Mycosis fungoides development after combined immune checkpoint blockade therapy in a patient with malignant melanoma: a case report.

Immune checkpoint blockade therapy can induce immune-related toxicity, but cutaneous lymphoma development has not been reported. A 56-year-old woman presented with two well-demarcated erythematous macules on the right sole and vitiligo on her extremities. Her facial melanoma had been treated with combination therapy (ipilimumab and pembrolizumab), followed by pembrolizumab monotherapy, a year prior. Microscopy revealed small-to-medium-sized lymphocytes permeating along with the basal epidermal layer. These were immuno-positive for CD2, CD3, and CD5, and showed complete CD7 loss; CD30, TCR-beta F1, and PD-1 were also detected. They exclusively expressed CD8, not CD4, and had a Ki-67 labeling index of 30-40%. Epstein-Barr virus in-situ hybridization was negative. Clonal T-cell receptor beta and gamma chain gene rearrangements were detected. Hence, the lesions were diagnosed as mycosis fungoides. This is the first report of mycosis fungoides development after anti-melanoma immunotherapy. The patient is currently on steroid ointments and phototherapy.

The effects of judicial admonitions on hearsay evidence.

Using a simulated civil case, this experiment investigated whether mock jurors: (a) are able to disregard hearsay evidence when admonished to do so, (b) experience psychological reactance and "backfire effects" in proportion to the strength of judicial admonition instructing them to disregard hearsay evidence, and (c) are able to recognize and disregard hearsay evidence without judicial instructions. Results indicate that jurors were unable to disregard inadmissible hearsay testimony in some legal decisions regardless of whether there were judicial instructions to do so. Jurors exhibited backfire effects paying more attention to inadmissible hearsay evidence when they were strongly instructed to disregard it. More specifically, juror backfire effects were evident in both their confidence in their liability verdicts and in their punitive damage awards. The legal and policy implications of these findings are discussed.