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A case of mistaken identity: primary cutaneous lymphoma presenting as venous ulceration.

A 88-year-old woman was referred to the surgical outpatient department with a recurrent, long-standing leg ulcer. On examination she was found to have signs of chronic venous hypertension (varicose veins, varicose eczema and lipodermatosclerosis), and a 10 mm ulcer which was thought to be a benign venous ulcer. Four-layer bandaging was instituted, but the ulcer failed to heal. A punch biopsy was therefore performed which supported the clinical diagnosis of a stasis ulcer. Three months later healing had not taken place, and the ulcer had grown in size and taken on a sinister appearance (Figure 1). A presumptive diagnosis of Marjolin's ulcer was made, and she subsequently underwent wide local excision and skin grafting. Histology revealed a high grade cutaneous B cell lymphoma. Excision was complete, with no evidence of regional or distant disease, and no further treatment was undertaken. She unfortunately died soon afterwards from an unrelated problem.