large cell lymphoma.

Graft-versus-host disease: part II. Management of cutaneous graft-versus-host disease.

Dermatologists are ideally suited to manage the various cutaneous sequelae of graft-versus-host disease (GVHD) outlined in part I of this review. However, the complexity of the patient with GVHD, including comorbidities, potential drug interactions related to polypharmacy, and the lack of evidence-based treatment guidelines, are significant challenges to optimizing patient care. In this section, we will provide an outline for the role of the dermatologist in a multispecialty approach to caring for patients with GVHD.

Graft-versus-host disease: part I. Pathogenesis and clinical manifestations of graft-versus-host disease.

Approximately 25,000 allogeneic hematopoietic cell transplants are performed worldwide each year for a variety of malignant and non-malignant conditions. Graft-versus-host disease represents one of the most frequent complications and is a major source of long-term morbidity and mortality. Whereas acute graft-versus-host disease is induced by recognition of host tissues as foreign by immunocompetent donor cells, the pathogenesis of chronic graft-versus-host disease is not as well understood, and continues to be a major treatment challenge.

Actinic granuloma occurring in an unusual association with cutaneous B-cell chronic lymphocytic leukemia.

Granulomatous cutaneous reactions are well described in association with T-cell non-Hodgkin lymphoma and Hodgkin lymphoma, but are rarely seen in association with B-cell non-Hodgkin lymphoma or leukemia. We report a case of a 65-year-old woman with B-cell chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) who presented with multiple, tender, firm pink papules on the face, upper trunk and upper extremities 6 years after diagnosis of CLL. Biopsy revealed both palisading granulomatous dermatitis consistent with actinic granuloma and a dense perivascular lymphocytic infiltrate consistent with the patient's known history of leukemia.

Extended-field irradiation and intracavitary brachytherapy combined with cisplatin and amifostine for cervical cancer with positive para-aortic or high common iliac lymph nodes: results of arm II of Radiation Therapy Oncology Group (RTOG) 0116.

Objectives: Radiation Therapy Oncology Group (RTOG) 0116 was designed to test the ability of amifostine (Ethyol; MedImmune LLC, Gaithersburg, MD), a cytoprotective agent, to reduce the acute toxicity of combined therapy with extended-field irradiation, brachytherapy, and cisplatin chemotherapy in patients with cervical cancer with para-aortic or high common iliac disease. This report presents the results of part 2.

Materials And Methods: Radiation Therapy Oncology Group 0116 was a 2-part trial.

Ulcerated plaque under a ruby ring in an immunosuppressed patient.

We report a primary inoculation fungal infection in a 76-year-old man with acute myeloid leukemia. The patient presented with a painful red plaque located where he routinely wore a ruby ring. Histopathology revealed multiple branching septate hyphae.

Longitudinal melanonychia induced by capecitabine.

Capecitabine is an oral prodrug of 5-fluorouracil (5-FU), used in the treatment of metastatic colon and breast cancers; it is also under investigation for use in gastric cancers. Multiple cutaneous adverse effects have been reported with the use of capecitabine including acral erythema, pyogenic granulomas, inflammation of actinic keratoses, cutaneous and mucosal hyperpigmentation, leopardlike vitiligo, radiation recall, onycholysis, onychomadesis, and subacute cutaneous lupus. To our knowledge, no cases of capecitabine-induced linear melanonychia have been reported to date in the literature.

Four patients with cutaneous metastases from medullary thyroid cancer.

Cutaneous metastasis from thyroid cancer, especially medullary thyroid cancer (MTC) is rare. We report four patients with cutaneous metastases from sporadic MTC, three women and one man, aged 50 to 69 years. They presented different cutaneous lesions phenotypes.

Adult Henoch-schönlein purpura in a patient with myelodysplastic syndrome and a history of follicular lymphoma.

Goal: To understand Henoch-Schönlein purpura (HSP) to better manage patients with the condition.

Objectives: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe the criteria for diagnosing HSP.

Approach to the morbilliform eruption in the hematopoietic transplant patient.

Morbilliform eruptions occur frequently in the hematopoietic transplant population. The differential diagnosis includes drug reaction, viral exanthem, and cutaneous graft versus host disease. Using a typical patient case, we discuss the diagnostic approach to this clinical problem.

Epidermodysplasia verruciformis in the setting of graft-versus-host disease.

We report a case of epidermodysplasia verruciformis (EV)-like lesions in a patient with graft-versus-host disease after peripheral blood stem cell transplantation from his HLA-matched brother. The patient presented with a diffuse papular eruption that was clinically consistent with graft-versus-host disease; however, histopathology demonstrated viral cytopathic changes and polymerase chain reaction confirmed EV human papillomavirus types 8 and 20. Repeated biopsy specimen showed both human papillomavirus cytopathic effect and graft-versus-host disease, and further workup revealed ocular and hepatic involvement.

Cutaneous manifestations of chronic graft-versus-host disease.

Cutaneous chronic graft versus host disease has traditionally been classified into lichenoid and scleroderma-like forms. However, the initial presentation is sometimes subtle and a variety of less common cutaneous manifestation may be prevalent. This clinical review focuses on the lesional morphology of chronic graft versus host disease, and presents a classification system that may prove useful in early diagnosis.