Actinically derived squamous cell carcinomas arising in light-complected individuals who have had extensive lifetime sun exposure are typically not aggressive. The cutaneous squamous cell carcinomas arising in patients receiving chronic immunosuppressive therapy or with underlying lymphoproliferative disorders, however, follow an aggressive course. These neoplasms occur with greater frequency, are often multiple or eruptive, and display a high metastatic potential. 1 Cutaneous T-cell lymphoma has not been found to intrinsically predispose individuals to second cutaneous malignancies.2 When these patients are treated with long-term topical mechlorethamine or psoralen and UV-A photochemotherapy, however, the relative risk of developing nonaggressive cutaneous squamous cell carcinomas increases.3,4 A new form of therapy for erythrodermic cutaneous T-cell lymphoma is extracorporeal photopheresis. It has many immunomodulatory effects but is not known to cause immunosuppression or cutaneous malignancies. In a recent review of the 149 patients with cutaneous T-cell lymphoma treated with photopheresis who have been described