Observations on occult malignant lymphomas in the skin

Six patients with malignant cutaneous lymphomas are described to show the diversified clinical patterning that may occur. None of the lesions, which ranged from solid nodules, through inflammatory infiltrative sesions, to gangrene, could be identified as malignant lymphoma at the time these patients sought medical attention. Histologic diagnosis of the lymphoma came much later. Pain was a particularly prominent symptom in three of the six patients. The clinician should discard the dictum that malignant lymphoma is a painless process and should not neglect the consideration of malignant lymphoma because of the presence of pain. The skin lesions described provide a model for recognition of extranodal lymphomas elsewhere in the body. Lymphoma should be considered in the presence of unexplained chronic inflammatory processes that affect any organ containing lymphoreticular or epithelial structures.