Complete Resolution of Primary Cutaneous Anaplastic Large Cell Lymphoma With Topical Imiquimod

May 2019 | Volume 18 | Issue 5 | Case Reports | 460 | Copyright © May 2019

Shelby L. Kubicki,a Katherine E. Park,b,c Phyu P. Aung MD PhD,d Madeleine Duvic MDc

aSchool of Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX bSchool of Medicine, Baylor College of Medicine, Houston, TX cDepartment of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX dDepartment of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX

Abstract
Primary cutaneous anaplastic large cell lymphoma (pc-ALCL) is a CD30+ subtype of cutaneous T-cell lymphoma. It typically has a very favorable prognosis; however, traditional treatment can be expensive, invasive, and associated with significant adverse events. Imiquimod is a topical toll-like receptor approved by the Food and Drug Administration (FDA) for genital warts, actinic keratosis, and primary superficial basal cell carcinoma. In previous case reports, imiquimod has been shown to be effective against pc-ALCL. We present a case of complete resolution of pc-ALCL within 8 weeks with topical imiquimod and review the current literature.

J Drugs Dermatol. 2019;18(5):460-462.

INTRODUCTION

Primary cutaneous anaplastic large cell lymphoma (pc-ALCL) is a CD30+ subtype of cutaneous T-cell lymphoma (CTCL). It typically presents as one or more nodules on the skin with a dermal infiltrate of >75% CD30+ lymphocytes.1

CASE REPORT

A 77-year-old Caucasian female presented for evaluation of a pink patch and papule on her forehead that appeared seven months prior. Examination revealed a 5 by 2 cm scaly pink patch on the right superior forehead with a 1 cm pink papule on the right medial forehead (Figure 1a). Lesional biopsy showed dense atypical lymphocytic infiltrate composed of medium to large cells with moderate amounts of eosinophilic cytoplasm, hyperchromatic or vesicular nuclei with irregular nuclear contours, conspicuous nucleoli, and frequent mitotic figures within the dermis without a Grenz zone, with prominent involvement of epidermis (Figures 2a & 2b). Atypical cells in the epidermis and dermis were diffusely positive for CD3, CD4 and CD30 (Figures 2c & 2d), and negative for CD8, CD20, and ALK1. CD7 was negative in epidermotropic cells. Together, these findings led to a diagnosis of pc-ALCL.Figure 1Figure 2