Department of Dermatology, Yale School of Medicine, New Haven, USA.
Department of Medicine (Hematology), Yale School of Medicine, New Haven, USA.
Blood Rev. 2017 Nov;31(6):370-388. doi: 10.1016/j.blre.2017.07.003. Epub 2017 Jul 14.
Cutaneous manifestations of myeloid malignancies are common and have a broad range of presentations. These skin findings are classified as specific, due to direct infiltration by malignant hematopoietic cells, or non-specific. Early recognition and diagnosis can have significant clinical implications, as skin manifestations may be the first indication of underlying hematologic malignancy, can reflect the immune status and stage of disease, and cutaneous reactions may occur from conventional and targeted agents used to treat myeloid disease. In addition, infections with cutaneous involvement are common in immunocompromised patients with myeloid disease. Given the varying presentations, dermatologic findings associated with myeloid malignancies can pose diagnostic challenges for hematologists and dermatologists. In this clinical review intended for the practicing hematologist/oncologist, we discuss the presentation, diagnosis, treatment, and prognostic value of the most common cutaneous manifestations associated with myeloid malignancies using illustrative macro- and microscopic figures and with a special emphasis on practical considerations.
髓系恶性肿瘤的皮肤表现较为常见,表现多样。这些皮肤表现可分为特异性表现,这是由于恶性造血细胞直接浸润所致,或为非特异性表现。早期识别和诊断具有重要的临床意义,因为皮肤表现可能是潜在血液系统恶性肿瘤的首发表现,可反映免疫状态和疾病分期,并且皮肤反应可能发生于用于治疗髓系疾病的常规和靶向药物。此外,患有髓系疾病的免疫功能低下患者常伴有皮肤感染。鉴于其多样的表现,与髓系恶性肿瘤相关的皮肤科发现可能会给血液科医生和皮肤科医生带来诊断挑战。在本篇面向临床医生的综述中,我们使用说明性的宏观和微观图像,重点讨论了最常见的与髓系恶性肿瘤相关的皮肤表现的临床表现、诊断、治疗和预后价值,这些表现与髓系恶性肿瘤相关。