Lesions turn out to be a lymphoma

AN ELDERLY lady says that this rash, which involves her trunk, arms and upper legs, arose in only four weeks. It does not trouble her but the lesions are raised and non-scaly. This suggests the process is dermal and probably an infiltrative disorder.

She is not ill enough for leukaemia but this could be a lymphoma. Clinically there were no glands in the neck, axillae or groin and the liver and spleen did not appear enlarged. The only way to diagnose a rash like this is to take a skin biopsy.

A punch biopsy is fine but take at least two. If a nodule