title: Atypical clinical presentation of primary and secondary cutaneous follicle center lymphoma (FCL) on the head characterized by macular lesions.
abstract: BACKGROUND
  Primary cutaneous follicle center lymphoma (pcFCL) usually presents with reddish nodules, plaques, and tumors on the head and neck or the back.
  
  
  OBJECTIVE
  We sought to describe a peculiar clinical presentation of pcFCL and secondary cutaneous follicle center lymphoma (FCL).
  
  
  METHODS
  We report a series of 13 patients (7 male and 6 female; median age 58 years, mean age 58.2 years, age range 26-83 years) with either pcFCL (11 patients) or secondary cutaneous FCL (2 patients) presenting with lesions on the head deviating from the classic clinical manifestations characterized by plaques and tumors.
  
  
  RESULTS
  All patients presented clinically with diffuse, ill-defined, partly hypochromic, partly erythematous macules or with inconspicuous lesions located predominantly on the scalp and forehead. Dimension ranged between 4 to 5 cm2and greater than 30 cm2. The initial diagnosis was never cutaneous lymphoma, and all patients received various diagnoses including rosacea, alopecia, erysipelas, discoid lupus erythematosus, angiosarcoma, Borrelia infection, or sarcoidosis. Histologic examination confirmed the diagnosis of FCL in all patients.
  
  
  CONCLUSIONS
  Small number of cases and retrospective study design are limitations.
  
  
  CONCLUSIONS
  This clinical presentation of both pcFCL and secondary cutaneous FCL is unusual and represents a pitfall in the clinical diagnosis. Dermatologists should be aware of this clinical variant of FCL to establish a timely diagnosis and treat patients properly.
authors.affiliation: Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria; Department of Dermatology, Galliera Hospital, Genoa, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Massone
authors.affiliation: Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Fink-Puches
authors.affiliation: Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria. Electronic address: lorenzo.cerroni@medunigraz.at.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cerroni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003951:Diagnostic Errors; D004890:Erythema / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005153:Facial Neoplasms / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005546:Forehead / Q000473:pathology; D018858:Germinal Center / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008224:Lymphoma, Follicular / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D012871:Skin Diseases / Q000175:diagnosis; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D063189:Symptom Assessment
keywords: alopecia; cutaneous B-cell lymphoma; diffuse macule; large cell lymphocytoma; primary cutaneous follicle center lymphoma; secondary cutaneous follicle center lymphoma