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November 1997

An Erythematous Plaque Above the Ear

Author Affiliations

University of Edinburgh Medical School, Edinburgh, Scotland

Arch Dermatol. 1997;133(11):1458. doi:10.1001/archderm.1997.03890470137024

REPORT OF A CASE  A previously fit, 54-year-old woman with non—insulindependent diabetes presented with a 3-month history of an asymptomatic follicular rash involving the anterior chest area, breasts, flexures, periauricular areas, and scalp. The rash had persisted despite 2 courses of systemic antibiotics. She also gave a history of recent weight loss and night sweats.Physical examination revealed a violaceous, pinkish, papular eruption on the anterior chest area, flexures, forehead, and scalp, particularly above the left ear (Figure 1). Systemic examination revealed generalized lymphadenopathy and hepatosplenomegaly. An incisional skin biopsy specimen was obtained from above the left ear and submitted for histologic examination (Figure 2 and Figure 3). Immunoperoxidase staining with CD20 is shown in Figure 4.What is your diagnosis?

DIAGNOSIS:  Skin involvement by a B-cell follicular centrocytic/centroblastic lymphoma.

HISTOPATHOLOGIC FINDINGS  The skin biopsy specimen revealed follicular aggregates of lymphocytes within the dermis with extension into the subcutaneous fat. Morphologically, the predominant cells

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