Recurrent Primary Cutaneous Anaplastic Large Cell Lymphoma With Systemic Involvement: A Case Report and Literature Review

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a rare, aggressive neoplasm that frequently relapses and requires the use of multiple treatment modalities. PC-ALCL most commonly presents in patients around the age of 60 and clinically manifests as red, single or sometimes grouped nodular lesions in the skin that tend to ulcerate over time. Although cases are limited to the skin, the extracutaneous spread has been occasionally reported. The diagnosis of PC-ALCL is made through excisional biopsy and subsequent immunohistochemical confirmation. Management of PC-ALCL is dependent on the extent of disease, and most patients can be effectively managed with surgical excision and/or radiation. If relapse occurs, systemic therapy including combination chemotherapy is considered. We present the case of a 43-year-old female who presented to an outpatient clinic with multiple suspicious, red, nodular lesions to her left elbow and right upper back. The further evaluation led to the diagnosis of a stage 4E, ALK-negative, CD30-positive PC-ALCL with recurrence after resection. This case highlights the diagnosis and management of PC-ALCL with systemic involvement that did not respond to initial radiotherapy.