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June 2009

Cutaneous Lymphomas: What Can We Learn From Location?

Arch Dermatol. 2009;145(6):710-712. doi:10.1001/archdermatol.2009.117

In this issue of the Archives, 2 American working groups describe 2 distinct subsets of cutaneous T-cell lymphomas (CTCLs) with a limb location and poor prognosis.1,2 Poligone et al1 report 3 cases of unusual variants of CTCL that originated on the lower legs of elderly patients (median age, 82 years) and had an aggressive behavior, with rapid relapses after radiotherapy and resistance to other treatments. Woo et al2 studied prognostic factors in a series of 48 patients with primary cutaneous anaplastic T-cell lymphoma (PCATCL) and identified a small subset of 4 cases with an extensive limb disease and a more aggressive clinical course. These 4 patients (median age, 73 years) were 25 years older than those with the classic form of the disease. Three of them had lesions located on the lower limbs. Microarray data revealed that patients with an extensive limb disease had a differential gene expression profile compared with classic cases. These original reports recall the first description by the Dutch cutaneous lymphoma working group, more than 10 years ago, of a distinct type of cutaneous B-cell lymphoma (CBCL) localized on the lower limbs.3 More generally, this raises the question of whether topographic variants of lymphomas, and especially cutaneous lymphomas,3,4 are clinically and biologically relevant.

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