Resumo No espetro de patologias linfoproliferativas associadas a imunodesregulação/deficiência constam hiperplasias linfoproliferativas e linfomas agressivos, estes últimos predominantemente de células B. Descrevemos um caso de linfoma de células T, Epstein-Barr virus positivo, com apresentação cutânea e características histopatológicas ambíguas, num doente sob imunossupressão com infliximab. Paciente de 60 anos, com antecedentes pessoais de espondilite anquilosante e anemia hemolítica autoimune, tratado com infliximab e baixa dose de prednisolona, desde 2013. Apresentou nódulo cutâneo ulcerado, bem delimitado, com 7 cm na região lombar esquerda e placas eritematosas, bem delineadas, com 20 cm, na região escapular esquerda. A biópsia cutânea revelou uma infiltração difusa da derme superficial e profunda por linfócitos atípicos, de tamanho intermédio, que expressavam CD2, CD3, CD56, TIA-1, Granzima B, TCRδ e EBER. Não se observou epidermotropismo, vasculotropismo ou necrose. A FDG-PET/CT demonstrou hipercaptação esplénica, hepática, medular e nodal. Concluiu-se o diagnóstico de linfoma de células T/NK extranodal em contexto de imunossupressão. Com este artigo pretendemos alertar para a dificuldade diagnóstica, alta suspeição clínica e vigilância atenciosa necessárias em doentes com uso prolongado de imunossupressores.

Abstract Lymphoproliferative disorders arising in a background of immune deficiency/dysregulation correspond to a spectrum of disorders ranging from non-noxious hyperplasias to aggressive lymphomas, mainly of B-cell type. We describe a case of an Epstein-Barr virus-positive T-cell lymphoma, with a cutaneous presentation and unusual pathological features in a patient under immunosuppression with infliximab. A 60-year-old patient, with a history of ankylosing spondylitis and autoimmune hemolytic anemia, treated with infliximab and low-dose prednisone since 2013, presented with a 7 cm ulcerated, well-demarcated tumor on his left lower back and a 20 cm scaly, well-demarcated erythematous patch in the left scapular region. A skin biopsy revealed a diffuse infiltration of the superficial and deep dermis by atypical, intermediate-size lymphocytes that expressed CD2, CD3, CD56, TIA-1, Granzyme B, TCRδ, and EBER. There was no evidence of epidermotropism, vasculotropism, or necrosis. The fluor-d-glucose positron emission tomography showed a large splenic, hepatic, bone marrow, and nodal uptake. A diagnosis of an extranodal NK/T-cell lymphoma in association with immunosuppression was rendered. With this article, we aim to add awareness to the difficulty of diagnosis, the careful use of immunomodulators, clinical suspiciousness, and surveillance of possible consequences warranted in all patients under prolonged immunosuppression.

RESUMO: A terapêutica dirigida e a imunoterapia melhoraram significativamente o prognóstico dos doentes com melanoma avançado. Por outro lado, a expansão destes fármacos levou ao aumento do espetro de efeitos adversos cutâneos. Embora a maioria das reações seja de baixo grau, muitas causam morbilidade considerável, com forte impacto na qualidade de vida dos doentes. O diagnóstico precoce e a intervenção atempada poderão evitar a descontinuação dos tratamentos oncológicos. Neste artigo, revemos os efeitos adversos cutâneos das pequenas moléculas e anticorpos monoclonais usados no tratamento do melanoma, assim como a sua fisiopatologia e abordagem terapêutica.

ABSTRACT: Targeted therapy and immunotherapy have markedly improved prognosis of advanced melanoma patients. With expanded use of these drugs, a range of cutaneous adverse events has emerged. Although the vast majority of adverse events are low-grade, they many cause significant morbidity and can affect patients' quality of life. Early diagnosis and prompt intervention may prevent unnecessary discontinuation of life-saving anticancer therapies. In this article, we review the cutaneous adverse events of small molecules and monoclonal antibodies used for the therapy of melanoma and discuss their pathophysiology and recommendations for prevention and management of these adverse events.

Abstract: BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients.