Eur J Plast Surg (1998) 21:243±245
J.A. Lozano ´ F.J. Escudero
Surgical treatment of primary cutaneous B-cell lymphoma
of the head and neck
Received: 30 September 1997 / Accepted: 30 December 1997
J.A. Lozano (
) ´ F.J. Escudero
Department of Plastic and Reconstructive Surgery,
Virgen del Camino Hospital, Pamplona, Spain
Mailing address: Pedro Malón de Echaide 41, 5C,
E-31008 Pamplona, Spain
Tel.: +34-48-176-905; Fax: +34-48-170-515
Abstract Cutaneous B-cell lymphoma with CD30, CD20
antigenic phenotype are a distinct group of cutaneous
lymphomas with a favorable prognosis after treatment.
Three patients are presented seen over a three year period
of time, they were all excised. A good response to this
therapy was observed with a satisfactory overall progno-
sis on long-term follow-up. This may prevent patients
from having unnecessarily aggressive treatment.
Key words Cutaneous B-cell lymphoma ´ CD30 antigen ´
Surgical treatment ´ Prognosis
Primary cutaneous B-cell lymphoma (PCBCL) is current-
ly classified heterogeneously as follicular center cell ma-
lignant lymphoma with a nonaggressive clinical behavior
and a low tendency to spread .
The presentation of malignant lymphoma as a solitary,
discrete cutaneous nodule without clinical evidence of
lymph node involvement on the face or scalp is rare .
In a three year period three patients were referred with cu-
taneous lesions diagnosed histologically as primary cuta-
neous B-cell lymphoma (PCBCL). The clinical presenta-
tion, course, and surgical treatment of these patients with
PCBCL of the head and neck is presented.
An 85-year-old woman was referred with two pink nodules of 53.5
cm and 22 cm over the vertex of the scalp (Fig. 1). These were sur-
rounded by slightly infiltrated annular erythema. The lesions had
been present for six months and were enlarging rapidly. Clinical ex-
amination including a full blood count, liver function test, and chest
X-ray was unremarkable. Early wide excision with a 2 cm margin
was performed, and the patient was referred to the Oncology Depart-
ment where no active therapy was recommended. The excised le-
sions were classified as a CD30 (ki-1) positive anaplastic large cell
lymphoma. The patient remains disease-free after five years.
A 54-year-old man was referred with a 1.7 cm diameter raised pink
cutaneous nodule at the dorsum of the nose (Fig. 2). This had been
present for two months. There was no palpable cervical adenopathy.
Clinical examination, full blood count, and chest X-ray showed no
other abnormality. Early excision was performed and the defect
was closed with a rotation flap. The lesion was classified as CD30
positive low-grade B-cell lymphoma. The patient received no fur-
ther treatment and remains disease-free five years later.
A 63-year-old man was referred with a 0.5 cm diamter smooth cu-
taneous mass on the nasal tip, this had been present for seven
months. Clinical examination, full blood count, liver function test,
and chest X-ray were all normal. The lesion was excised and cov-
ered with a local myocutaneous flap. The histological diagnosis
was a large B-cell lymphoma with ki-1 antigen (Fig. 3). The patient
was referred to the Oncology Unit where further investigation re-
vealed no evidence of dissemination. The patient remains free of
disease four years later.
PCBCL are a group of lymphomas that originate in the
skin and constitute approximately 20% of primary cutane-
ous lymphomas. The presentation of malignant B lym-
phoma as a solitary cutaneous nodule without clinical ev-
idence of lymph node involvement is rare.
Several reports of these patients have described a fa-
vorable prognosis after radiotherapy and chemotherapy.
Santucci et al.  reported 83 cases of PCBCL and de-
scribed a nonaggressive clinical behavior with a substantial
tendency to remain localized to a limited area of the skin.