{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:54:17Z","timestamp":1791561257397,"version":"4.3.4"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Adult T-cell leukemia\/lymphoma (ATLL) is a rare aggressive mature T-cell neoplasm caused by the human T-cell leukemia virus type 1 (HTLV-1). The disease predominantly affects patients from endemic regions of Japan, the Caribbean, Sub-Saharan Africa, and South America. Cutaneous involvement of ATLL is common and may appear before or in the absence of systemic involvement. However, the lesions are non-specific and often mimic more common inflammatory and neoplastic skin diseases, making diagnosis challenging. Moreover, morphology is variable among patients, ranging from macules and papules to tumors and erythroderma. Recent data suggests that the presence of cutaneous lesions and lesion morphology are important for prognostication and for guiding treatment. Here, we provide an overview of the spectrum of cutaneous findings in ATLL, highlighting their diagnostic, prognostic, and therapeutic implications. We emphasize the importance of early recognition and workup of suspicious skin lesions, particularly in endemic regions or high-risk populations. Finally, we describe fundamental concepts and controversies, and highlight current knowledge gaps.<\/jats:p>","DOI":"10.3389\/fmed.2025.1603102","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T05:33:48Z","timestamp":1758864828000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A review of cutaneous manifestations of HTLV-associated adult T-cell leukemia\/lymphoma"],"prefix":"10.3389","volume":"12","author":[{"given":"Tessa M.","family":"LeWitt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro A.","family":"Gru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"388","DOI":"10.3389\/fmicb.2012.00388","article-title":"Epidemiological aspects and world distribution of HTLV-1 infection.","volume":"3","author":"Gessain","year":"2012","journal-title":"Front Microbiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"322","DOI":"10.3389\/fmicb.2012.00322","article-title":"Adult T-cell leukemia: a review of epidemiological evidence.","volume":"3","author":"Iwanaga","year":"2012","journal-title":"Front Microbiol."},{"key":"B3","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1182\/blood.V50.3.481.481","article-title":"Adult T-cell leukemia: clinical and hematologic features of 16 cases.","volume":"50","author":"Uchiyama","year":"1977","journal-title":"Blood."},{"key":"B4","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1200\/JOP.2017.021907","article-title":"Adult T-cell leukemia\/lymphoma.","volume":"13","author":"Mehta-Shah","year":"2017","journal-title":"J Oncol Pract."},{"key":"B5","doi-asserted-by":"publisher","first-page":"107635","DOI":"10.1016\/j.leukres.2024.107635","article-title":"Immunological aspects of HTLV-1 persistence; for the prevention and treatment of Adult T-cell leukaemia-lymphoma (ATL).","volume":"148","author":"Weterings","year":"2025","journal-title":"Leuk Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1073\/pnas.0507631103","article-title":"HTLV-I basic leucine zipper factor gene mRNA supports proliferation of adult T cell leukemia cells.","volume":"103","author":"Satou","year":"2006","journal-title":"Proc Natl Acad Sci U S A."},{"key":"B7","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1002\/ijc.20007","article-title":"Genetic and epigenetic inactivation of tax gene in adult T-cell leukemia cells.","volume":"109","author":"Takeda","year":"2004","journal-title":"Int J Cancer."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1182\/blood-2009-12-257410","article-title":"Joint study on predisposing factors of atl development investigators. human T-cell leukemia virus type I (HTLV-1) proviral load and disease progression in asymptomatic HTLV-1 carriers: a nationwide prospective study in Japan.","volume":"116","author":"Iwanaga","year":"2010","journal-title":"Blood."},{"key":"B9","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1002\/ijc.20144","article-title":"Role of HTLV-1 proviral DNA load and clonality in the development of adult T-cell leukemia\/lymphoma in asymptomatic carriers.","volume":"110","author":"Okayama","year":"2004","journal-title":"Int J Cancer."},{"key":"B10","doi-asserted-by":"publisher","first-page":"385","DOI":"10.3324\/haematol.2012.069476","article-title":"Pre-morbid human T-lymphotropic virus type I proviral load, rather than percentage of abnormal lymphocytes, is associated with an increased risk of aggressive adult T-cell leukemia\/lymphoma.","volume":"98","author":"Hodson","year":"2013","journal-title":"Haematologica."},{"key":"B11","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1111\/j.1346-8138.2008.00465.x","article-title":"New entity, definition and diagnostic criteria of cutaneous adult T-cell leukemia\/lymphoma: human T-lymphotropic virus type 1 proviral DNA load can distinguish between cutaneous and smoldering types.","volume":"35","author":"Amano","year":"2008","journal-title":"J Dermatol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/j.1365-2133.2004.06274.x","article-title":"Clinicopathological features of cutaneous lesions of adult T-cell leukaemia\/ lymphoma.","volume":"152","author":"Yamaguchi","year":"2005","journal-title":"Br J Dermatol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/j.1365-2141.1991.tb08051.x","article-title":"Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. 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