Summary
Definition
History and exam
Key diagnostic factors
- skin patches, plaques, or tumours
- poikiloderma
- erythroderma
Other diagnostic factors
- pruritus
- hypopigmented skin lesions
- unilesional acral site involvement
- lymphadenopathy
- constitutional symptoms
- palmar-plantar keratoderma
- alopecia
- leonine facies
- onychodystrophy
- hepatomegaly
- ectropion
- bullous, granulomatous, ichthyosiform, and purpuric lesions
Risk factors
- age >60 years
- male gender
- black ethnicity (mycosis fungoides); white ethnicity (Sézary's syndrome)
- exposure to infectious agents
- chromosomal abnormality
- environmental exposure to industrial chemicals, herbicides, pesticides
Diagnostic investigations
1st investigations to order
- FBC
- screen for Sézary's cells on blood film
- skin biopsy
- polymerase chain reaction (PCR) for T-cell receptor
- flow cytometry
- basic metabolic panel
- LFTs
- serum LDH
Investigations to consider
- human T-cell lymphotropic virus (HTLV)-I serology
- bone marrow biopsy
- lymph node biopsy
- CT scan
- HIV test
Treatment algorithm
Contributors
Authors
Professor of Targeted Therapy and Oncology
University of Manchester
Manchester Academic Health Sciences Centre
Manchester
UK
Disclosures
TMI declares that he has no competing interests.
Consultant in Clinical Oncology
Christie NHS Foundation Trust
Manchester
UK
Disclosures
RC declares that he has no competing interests.
Consultant Dermatologist
Tameside Hospital Integrated Care Organisation NHS Trust
Manchester
UK
Disclosures
EP declares she has no competing interests.
Peer reviewers
Assistant Professor
Department of Radiation Oncology
Duke University School of Medicine
Durham
NC
Disclosures
CK declares that he has no competing interests.
Professor and Head of Dermatology
Department of Medicine
New Jersey Medical School
Newark
NJ
Disclosures
RAS declares that he has no competing interests.
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