Distribution and clinical features of lymphomas involving skin in Taiwan

Abstract

A wide variety of primary and secondary lymphoma types involves the skin. However, reports with comparisons between both groups are limited in Taiwan. We retrospectively enrolled all cutaneous lymphomas and evaluated their clinicopathologic features. There were 221 cases of lymphoma: 182 (82.3%) primary and 39 (17.7%) secondary. Mycosis fungoides was the most common primary T-cell lymphoma, 92 (41.7%) cases, followed by CD30-positive T-cell lymphoproliferative disorders including lymphomatoid papulosis (n = 33, 14.9%) and cutaneous anaplastic large cell lymphoma (n = 12, 5.4%). The most frequent primary B-cell lymphomas were marginal zone lymphoma (n = 8, 3.6%) and diffuse large B-cell lymphoma (DLBCL), leg type (n = 8, 3.6%). DLBCL including variants was the most common secondary lymphoma involving skin. Most primary lymphomas presented at low-stage (T-cell, 86%; B-cell, 75%), whereas the majority of secondary lymphomas presented at high-stage (T-cell, 94%; B-cell, 100%). Patients with secondary lymphomas had an older mean age, more frequent B symptoms, lower serum albumin and hemoglobin, and a higher frequency of atypical lymphocytes in blood than those with primary lymphomas. In primary lymphomas, older age, lymphoma types, decreased lymphocyte counts and atypical lymphocytes in blood were poorer prognostic factors. In secondary lymphoma patients, lymphoma types, high serum lactate dehydrogenase and low hemoglobin levels predicted poorer survival. We found that the distribution of primary cutaneous lymphomas in Taiwan mirrors that of other Asian countries but shows some differences as compared with Western countries. Primary cutaneous lymphomas have a better prognosis than secondary lymphomas. Histologic classification of lymphomas highly correlated with disease presentation and prognosis.

Keywords: clinicopathologic factors; cutaneous lymphoma; primary; prognosis; secondary.

FIGURE 1

Survival curves of cutaneous lymphomas. (A) Kaplan–Meier curves illustrate that secondary cutaneous involvement of systemic lymphomas is associated with worse overall survival (p < 0.001, log‐rank test). (B–D) Kaplan–Meier plots of overall survival show that advanced age (B, >70 years, p < 0.001, log‐rank test), decreased blood lymphocyte counts (C, <15.4%, p < 0.001, log‐rank test) and present blood atypical lymphocytes (D, p = 0.019, log‐rank test) were poorer prognostic factors for primary lymphomas. (E, F) Elevated LDH levels (D, p = 0.044, log‐rank test) and decreased hemoglobin levels (E, p = 0.001, log‐rank test) are poorer prognostic factors in secondary cutaneous lymphomas.