Kilmer et al. Journal of the American Academy of Dermatology cell carcinoma and adenocarcinoma of the lung. lnt J Der- matoi 1986;25:459-60. i 3. Kameya S, Noda A, Isobe E, et al. The sign of Leser-Tr~lat associated with carcinoma of the stomach. Am J Gastroen- terol 1988;83:664-6. 14. Heng MCY, Soo-Hoo K, Levine S, et al. Linear seborrheic keratoses associated with underlying malignancy. J AM ACAD DERMATOL 1988;18;1316-21. 15. F~eingold KR, Elias PM. Endocrine-skininteractions. J AM ACAD DERMATOL 1987;17:921-40. 16. Gree KE. Cutaneous endocrinology and metabolic disease. In: Call JP, Jorizzo JL, eds. Dermatologic signs of internal disease. Philadelphia: WB Saunders, 1988:198-205. 17. Westrom DR, Berger TG. The sign of Leser-Tr~lat in a young man. Arch Dermatol 1986;122:1356-7. 18. Rigel DS, Jacobs MI. Malignant acanthosis nigricans: a review. J Dermatol Surg Oncol 1980;6:923-7. 19. Jansson JO, Ekberg S, Hoath S, et al. Growth hormone enhances hepatic epidermal growth factor receptor con- oentration in mice. J Clin Invest 1988;82:1871-6. Cutaneous type of adult T cell leukemia/lymphoma in a French West Indian woman Clonal rearrangement of T-cell receptor/3 and 3' genes and monoclonal integration of HTLV-l proviral DNA in the skin infiltrate Antoine Gessain, MD, a, b Isabelle Moulonguet, MD, c Bratrice Flageul, MD, c Pascal Perrin, MD, c Catherine Capesius, MD, b Marie-Fran~oise D'Agay, MD, d Christian Gisselbrecht, MD, e Fran9ois Sigaux, MD, a and Jean Civatte, MD c Paris, France A 45-year-old woman, a native of the French West Indies who had lived in France since 1973, developed multiple cutaneous plaques and nodules in 1987. Histopathologic studies revealed dermal infiltration with mature activated T cells (CD4 +, CD25 +, DR +) with nuclear con- volutions and epidermatotropism. High titers of specific human T lymphotropic virus (HTLV)-I antibodies were detected in the serum. Molecular analysis of DNA extracted from the skin tumor biopsy specimen showed a clonal integration of an HTLV-I provirus and a T-cell clonal population as demonstrated by T-cell receptor/3 and 3' gene rearrangement studies. Neither HTLV-I provirus nor T-cell receptor rearrangements were detected in pe- ripheral blood mononuclear cells DNA despite the presence of rare adult T cell leukemia cells (<1%) and a small excess of DR-expressing cells, and detection of HTLV-I Pol and Px se- quences by in vitro gene amplification. In this case only gene analysis of the skin lesions made possible an early diagnosis of a cutaneous adult T cell leukemia. This illustrates the need for such molecular studies to differentiate, in HTLV-I seropositive patients from endemic areas, a HTLV-I-induced T cell lymphoma from HTLV-I-nonrelated cutaneous T cell lympho- mas. (J AM ACAD DERMATOL1990;23:994-1000.) From the Laboratoired'H~matologieMol~eulaire et LaboratoireCen- tral d'Hematologie, a UPR 0043 CNRS "Retrovirus et Retrotrans- posons des Vert~brds, ''b Service de Dermatologie, e Laboratoire d'Anatomie Pathologique, a and Service d'Hrmatologie Cliniquep Hrpital Saint-Louis. Supported in part by grants from Association pour la Recherche contre le Cancer (ARC) (contrat 6670) Programme National de recherche sur le SIDA et les r&ro-virushumains (contract 060166) and from La Fondation contre la Leucrmie. Reprint requests: F. Sigaux, MD, Laboratoried'H~matologie Mol~cu- laire, Hrpital Saint-Louis 1, Avenue Claude Vellefaux,75475 Paris Cedex 10, France. 1614t21398 Human T lymphotropic virus type I (HTLV-I) I has been etiologically associated with adult T cell leukemia (ATL), an aggressive form of CD4 + lymphoprolifer ation 2' 3 and, sin ce 1985, with chronic progressive myelopathies. 4,5 ATL is endemic in southwestern Japan, 6'7 the Caribbean region, 8"1~ Central and South America, and some parts of Africa. tl Furthermore, in these areas the virus is widespread in the general population and 1% to 30% of the subjects, depending on age, sex, and region, 994