Dermoscopy of Lymphomatoid Papulosis

Abstract

L YMPHOMATOID PAPULOSIS (LYP) IS CHARACterized by papular, papulonecrotic, and/or nodular skin lesions at different stages of development, predominantly on the trunk and limbs. We prospectively evaluated 8 patients using dermoscopy and histopathologic correlations. The aim of this pilot study was to define dermoscopic criteria associated with the different stages of the disease (erythematous papule, ulcerated and/or necrotic papule, and cicatricial lesion). The dermoscopic pattern was similar in all patients and varied with the different stages of the disease. The initial inflammatory papular lesion (Figure 1A) showed essentially a vascular pattern of tortuous irregular vessels radiating from the center to the periphery of the lesion (Figure 1B). A white structureless area was seen around the vessels (Figure 1B, inset). On histopathologic evaluation, dilated vessels were observed on the upper dermis (Figure 1C and D, arrow) among the tumoral dense infiltrate of large CD30 cells (for type A LyP). Intravascular thrombosis was noted on the small vessels, usually at the beginning of the ischemic process (Figure 1E, arrow). On more mature lesions (hyperkeratotic papules), a whitish structureless area was seen at the center of the papule (Figure 2A). The vessel pattern was still observed, but it spared the middle of the lesion (Figure 2B). This central pattern was correlated with the onset of a hyperkeratosis on histologic samples and the onset of fibrinoid necrosis (Figure 2C, arrow) associated with intravascular thrombosis on the upper dermis. In the third stage, the necrotic ulceration replaced the whitish structureless area (Figure 3A). We observed centrally a brown-gray structureless area corresponding to the fibrinocruoric material; the vessel pattern was strictly limited to the extreme periphery of the lesion (Figure 3B). On histopathologic analysis (Figure 3C), a crust was seen on the center of the lesion, while the tumoral infiltrate and vessels were only seen deeper and at the periphery. Finally, in the cicatricial phase (Figure 4A), we observed no more residual vessel pattern; only a browngray structureless mark suggesting postinflammatory pigmentation persisted (Figure 4B). Histopathologically, findings corresponded to the dermal fibrosis noted in scarring LyP but without residual tumoral infiltrate (Figure 4C). As LyP lesions mature, their histopathologic changes can be well correlated with morphologic features seen on dermoscopy.