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Marginal zone lymphoma masquerading as phymatous acne rosacea: a case study
Hina S Baloch1, Zhenghao Wang1,2, Joy U L Staniforth3
1Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK.
Skin Health and Disease
|June 30, 2025
Summary
Marginal zone lymphoma (MZL) can rarely mimic phymatous acne rosacea. Early skin biopsy is crucial for diagnosing this rare presentation of MZL, ensuring timely treatment and improved outcomes.
Area of Science:
- Hematology
- Dermatology
- Oncology
Background:
- Marginal zone lymphoma (MZL) is a heterogeneous indolent B-cell lymphoma.
- Cutaneous MZL typically presents as papules, plaques, or nodules on the trunk and arms.
- MZL presenting as acne rosacea, particularly the phymatous subtype, is exceptionally rare and poorly documented.
Observation:
- A case of primary systemic nodal MZL with concurrent cutaneous extranodal MZL mimicking rhinophymatous and otophymatous acne rosacea is presented.
- An 84-year-old male with a history of nodal MZL developed erythematous, swollen ear and nose lesions initially diagnosed as acne rosacea.
- Conventional acne rosacea treatment was ineffective, prompting dermatological referral and biopsy.
Findings:
- Skin biopsy revealed a diffuse infiltrate of CD20+, CD79a+, BCL2+ small lymphoid B cells, consistent with cutaneous MZL.
- Further imaging confirmed systemic involvement, including lymphadenopathy and splenomegaly.
- Treatment with R-CVP chemotherapy led to significant improvement in both cutaneous and systemic disease.
Implications:
- This case highlights a rare mimicry of phymatous acne rosacea by MZL, emphasizing the risk of misdiagnosis and treatment delay.
- It underscores the importance of considering alternative diagnoses for atypical or unresponsive dermatological conditions.
- Early histological evaluation via skin biopsy is critical for accurate diagnosis and timely management of MZL.
