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59-Year-Old Male with Erythematous Plaques on Cheeks

Can you diagnose this case?

David Kaplan, MD – Series Editor – 2016

Signs and Symptoms

This 59-year-old man had been followed in the clinic for years for indurated, erythematous plaques on the sun-exposed surface of the lateral cheeks, 3 biopsies of which have confirmed pseudolymphoma. Pseudolymphoma is not a specific disease; rather, it is an inflammatory response that results in a lymphoma-appearing patch or plaque but is a benign accumulation of inflammatory cells. While it tends to wax and wane in this patient, he noticed a new bump in the plaque noted in the photograph. He did not have any localized adenopathy and otherwise felt fine.

What is the best approach to this man’s pseudolymphoma plaques?

Choose one to reveal diagnosis and discussion

Repeat the biopsy, despite the previous 3 having the same results
Reassure the patient, and follow up in 6 months
Order chest radiography
Start a potent topical corticosteroid cream
Perform cryosurgery

Answer: Repeat the biopsy one more time, despite the previous 3 having the same results

See the full case at Consultant360

This patient had a repeat biopsy, which now showed progression to a cutaneous B-cell lymphoma, a rare but reported possibility in patients with benign pseudolymphoma. Fortunately, these lesions respond to a variety of treatments once a patient is evaluated to determine the type of B-cell lymphoma and to ensure only cutaneous involvement.

Chest radiographs would not be helpful in establishing the diagnosis in the case. The slow, indolent course would make reassurance and follow-up a reasonable approach in an otherwise stable patient, but maintaining clinical alertness for a change in character of the lesions is helpful, as was the case here.

Topical corticosteroid cream or cryosurgery would be appropriate, but as his or her clinician, you would want to see the patient in a timely fashion to evaluate the response to therapy (in 6 to 8 weeks, for example).

Topical corticosteroid cream or cryosurgery would be appropriate, but as his or her clinician, you would want to see the patient in a timely fashion to evaluate the response to therapy (in 6 to 8 weeks, for example).

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