Non-invasive Skin Imaging in Cutaneous Lymphomas

Abstract

The diagnosis of cutaneous lymphomas is challenging and requires skin tissue for histology and immunophenotyping using immunohistochemistry and molecular studies. In recent years, the role of non-invasive imaging techniques has been described as part of the clinical assessment of cutaneous lymphoma lesions. Imaging modalities such as dermoscopy, reflectance confocal microscopy (RCM), and high frequency ultrasound (HFUS) have been shown to be very valuable in raising the clinical suspicion for lymphomas of the skin, and in distinguishing cutaneous lymphomas from inflammatory dermatoses such as lupus, psoriasis, or eczema. These non-invasive methods can be used to direct the clinician to the optimal biopsy site to maximize the histopathological results and minimize false negatives. These methods also have a potential place in monitoring treatment response. In this review we present a concise summary of the dermoscopic imaging, RCM, and HFUS features seen in cutaneous T-cell lymphomas (CTCL) and B-cell lymphomas (CBCL).

Figure 1. Cutaneous B-cell lymphoma. Clinical and Dermoscopy images.

a) Red papules and nodules on the arm of a 65 year-old female patient. B) Dermoscopy shown out-of focus short linear vessels on a salmon-colored background.

Figure 2. Mycosis Fungoides, Patch stage. Clinical and RCM images.

a) Hyperpigmented patch of mycosis fungoides located on the sole of a 55 year-old male patient. b) RCM images showing parakeratosis (oval) in the stratum corneum surrounding eccrine gland opening; c) spongiosis (circle) and exocitosis of inflamatory cells (arrows); d) Poutirer’ micro-abscesses in the epidermis (cirles); innflammatory cells at the level of the DEJ with partial obscuration of the DP rimming (non edge papillae); f) sclerosis of the superficial dermis.

Figure 3. Lymphomatoid Papulosis. Clinical and RCM images.

a) Partially necrotic papule of lymphomatoid papulosis on the left right arm of a 35 year-old feample patient. b) RCM image of the stratum corneum with focal parakeratosis (circle); c) diffuse exocytosis of highly refractile inflammatory cells in the epidermis; d) 1,5 by 1,5 mm block showign diffuse distribution of inflsammatory cells in the epidermis (arrows); e) non edge papillae with obscuration of the DEJ by dense infiltrate of inflammatory cells (arrows); f) dermal sclerosis with inflammatory cells (arrows) in the upper dermis and dilated vessels (circle).

Figure 4. Mycosis Fungoides, Tumor stage. Clinical Dermoscopy and HFUS images.

a)Red tumor (arrow) and pink patches on the medial thigh of a 75 year-old female patient. b) Dermoscopic imaging of the lesion showed dotted vessels, white scale and bright white lines with orange structureless areas. c) HFUS of the tumor shows thickened dermis and hypodermis with hypoechoic to un-echoic dermis and hyperechoic hypdermis with d) significant vascularization of the tumor.