Her hair dresser noticed a 9-mm pearly papule on the right posterior neck in a 76-year-old woman.


    A 76-year-old woman presented with a 9-mm pearly papule on the right side of her posterior neck. It was noticed incidentally by her hair dresser as a pimple. She also had numerous warty papules consistent with seborrheic keratoses on the trunk that were treated with liquid nitrogen. A shave biopsy of the neck lesion was performed.

    Pathology findings. The skin shave biopsy showed a dense, atypical lymphoid infiltrate comprising a mixed population of small, medium, and large lymphocytes, extending full thickness of the dermis with minimal

    epidermotropism. The larger lymphocytes were atypical with irregular nuclear contour and hyperchro- matic nuclei. Mitoses were noted. The vast majority of atypical lymphocytes were positive for CD3 and CD4 and were negative for CD8 and CD7. A subset of the large atypical cells showed weakly positive for CD30. Rare clusters of CD20+ B-cells were also present within the infiltrate.

    Molecular findings. Molecular PCR studies demonstrated monoclonal gene rearrangements of the TCR- gamma and TCR-beta genes.

    Staging, treatment, and follow-up. She was diagnosed as having an unilesional MF. Result of a full staging evaluation including bone marrow and peripheral blood analyses and computed tomographic scans of the pelvis, abdomen, and thorax was negative for systemic lymphoma.

    The patient is being followed without receiving any treatment. The patient has been followed for 4 months; and to date, there is no evidence of local and/or systemic relapse.