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Leukemic and Lymphomatous Infiltrates of the Skin

»Define lymphoma.

Mycosis Fungoides

»Is there a lymphoma that begins in the skin?
»What type of lymphoma is mycosis fungoides?
»How common is mycosis fungoides?
»How does mycosis fungoides begin?
»What is parapsoriasis?
»What type of skin lesions are seen in patients with mycosis fungoides?
»Describe the three subtypes of mycosis fungoides.
»What is the TNM classification of mycosis fungoides?
»How is mycosis fungoides treated?
»Describe topical nitrogen mustard (HN2) therapy.
»If a patient develops allergic contact dermatitis to topical nitrogen mustard, does the treatment have to be permanently discontinued?
»Is photochemotherapy an effective treatment of mycosis fungoides?
»What are the major side effects of bexarotene in the treatment of patients with cutaneous T-cell lymphoma?
»How does one manage the side effects of bexarotene?
»Are interferons effective in treating mycosis fungoides?
»Is chemotherapy an effective treatment of mycosis fungoides?
»What is extracorporeal photophoresis?
»Are there any other FDA-approved treatments for cutaneous T-cell lymphoma?

Other Lymphomas and Leukemias

»Outline the Ann Arbor clinical staging system for Hodgkin’s disease.
»What is a Reed-Sternberg cell?
»What are the histologic classes of Hodgkin’s disease?
»Does Hodgkin’s disease occur in the skin?
»How are cells immunophenotyped? What does the CD nomenclature mean?
»What is lymphomatoid papulosis?
»Are CD30-positive cells specific for lymphomatoid papulosis?
»What is HTLV-1 virus? What is its significance?
»Can multiple myeloma present with skin lesions only?
»What is pseudolymphoma of the skin?
»Can B-cell lymphomas present with skin lesions?
»What is the most common type of leukemia in adults?
»Can leukemia present with specific skin lesions?
»What are some nonspecific skin lesions seen in patients with leukemia?

 
 
 

How does one manage the side effects of bexarotene?

Hypothyroidism caused by bexarotene (Targretin) results in a low thyroid-stimulating hormone level because the drug stops RNA transcription. Central hypothyroidism is managed with levothyroxine replacement. It is recommended that one start and stop levothyroxine and bexarotene together. Measure free T4 at baseline, at 2 weeks, then monthly. Normalizing free T4 helps clear plasma lipids.

Hyperlipidemia caused by bexarotene (Targretin) can be managed with lipid-lowering agents. The preferred lipidlowering agents include atorvastatin (Lipitor), an HMG CoA reductase inhibitor (statin), and fenofibrate (Tricor), which acts by increasing lipolysis through activation of lipoprotein lipase. Other statins include simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), lovastatin (Mevacor), and rosuvastatin (Crestor). It is recommended that one start the preferred statin 1 week before starting bexarotene.