Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma Follow-up

  • Author: Cary Chisholm, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Feb 26, 2010
 

Further Outpatient Care

  • In cutaneous CD30+ (Ki-1) anaplastic large-cell lymphoma (cutaneous CD30+ ALCL), arrange for follow-up care to look for any new skin lesions or lymphadenopathy.
  • Obtain a CBC count if the patient is undergoing chemotherapy.
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Complications

  • Chemotherapy drugs are myelosuppressive.
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Prognosis

  • Generally, cutaneous CD30+ (Ki-1) anaplastic large-cell lymphoma (cutaneous CD30+ ALCL) has a favorable clinical course (5-y survival rate of 90%) for the primary cutaneous form, with occasional spontaneous regression (up to 25% of cases) of the skin lesions. The systemic form has a worse prognosis than the primary cutaneous form. The primary cutaneous CD30- large-cell lymphoma also has a much worse prognosis (5-y survival rate of 15%) than that of the primary cutaneous form of CD30+ ALCL.
  • Primary cutaneous disease, spontaneous regression, absence of extracutaneous involvement, and younger age at onset (£60 y) have been suggested to be associated with a better prognosis.
  • The expression of either nucleophosmin-anaplastic lymphoma kinase (NPM-ALK) transcripts or anaplastic lymphoma kinase (ALK) protein is not correlated with prognosis or age in the primary cutaneous form of CD30+ cutaneous lymphoproliferations; however, expression of either NPM-ALK transcripts or ALK protein indicates a better prognosis in the systemic form of ALCL.
  • Prior studies have suggested that the stage of disease may be more important than the cytologic subtype.
  • CD30 ligand expression is detected in regressing lesions only and indicates a better prognosis. Cutaneous CD30+ ALCLs developing from preexistent mycosis fungoides are often associated with a poor prognosis (5-y survival rate of 10-30%).
  • Regional lymph node involvement is not necessarily associated with an unfavorable prognosis.
  • P53 expression by immunohistochemistry is not associated with spontaneous regression, extracutaneous spreading, or survival.
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Patient Education

  • Regular follow-up care is indicated for possible relapse or recurrent disease.
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Contributor Information and Disclosures
Author

Cary Chisholm, MD  Resident Physician, Department of Pathology, Texas A&M Health Science Center College of Medicine

Cary Chisholm, MD is a member of the following medical societies: College of American Pathologists, Texas Medical Association, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Bennett, MD  Assistant Professor, Department of Internal Medicine, Texas A&M Health Science Center College of Medicine; Senior Staff, Department of Dermatology, Scott and White Memorial Hospital

Daniel D Bennett, MD is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, American Medical Association, Dermatology Foundation, National Psoriasis Foundation, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Daniel S Loo, MD  Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center

Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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This ulcerated nodule of localized primary cutaneous CD30+ anaplastic large cell lymphoma is relatively nonspecific in appearance. Courtesy of Dr. Ronald Grimwood.
Sheets of atypical cells are seen infiltrating through the superficial and deep dermis. The epidermis is hyperkeratotic (hematoxylin and eosin, 40X).
The markedly atypical, large, and pleomorphic, epithelioid cells have frequent mitoses. Prominent nucleoli are present (hematoxylin and eosin, 400X).
CD30 strongly stains all the malignant cells in the characteristic membranous pattern (CD30 immunostain, 100X).
 
 
 
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