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7 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A skin condition that keeps producing crops of small red bumps which ulcerate, crust and heal on their own over a few weeks, leaving small scars, and then come back. The biopsy looks like an aggressive lymphoma and the disease behaves nothing like one: nobody in the published series has died of it, but it carries a raised risk of a second lymphoma.
What it is. A chronic, relapsing condition of the skin in which crops of papules and small nodules appear, sometimes dozens at a time, go through a cycle of ulceration and crusting over three to twelve weeks, and heal on their own, often leaving a small scar. New crops follow. It can go on for years or decades, and it can stop.
The gap between the biopsy and the person. Under the microscope the lesions contain large, atypical CD30-positive cells that look like those of an aggressive lymphoma, and a pathologist who is given the slide without the history can reasonably report anaplastic large cell lymphoma. The diagnosis is made by putting the two together: lesions that come and go in crops and heal spontaneously, with that biopsy, are lymphomatoid papulosis. This is the clearest example in the lymphoma family of a diagnosis that cannot be made on the biopsy alone, and WHO-HAEM5 says as much of the skin lymphomas generally, that dermatological examination and clinical photographs are indispensable.
| Setting | Approach | Guideline |
|---|---|---|
| Making the diagnosis, which needs the history as much as the biopsy | The biopsy shows large atypical CD30-positive cells that on their own would suggest an aggressive lymphoma. What makes the diagnosis is the course: crops of papules that ulcerate, crust and heal on their own over three to twelve weeks, often leaving small scars, recurring over years. Photographs and a dated history are part of the diagnostic record, not an extra. Staging confirms there is no disease outside the skin. | not mapped |
| Treatment, which is often none | No treatment has been shown to change the course or to reduce the risk of a second lymphoma, so treatment is for the lesions that bother the person. Observation with emollients and an explanation is a legitimate plan for somebody with a few lesions, and in the published series nobody has died of this condition. Where crops are frequent, numerous or scarring, low-dose weekly methotrexate, phototherapy or potent topical steroids suppress them, and the lesions return when treatment stops. Combination chemotherapy has no place. | not mapped |
| Why follow-up continues in a condition that does not shorten life | People with lymphomatoid papulosis have a raised risk of a second lymphoma, most often mycosis fungoides, primary cutaneous anaplastic large cell lymphoma or Hodgkin lymphoma, which may come before, alongside or after the skin lesions. Continuing dermatological review, and biopsy of any lump that behaves differently from the usual crops, is the reason for follow-up. Nothing prevents the second lymphoma, so the aim is to find it early. | not mapped |