Cutaneous lymphomas in Germany: an analysis of the Central Cutaneous Lymphoma Registry of the German Society of Dermatology (DDG).

BACKGROUND: Primary cutaneous lymphomas form a heterogeneous group of lymphatic neoplasias. They manifest themselves on the skin and are the second most frequent group of non-Hodgkin lymphoma (NHL) following gastrointestinal lymphomas. The number of epidemiologic studies is small due to limited availability and limited comparability on population-based data. PATIENTS AND METHODS: In the present study the first evaluation of the German Central Registry for Cutaneous Lymphomas (ZRKL) of the German Society of Dermatology (DDG) is undertaken on the basis of 998 patients. The epidemiology of cutaneous lymphomas in Germany is compared to other national or regional lymphoma registries. RESULTS: Based on the registration of 998 patients from 26 clinics in Germany,a clear predominance of cutaneous T-cell lymphomas (85 %) in comparison to cutaneous B-cell lymphomas (14 %) is seen. The most frequent representative of CTCL is mycosis fungoides,composing 62 % of cases with a slight predominance of men (M:F = 1.6:1). Differences are also seen in stage of the disease at first presentation of patients with cutaneous lymphomas.While, for example, 80 % of patients with mycosis fungoides in Germany present in early stages (I-IIA),in the USA 34 % of patients are in the tumor stage or have organ involvement at presentation. CONCLUSIONS: The ZRKL of the DDG for the first time presents epidemiologic data from Germany, allowing comparison with other nations for the study of etio-logical factors and socioeconomic influences. Further, the ZRKL supports the development of uniform and quality-oriented diagnostic criteria and therapeutic options. Finally, the ZRKL provides a foundation for future intensive study of clinical and scientific questions regarding cutaneous T- and B-cell lymphomas.

Topical imiquimod as treatment for different kinds of cutaneous lymphoma.

Imiquimod as a topical immune response modifier leads to a localized production of interferon and other cytokines. Apart from its use for genital warts it has therefore been used as treatment for different cutaneous neoplasms, including a few cases of cutaneous T-cell lymphoma. We treated 8 patients (4 with mycosis fungoides, 1 with CD30+ anaplastic large cell lymphoma and 3 with primary cutaneous B-cell lymphoma) with topical imiquimod. Therapy was started three times per week, in cases without response, the frequency was increased to a daily application. Two patients with mycosis fungoides and the patient with the CD30+ anaplastic large cell lymphoma had a complete clinical remission, the other two patients with mycosis fungoides did not show a response to imiquimod. Of the patients with cutaneous B-cell lymphoma, two reached a partial remission, one did not respond to therapy. Two patients had side effects such as erythema and pruritus which disappeared when the frequency of therapy was reduced. Our preliminary data show that imiquimod might be effective in some cases with therapy resistant lesions of cutaneous T-cell lymphoma as well as of cutaneous B-cell lymphoma, but more controlled studies are needed.

[The new German educational law for medical schools: the Hamburg concept in dermatology and venereology]. / Die neue Approbationsordnung für Arzte: Das Hamburger Konzept im Fach Dermatologie und Venerologie.

Medical school graduates are required to deal with complex situations in their future work which require profound theoretical knowledge as well as many practical skills. The University of Hamburg used a new educational law (AappO 2002) as catalyst to define learning objectives relevant for practice and to guarantee a close connection between theory and practice. A newly founded curriculum committee with twelve members developed a strategy and structure for the new clinical curriculum (KliniCuM) in weekly sessions. The subject dermatology and venereology is taught in the thematic block "The Internal and External Human Being" in integrated courses with the subjects internal medicine, pathology and pharmacology. The teaching modules (introductory lectures, symptom-oriented lectures, problem-based tutorials and bedside-teaching) are practice oriented and teach diseases and skills of dermatology which are important for "general medicine". Written and practical exams take place at the end of the block. Although there is more required attendance and increased demands on students' time, dermatology has received very positive evaluation results. Students consider their gain in knowledge and skills as very high. The new curriculum in Hamburg could provide helpful orientation for other medical faculties in changing their curricula for the subject "dermatology and venereology" according to the new educational law.

Polysorbate 80 in medical products and nonimmunologic anaphylactoid reactions.

BACKGROUND: Polyoxyethylene-sorbitan-20-monooleate (also known as polysorbate 80 and Tween 80) is a solubilizing agent ubiquitously used in nutritives, creams, ointments, lotions, and multiple medical preparations (e.g., vitamin oils, vaccines, and anticancer agents) and as an additive in tablets. Whereas its relevance as a contact allergen has declined during the past decades, it is of current relevance as a "hidden" inductor of anaphylactoid reactions. OBJECTIVE: To identify polysorbate 80 (generally believed to be an inert vehicle) as an inductor of a severe anaphylactoid reaction. METHODS: Skin prick testing, enzyme-linked immunosorbent assay, IgE immunoblotting, and flow cytometric detection of basophil activation were performed in controls and in a patient with a medical history of anaphylactic shock due to intravenous administration of a multivitamin product during pregnancy. RESULTS: Polysorbate 80 was identified as the causative agent for the anaphylactoid reaction of nonimmunologic origin in the patient. Polysorbate specific IgE antibodies were not identified in enzyme-linked immunosorbent assay and immunoblot examinations, confirming the nonimmunologic nature of the anaphylactoid reaction. CONCLUSIONS: Polysorbate 80 is a ubiquitously used solubilizing agent that can cause severe nonimmunologic anaphylactoid reactions.

Topical photodynamic therapy for patients with therapy-resistant lesions of cutaneous T-cell lymphoma.

Photodynamic therapy after topical application of 5-aminolevulinic acid is an effective therapy for nonmelanoma epithelial skin cancers. It has also been used for some cases of cutaneous T-cell lymphoma. We treated 4 patients with different cutaneous T-cell lymphomas with photodynamic therapy. Those patients had previously reached a partial remission with more conventional therapies, but single lesions had remained. In all of these cases a complete remission of these lesions was achieved. We, therefore, suggest that photodynamic therapy can be a useful additional treatment modality for patients with therapy-resistant lesions of cutaneous T-cell lymphoma.

Localized cutaneous small to medium-sized pleomorphic T-cell lymphoma: a report of 3 cases stable for years.

Small to medium-sized pleomorphic cutaneous T-cell lymphomas represent a provisional entity in the new European Organization for Research and Treatment of Cancer classification. We describe 3 patients with a localized and outstanding stable variant of this tumor. A median follow-up period of 50 months did not reveal any spread into regional lymph nodes or to distant sites in any patient.

Bilateral temporal arteritis.

Temporal arteritis is a giant cell arteritis that affects large- or medium-sized elastic arteries. Often, only 1 temporal artery is affected. We describe a patient with both temporal arteries being involved simultaneously. To our knowledge, this particular constellation has rarely been described so far.