Pediatric Acral Site Cutaneous T-Cell Lymphoma Imitating Acromegaly

Cutaneous T-cell lymphoma (CTCL) is an infrequent non-Hodgkin lymphoma of the skin, with mycosis fungoides (MF) as the most common subtype. MF in palms and soles is an exceptionally rare presentation, particularly in pediatric patients. We report a case of a 17-year-old boy presenting with progressive enlargement of his hands and feet with thickening of palms and soles, initially suspected to have acromegaly. Laboratory and imaging workup ruled out endocrine and genetic causes of acromegaly. A skin biopsy confirmed a diagnosis of MF. This case illustrates the diagnostic challenges of pediatric MF, due to both its extreme rarity and potential for overlapping clinical presentation with other systemic conditions. The patient's socioeconomic background and immigration status limited initial access to specialized care, further complicating the evaluation and underscoring the health care barriers for immigrant populations. Community health centers play a crucial role in early diagnosis and care coordination, yet limited access to dermatology services in rural areas remains a significant challenge. Beyond expanding our current understanding of pediatric MF and broadening the differential diagnosis of acral enlargement in adolescents, this case emphasizes the importance of equitable health care access for immigrant patients. The findings highlight the need for increased dermatologic services in community health settings and among underserved populations.