Mycosis Fungoides Palmaris et Plantaris on the Plantar Aspec
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A 54-year-old man presented with a diffuse, hard lesion in the middle of the arch of his left foot, which had been there for 3 years. He described the onset as insidious and its nature as cracked, dry, scaly, and not painful. The patient reported a history of severe eczema with dry patches in the same area, which he had treated unsuccessfully with topical cortisone cream and over-the-counter acid. Over the past several months, the lesion had gradually thickened, hardened, and becoming noticeably tender, progressing to the point where it was painful to walk.

Dermatological examination revealed a 3.0-cm, scaly, keratotic patch with slight erythema in the plantar central region of the left arch, which was tender to palpation. Neither clear signs of skin atrophy nor lymphadenopathy were found. Histological evaluation of a specimen from skin punch biopsyrevealed infiltration of atypical lymphocytes in the upper dermis. Most of the atypical lymphocytes were round or ovoid with a cerebriform nuclear contour but with no clear nuclear membrane or nucleoli. The atypical lymphocytes infiltrated up into the epithelial layers (epidermotropism) in single units or small clusters, and down into the eccrine sweat glands (syringotropism) and the walls of the blood vessels in the dermis.

Immunostaining of the atypical lymphocytes showed almost uniformly strong positive staining for CD3, CD4, and CD5, and about 30% positivity for CD7 and CD8, but staining for CD20 was negative. The ratio of CD4- to CD8-positive cells was about 3: 1. The histomorphology and immunostaining profiles were consistent with MFPP.

Treatment options were discussed with the patient in detail, and he was referred to a dermatologist for topical psoralen plus ultraviolet A (PUVA) photochemotherapy. Complete remission was achieved and the patienthad no recurrence at 5-year follow-up.

source: https://www.amjcaserep.com/download/index/idArt/923361
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