Een pleister of zalf op de wonde is niet altijd voldoende, of toch?

Abstract

A band-aid or ointment on the wound is not always enough, or is it? A healthy 68-year-old man presents with a progressive, ulcerated, livid swelling on the right elbow. After clinicopathological correlation, the diagnosis of a primary cutaneous anaplastic large-cell lymphoma (ALCL) is made. This entity is part of the heterogeneous group of ALCL, which is a subtype of T-cell lymphoma with a similar morphology, but a variable clinical presentation, therapy and prognosis. An ALCL usually occurs in adults, rarely in children and adolescents. Locally or scattered over several sites, large single or multiple slow-growing erythematous papules, nodules or tumours develop. These lesions may ulcerate, exudate and/or itch. Generally, the prognosis is favourable, with a 5-year survival rate of 90%. Spontaneous regression is observed in 25% of the cases. Recurrences are frequent (up to 30% of the cases), but usually remain cutaneous. If technically feasible, a solitary or localized primary cutaneous ALCL can be excised, but if inoperable, radiotherapy is initiated, as in the discussed patient. Case series also describe good responses to a low dose of methotrexate (15-20 mg per week), but recurrences are frequent and the evidence is limited. In case of multifocal skin involvement, combination chemotherapy is used.