Dilemmas associated with the surgical treatment of cutaneous B cell lymphomas

Abstract

Cutaneous lymphomas belong to the group of non-Hodgkin lymphomas. However, in case of an in-time diagnose and adequate treatment the prognosis of the disease is fairly good. Nevertheless, a thorny path leads to the correct diagnosis as several dermatological diseases cause problems in differential diagnostics. The authors describe the case history of a 53-year-old woman patient, who had a dermatological check-up due to a dermatitis in the shoulder region. A conservative treatment was started because of a suspected mycosis. Following its inefficiency an operative excision was carried out. The postoperative biopsy verified cutaneous B-cell lymphoma. The cutaneous B-cell lymphomas are such forms of non-Hodgkin lymphomas, where the malignant proliferation appears primarily in the skin, and in 6 months after the diagnosis extracutaneous manifestation cannot be detected. Several cases can be found in the literature, which show long interval between the manifestation of the symptoms and the setting of the diagnosis. This calls the attention to the significance of difficulties in the differential diagnosis. During the treatment of cutaneous lymphomas the type, the cutaneous extension, and the extracutaneous manifestation of the disease must be defined. The therapeutic plan can be made up by analysing these findings. On the basis of findings in this case and in the literature, a surgical treatment--beyond determining the correct diagnosis--could be a therapeutic alternative in the treatment of cutaneous B-cell lymphomas.