Primary cutaneous smoldering adult t-cell leukemia/ lymphoma

HTLV-1 is a virus that is endemic in southwestern Japan and the Caribbean and has been implicated in the development of ATLL. ATLL, which is an uncommon malignant condition of peripheral T-lymphocytes, is characterized by four clinical subtypes, which include acute, lymphomatous, chronic, and smoldering types, that are based on LDH levels, calcium levels, and extent of organ involvement. We present a 52-year- old woman with pruritic patches with scale on the buttocks and with tender, hyperpigmented macules and papules of two-years duration. Histopathologic examination was suggestive of mycosis fungoides, laboratory results showed HTLV-I and II, and the patient was diagnosed with primary cutaneous ATLL. We review the literature on HTLV-1 and ATLL and specifically the prognosis of cutaneous ATLL. The literature suggests that a diagnosis of ATLL should be considered among patients of Caribbean origin or other endemic areas with skin lesions that suggest a cutaneous T-cell lymphoma, with clinicopathologic features of mycosis fungoides. Differentiation between ATLL and cutaneous T-cell lymphoma is imperative as they have different prognoses and treatment approaches.