Simulators of Cutaneous Lymphoma

Abstract

This issue of the Journal contains the report of a workshop on cutaneous lymphoma sponsored by the Society for Hematopathology and the European Association for Haematopathology. Although consensus appears elusive regarding the spelling of the name of one of their subspecialties, the exercise is obviously worthwhile. Dermatopathologists and h(a)ematopathologists bring different perspectives to the study of cutaneous lymphoma, and the field needs input from and, indeed, continuing contact between both groups. Dermatopathologists have been the first to recognize some conditions, such as primary cutaneous follicular lymphoma and leg type B-cell lymphoma. These neoplasms have turned out to have counterparts in other organs, but they are recognized in the World Health Organization lymphoma classification.1 Hematopathologists can bring a broad perspective to the table and, in many cases, know better how to apply evolving technologies used to evaluate lymphomas in general. The workshop, the highlights of which are delineated in this issue, concentrated on cutaneous lymphoid hyperplasia, drug reactions, lupus profundus, pityriasis lichenoides, Kikuchi disease, mucocutaneous ulcers, and pigmented purpuric dermatosis. The authors’ description of their experience notes some interesting and controversial cases among these entities. Certainly, anyone with an interest in this area would benefit from seeing these cases and hearing their discussion. But does it address the problems that pathologists who may encounter such cases have? Does it address the difficulties that consultant dermatopathologists have with this area? Are the issues important ones for the care of patients? Troubling issues in the culture of medicine need to be solved to make the diagnosis of cutaneous lymphoma more accurate. Let’s start with dermatologists. Most dermatologists see more patients with cutaneous lymphoma during residency than in their careers. One senior physician who attended our cutaneous lymphoma clinic some years ago told me that he had never had a patient appear in …