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Non-Hodgkin lymphoma - Skin
See also in: Oral Mucosal Lesion
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Non-Hodgkin lymphoma - Skin

See also in: Oral Mucosal Lesion
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Contributors: Art Papier MD, William Van Stoecker MD
Other Resources UpToDate PubMed

Synopsis

The non-Hodgkin's lymphomas are a heterogenous group of malignant monoclonal proliferations of lymphoid cells of varying clinical presentation and prognosis. Exclusive of cutaneous T-cell lymphoma (CTCL or mycoses fungoides), skin involvement in the non-Hodgkin's lymphomas is relatively rare. For the purpose of this summary, CTCL and its leukemic phase, the Sezary syndrome, will be discussed separately; here, we will describe B-cell lymphomas involving the skin and some of the rare histiocytic lymphomas. B-cell lymphoma involving the skin is typically associated with lymph node involvement and is usually manifested by discrete solitary or multiple discrete nodules or tumors appearing over weeks to months, as opposed to the skin involvement of CTCL, which can evolve over a period of years. Large cell or histiocytic lymphoma can also show skin involvement and usually presents with nodal involvement. Complications of the lymphomas are often caused by mediastinal or retroperitoneal lymph node involvement where enlarged nodes can affect organs through pressure effects. Erythema and edema of the face and neck can result from pressure on the superior vena cava (superior vena cava syndrome); pelvic lymph nodes can cause pressure on ureters and lead to renal failure. Anemia is also a common feature in patients. Night sweats, fever, and malaise are frequent accompanying symptoms.

Codes

ICD10CM:
C85.90 – Non-Hodgkin lymphoma, unspecified, unspecified site

SNOMEDCT:
118601006 – Non-Hodgkin's lymphoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Drug eruption – Drug eruptions often present with urticarial, exanthematous, or vesicular/bullous lesions. Systemic symptoms include fever, lymphadenopathy, and facial edema. Eosinophilia on CBC and histology are often seen (but not an invariable finding). Look for NSAIDs, sulfonamides, and penicillin medication history.
  • Pityriasis lichenoides et varioliformis acuta – Papules and nodules in various stages of healing. Central necrosis can be noted in some papules, like lymphomatoid papulosis.
  • Secondary syphilis – Generalized scaling papules and plaques. Can involve the palms and soles. Check RPR, history of chancre.
  • Lichen planus – Very pruritic, flat-toped violaceous papules with fine scale. Associated with hepatitis C.
  • Lepromatous leprosy
  • Sarcoidosis
  • Leukemia cutis
  • B-cell lymphoma
  • Pseudolymphoma

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 12/31/2015
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Non-Hodgkin lymphoma - Skin
See also in: Oral Mucosal Lesion
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Non-Hodgkin lymphoma : Fever, Night sweats, Lymphadenopathy, Malaise, Smooth nodule
Clinical image of Non-Hodgkin lymphoma
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