Primary cutaneous follicle centre cell lymphoma of the scalp presenting with scarring alopecia

Abstract

Funding sources: none. Conflicts of interest: none declared. Madam, The World Health Organization–European Organization for Research and Treatment of Cancer distinguishes three main types of primary cutaneous B‐cell lymphoma. These are primary cutaneous follicle centre cell lymphoma (PCFCCL), marginal zone lymphoma and diffuse large B‐cell lymphoma.1 PCFCCL is the most common subtype, representing 11% of all primary cutaneous lymphomas.2 It is an indolent lymphoma, typically manifesting as solitary or grouped papules, nodules or tumours on the head, neck or upper back. Histologically, the disease is characterized by a bottom‐heavy dermal infiltrate showing irregular follicular structures with a reduced or absent mantle zone.3 Lesions generally increase in size and number over a period of years and, left untreated, may eventually progress to ulceration and scarring.4, 5 Alopecia is not a recognized presenting feature of PCFCCL. A 55‐year‐old woman presented to the department of dermatology with a 5‐year history of hair thinning, predominantly over the frontal scalp. For 3 years, the hair loss had been associated with redness, soreness and pruritus. Symptoms were limited to the scalp and the patient was systemically well. She denied photosensitivity, weight loss, pyrexia and malaise, but admitted occasional nondrenching night sweats.