Recognizing presentations of conditions linked to new medical therapies is an emerging clinical trend, according to experts speaking at a symposium on what is new in dermatopathology held during the 73rd annual meeting of the American Academy of Dermatology (San Francisco, 2015). BRAF inhibitors, for example, are therapies that are producing cases of neutrophilic panniculitis, according to Nooshin Ketabchi Brinster M.D., assistant professor, department of dermatology, New York University School of Medicine/Langone Medical Center, New York. “The common theme is that they develop painful, non-ulcerating nodules that occur on the lower extremities,” she says. “They can mimic erythema nodosum, but patients can also develop lesions on the upper extremities and on the trunk. There is a 48-day delay in onset of this condition from the time treatment is initiated. More and more BRAF inhibitors are being used in patients with melanoma, so it may be something that you come across.” Patients do not need to stop BRAF inhibitor therapy, Dr. Ketabchi Brinster says. Rather, the dose can be reduced, she adds. “No patients thus far have required stopping treatment,” she says. Other relatively new phenomena that clinicians should be aware of are follicular papules on the face, particularly the forehead, that present with frontal fibrosing alopecia, Dr. Ketabchi Brinster says, noting this presentation can occur atypically in younger patients. Tammie C. Ferringer M.D., an associate in the department of dermatology at Geisinger Medical Center and director of the dermatopathology Fellowship Program, Danville, Penn., says dermatopathologists should be careful not to mistake a plaque type syringoma for microcystic adnexal carcinoma. “It (plaque type syringoma) stays superficial,” Dr. Ferringer says, in terms of looking at clues to differentiate a plaque-type syringoma from a microcystic adnexal carcinoma. Other presentations that Dr. Ferringer described include papules on the nose, which may prove to be spindle cell predominant trichodiscoma, and these presentations are CD34 positive, she notes. Jacqueline M. Junkins-Hopkins M.D., a dermatopathologist at the American Academy of Dermatopathology in New York, discussed variants of mycosis fungoides such as folliculotropic mycosis fundgoides, which can be an aggressive variant of cutaneous T-cell lymphoma. “Patients can still have an aggressive course of disease even though they don’t have tumors per se,” said Dr. Junkins-Hopkins. “The patients tend to be younger, and it tends to be an indolent disease but some can have systemic lymphoma. There can be some fatal disease with this, so these patients have to be watched.”
Modern medicine – dermatopathology