Derma Case: 69-year-old Man with PMHx of CAD and Dyslipidemia

00:02 Let's go to another case.

00:04 Now, this is a 69-year-old man with a past medical history of CAD and dyslipidemia who presents with a slowly progressive eruption of bumps on his left knee over the past year.

00:18 He's tried over the counter anti-fungal creams and an old topical corticosteroid cream but it just won't go away.

00:24 He also reports some weight loss of about 10 pounds over the past six months.

00:29 Now, the lesions that are on his knee are pruritic.

00:32 Over the next few months, the lesions progressed to areas of confluence, some of which are ulcerating.

00:38 When you do the skin exam, you see innumerable pink papules and plaques of varying size and shape distributed on the lower torso and the legs.

00:46 There's minimal scale, and there's no pustules.

00:49 What do you think the diagnosis could be in this case? This is a tricky one.

00:55 This is mycosis fungoides (cutaneous T cell lymphoma).

00:59 You wouldn't necessarily come to that conclusion just from the history and physical alone.

01:04 But it's one of those conditions that you have to think of it or you'll never think of it, get it? Talking about mycosis fungoides a little bit more again, cutaneous T cell lymphoma this is an idiopathic, slowly progressive skin cancer and essentially, it represents a type of non-Hodgkins lymphoma.

01:23 The thing about mycosis fungoides is that it can present almost any way that it wants to.

01:28 You're going to have persistent and/or very slowly progressive skin lesions of varying size and shape.

01:33 You could have localized patches.

01:35 You could have widespread plaques which appear to be what's shown in this picture.

01:40 You can have tumors that continue to enlarge and are exophytic or you could have generalized erythroderma.

01:45 Really, any different way it wants to present, it can present.

01:49 Importantly, this can be a fairly aggressive tumor insofar as they can invade lymph nodes and visceral organs as well.

01:56 It's just one of those things that you have to have on your differential diagnosis even if it is fairly infrequent.

02:02 It's something you just have to keep in the back of your mind.