Can B-cell lymphomas present with skin lesions?

Yes. Most benign and malignant cutaneous lymphocytic infiltrates are predominantly T cell in origin. Cutaneous involvement occurs in >5% of patients with B-cell nodal lymphoma. Also, an entity termed SALT (skin-associated lymphoid tissue) lymphoma, or primary cutaneous B-cell lymphoma (PCBCL) may present as solitary or multiple, red to violaceous nodules or plaques (Fig. 46-7). The treatment of choice is local radiation therapy.

Some primary cutaneous B-cell lymphomas (approximately 8%) are associated with Lyme disease (Borrelia spp.), and some reports suggest an improvement with Lyme disease therapy, analogous to results with Helicobacter pylori treatment and regression of mucosa-associated lymphoid tissue (MALT) lymphoma. Patients with PCBCL should be screened for positive Lyme serologies.

Jelic S, Filipovic-Ljeskovic I: Positive serology for Lyme disease borrelias in primary cutaneous B-cell lymphoma: a study in 22 patients; is it a fortuitous finding? Hematol Oncol 17:107–116, 1999.

Santucci M, Pimpinelli N, Arganini L: Primary cutaneous B-cell lymphoma: a unique type of low-grade lymphoma, Cancer 67:2311–2326, 1991.