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  #1  
Old 12-20-2012
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Skin A 45-year-old man with skin lesions

A 45-year-old man presents to his primary care physician with a complaint of patchy dry areas on his skin. After several trials of skin emollients and corticosteroid therapies without improvement, the lesions are biopsied by a dermatologist. Pathologic examination reveals a monoclonal population of B lymphocytes infiltrating the dermis and epidermis. A complete blood count is normal, and no atypical cells are observed on peripheral blood smear.The patient states that he feels quite well. Which of the following management options would be appropriate as recommended by the patient’s dermatologist?

(A) Anticipation of bone marrow transplant
(B) Observation alone
(C) Systemic chemotherapy
(D) Systemic corticosteroids
(E) Treatment of the affected areas of skin with topical nitrogen mustard
(F) Treatment of the entire skin surface via total skin electron beam therapy
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(D) Systemic corticosteroids ??
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Would go with D
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Can't figure this one out clinically it looks like cutaneous T cell lymphoma but no pruritus (T/t -topical nitrogen mustard) but the histology is suggestive of cutaneous B cell lymphoma (treatment of which is either surgical excision or local radiotherapy).
So, I'll go with (B) Observation alone
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Last edited by Novobiocin; 12-20-2012 at 05:43 PM.
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I'm not sure on the diagnosis....but would go with OBSERVATION ALONE....
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The correct answer is E. The patient is presenting with cutaneous T-cell lymphoma (CTCL), or mycosis fungoides. This disease is a B-lymphocyte lymphoma that is generally indolent. The malignant process involves B-lymphocyte that normally inhabit the dermis and epidermis, and may not affect the lymph nodes themselves at all. CTCL may affect patients in several different stages, although one stage does not necessarily lead to another. Patients may live for 20+ years without progression of disease. The phases of disease are as follows: The phase of least severity is a patch stage, involving only the epidermis in discrete areas of the skin. This phase may or may not progress to a plaque stage, affecting discrete skin areas but invading the dermis as well as the epidermis. The tumor phase may follow the plaque stage, and involves deep involvement of the dermis with growth in height, forming discrete tumors. The final and most severe stage of disease is a systemic illness generally called Sézary’s syndrome. During this phase the entire skin is involved with lymphoma cells, and telltale Sézary cells are found in the circulation. This is the only phase of CTCL that affects the systemic circulation. This patient’s disease is consistent with the plaque stage of disease, since the dermis is invaded by lymphomatous cells. Several treatments exist for CTCL and vary according to stage. Early (patch or plaque) stage disease may be treated with topical nitrogen mustards on an outpatient basis. More advanced disease may be treated with conventional radiation therapy or total skin electron beam therapy.

Answer B is incorrect. Although observation is appropriate for certain patients, it is rarely relied upon because of the real chance that disease might progress to disfigurement or death. Because topical treatments have relatively benign adverse effect profiles, they are generally used for even mild early-stage disease.

Answer D is incorrect. Systemic corticosteroids are not generally used to treat CTCL.
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Old 12-25-2012
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While I can understand that cutaneous T-cell lymphoma (CTCL), or mycosis fungoides may not have pruritus in initial stages but it's the T cells not B cells which are malignant.

Quote:
Mycosis fungoides

Mycosis fungoides is a malignant lymphoma characterized by the expansion of a clone of CD4+ (or helper) memory T cells (CD45RO+) that normally patrol and home in on the skin.[2] The malignant clone frequently lacks normal T-cell antigens such as CD2, CD5, or CD7.
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Old 12-27-2012
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Quote:
Originally Posted by Novobiocin View Post
While I can understand that cutaneous T-cell lymphoma (CTCL), or mycosis fungoides may not have pruritus in initial stages but it's the T cells not B cells which are malignant.
You are absolutely wright there is a lot off mistakes in First Aid Q&A 2008
Thanks bro for correction.
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Old 12-28-2012
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I should used skin cream for your skin........ I understood .. About your skin . Because I am also surrived same problem
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Old 12-31-2012
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Quote:
Originally Posted by heartbeat View Post
You are absolutely wright there is a lot off mistakes in First Aid Q&A 2008
Thanks bro for correction.
Looks like they corrected this mistake in later version of the book.
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