Meenal K Kheterpal1, Julia Dai2, Shamir Geller3, Melissa Pulitzer4, Andy Ni5, Patricia L Myskowski3, Alison Moskowitz6, Jinah Kim7, Eric K Hong2, Sophia Fong2, Richard T Hoppe8, Youn H Kim9, Steven M Horwitz6. 1. Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Duke University, Durham, North Carolina. Electronic address: meenal.kheterpal@duke.edu. 2. Department of Dermatology, Stanford University, Stanford, California. 3. Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 6. Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Pathology, Stanford University, Stanford, California. 8. Department of Radiation Oncology, Stanford University, Stanford, California. 9. Department of Dermatology and Medicine, Stanford University, Stanford, California.
Abstract
BACKGROUND: Whole-body imaging is the current standard of care for staging all patients presenting with skin lesions of B-cell lymphomas (BCLs), regardless of skin disease extent; however, supporting data are lacking. OBJECTIVE: To determine the clinical utility of imaging in the detection of systemic involvement in low-grade cutaneous BCLs in the skin. METHODS: Retrospective cohort analysis of patients presenting with cutaneous lesions of BCLs at Memorial Sloan Kettering Cancer Center and Stanford University during 1997-2016. RESULTS: At initial staging, of the 522 patients, extracutaneous disease was noted in 3.6% and 8.8% of patients with marginal zone lymphoma (MZL, n = 306) and follicle center lymphoma (FCL, n = 216) histology, respectively. In patients with systemic involvement, imaging alone identified 81.8% (9/11) of MZL cases and 89.4% of follicular lymphoma cases. In primary cutaneous MZL, 1.7% of patients subsequently had extracutaneous involvement (median follow-up 45 months), and in primary cutaneous FCL. 3.0% subsequently had extracutaneous involvement (median follow-up 47 months). LIMITATIONS: This was a retrospective study. CONCLUSION: Imaging is effective at identifying patients with systemic involvement in indolent BCLs present in the skin; however, incidence is low. After negative initial staging, primary cutaneous MZL patients may be followed clinically without routine imaging.
BACKGROUND: Whole-body imaging is the current standard of care for staging all patients presenting with skin lesions of B-cell lymphomas (BCLs), regardless of skin disease extent; however, supporting data are lacking. OBJECTIVE: To determine the clinical utility of imaging in the detection of systemic involvement in low-grade cutaneous BCLs in the skin. METHODS: Retrospective cohort analysis of patients presenting with cutaneous lesions of BCLs at Memorial Sloan Kettering Cancer Center and Stanford University during 1997-2016. RESULTS: At initial staging, of the 522 patients, extracutaneous disease was noted in 3.6% and 8.8% of patients with marginal zone lymphoma (MZL, n = 306) and follicle center lymphoma (FCL, n = 216) histology, respectively. In patients with systemic involvement, imaging alone identified 81.8% (9/11) of MZL cases and 89.4% of follicular lymphoma cases. In primary cutaneous MZL, 1.7% of patients subsequently had extracutaneous involvement (median follow-up 45 months), and in primary cutaneous FCL. 3.0% subsequently had extracutaneous involvement (median follow-up 47 months). LIMITATIONS: This was a retrospective study. CONCLUSION: Imaging is effective at identifying patients with systemic involvement in indolent BCLs present in the skin; however, incidence is low. After negative initial staging, primary cutaneous MZLpatients may be followed clinically without routine imaging.
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