ASDP: Benign Lichenoid Keratosis Can Histologically Mimic Mycosis Fungoides
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ASDP: Benign Lichenoid Keratosis Can Histologically Mimic Mycosis Fungoides

By Alison Palkhivala
Special to DG News

PHOENIX, AZ -- October 14, 2002 -- Clinically typical benign lichenoid keratosis (BLK) can share several histopathologic features with mycosis fungoides (MF). Physicians should be aware of this potential pitfall in diagnosis.

Ibrahim A. Al-Hoqail, MD, and Richard I. Crawford, MD, from the division of dermatology and department of pathology at University of British Columbia, in Vancouver, British Columbia, Canada, conducted a study to investigate the histopathological patterns shared by BLK and MF. They presented their findings here October 12 at the annual meeting of the American Society of Dermatopathology (ASDP).

As part of a retrospective study, the investigators examined tissue samples from 15 individuals with BLK. The original lesions ranged in size from 0.2 to 1.8 cm, with a mean of 0.6 cm, and were mostly present on patients' trunks. Most had been removed because of a suspicion of cutaneous malignancy, usually basal cell carcinoma.

In each tissue sample, the researchers looked for histopathological features that would be suggestive of MF. All of the samples, as part of the inclusion criteria, had at least three MF-related histopathologic features.

The number of MF histopathological parameters found in each BLK sample varied, but nine samples had at least four of these features. The features seen most frequently in the samples were Pautrier microabscesses and alignment of lymphocytes along the basal layer, and were found in 93 percent of samples.

"Pathologists considering suggesting the diagnosis of MF on a histological basis should first search for clinical or histological clues that the biopsied lesions might be BLK masquerading as MF," according to the researchers. "On the other hand, clinicians who receive pathologic interpretations of MF in an incongruous clinical setting should consider BLK as a potential explanation."

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