Classic Example

88-year-old man with red-purple plaques on chest and face and a history of Waldenstrom's macroglobulinemia

88-year-old man with a one-year history of red to purple, asymptomatic, indurated plaques on his upper chest and back which the patient believes to be growing darker with time.  He also has a 8 year history of IgM monoclonal gammopath. The levels of macroglobulins were oscillating at the low levels consistent with Waldenstrom's macroglobulinemia. 

Diagnosis: 
Cutaneous extranodal marginal zone B-cell lymphoma with Waldenstrom's macroglobulinemia
Comment: 

The most common underlying cause of Wandenstrom's macroglobulinemia is lymphoplasmacytic lymphoma. Lymphoplasmacytic lymphoma typically involves bone marrow, spleen and lymph nodes. 

Cutaneous presentation of lymphoblastic lymphoma would be very rare. Also this patient has negative bone marrow.

Therefore, the case is best interpreted as extranodal marginal B cell lymphoma with monoclonal gammopathy.

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