Morphologic Features of Cutaneous T-Cell Lymphomas Using Dermoscopy and High Frequency Ultrasound

Abstract

The diagnosis of cutaneous T-cell lymphomas (CTCL) is frequently delayed by a median of three years and requires the clinical evaluation of an experienced dermatologist and a confirmatory skin biopsy. Dermoscopy and high-frequency ultrasound (HFUS) represent two non-invasive diagnostic tools. While dermoscopy is inexpensive and widely used for the diagnosis of melanoma and non-melanoma skin cancers, HFUS of skin lymphomas represents a novel diagnostic approach that is not yet implemented in the routine dermatologic practice. The aim of our study was to prospectively assess skin lesions of patients with either CTCL patches or plaques with dermoscopy and HFUS and to compare the findings with atopic dermatitis (AD) and psoriasis. Thirteen patients with an established diagnosis of CTCL, psoriasis, or AD were studied: Dermoscopy features including spermatozoa-like structures and the presence of white scales could assist in differentiating between early-stage CTCL and AD. HFUS measurements of the skin thickness indicated increased epidermal-, thickness in CTCL, and psoriasis compared with AD. Our results support the use of dermoscopy as a useful tool to diagnose CTCL. HFUS could augment the dermatologic assessment, but further studies will be needed to define standardized parameters.

Keywords: atopic dermatitis; cutaneous T-cell lymphoma; dermoscopy; high frequency ultrasound; mycosis fungoides; psoriasis; validation.

Figure 1

(A–I): Vascular patterns. Dermoscopic features of vascular patterns. (A–C): clinical, dermoscopy and schematic image of dotted vessels. (D–F): clinical, dermoscopy and schematic image of fine short linear vessels. (G–I): clinical, dermoscopy and schematic image of spermatozoa-like structures.

Figure 2

(A,B): Assessment of CTCL using HFUS. (A): High-frequency ultrasound image obtained in a CTCL patient depicting the epidermis (b), SLEB (c), papillary dermis (d), reticular dermis (e) and hypodermis/subcutis (f). (B): Schematic representation of the skin in high-frequency ultrasound images. Abbreviations: CTCL, cutaneous T-cell lymphoma; HFUS, high-frequency ultrasound; µm, micrometer; SLEB, subepidermal lower echogenic band.

Figure 3

(A–C): Epidermal-, SLEB-, and Dermal thickness in CTLC, AD and Psoriasis. (A): Epidermal thickness in µm measured from the epidermal entrance echo to the upper border of the SLEB (average of 5 measurements per patient); (B): SLEB thickness in µm measured from the lower border of the epidermis to the upper dermal border (average of 5 measurements per patient); (C): dermal thickness in µm measured from the lower border of the epidermis or if present from the lower border of the SLEB to the interface of the dermis and hypodermis (average of 5 measurements per patient). Abbreviations: AD, atopic dermatitis; CTCL, cutaneous T-cell lymphoma; µm, micrometer; SLEB, subepidermal lower echogenic band.