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80-Year-Old Female with Persistent Red Bump on Back

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

An 80-year-old female presents with a persistent red bump on her back of 3 months duration. She is otherwise healthy and has been taking the same statin drug for over 5 years. She said the bump is asymptomatic.

What is the cause of her bump?

Choose one to reveal diagnosis and discussion

Persistent tick bite reaction
Epidermoid cyst
Cutaneous B-cell lymphoma
Amelanotic melanoma
Irritated seborrheic keratosis

Answer: Cutaneous B-cell lymphoma

See the full case at Consultant360

A biopsy confirmed the diagnosis of a cutaneous B-cell lymphoma (CBCLs). Primary CBCLs represent 20% to 25% of all cutaneous lymphomas and tend to have an overall favorable prognosis. The workup includes using histomorphology and cytomorphology, immunohistochemistry and phenotypic features, and genotyping.

Treatments may include surgical excision, antibiotics, and radiotherapy. Overtreatment should be avoided.

Differential diagnosis: Tick bite is typically very pruritic. Epidermoid cyst has a cystic feel unlike the nodule seen here. Seborrheic keratoses have a characteristic surface texture that is not seen here. Melanoma can only be excluded by biopsy.

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