Primary cutaneous cd8-positive t-cell lymphoma: a case report of a rare and aggressive disease with oral presentation

Lymphoma is the second most common malignant oral disease.1,2 Non-Hodgkin lymphoma is the fifth most common cancer in the UK.3 Lymphoma represents a group of haematological neoplasms with many defined classifications, essentially divided into Hodgkin and non-Hodgkin lymphoma of B or T lymphocyte origin. The disease is a malignant proliferation of lymphocytes, usually seen in lymph nodes with extra-nodal primary malignancies less common. The incidence of cutaneous lymphoma has been reported as increasing.1,4

A 66-year-old gentleman was referred to the Oral Medicine service by his general medical and dental practitioners simultaneously. In his referral, the GP outlined a history of persistent, worsening and confluent mouth ulcers. These had arisen at the same time as a widespread, macular and erythematous skin rash.

The patient had presented to both his general medical and dental practitioners three months earlier with left-sided angular cheilitis, which he associated with recent dental treatment. Swabs from this lesion showed a growth of Candida, which duly responded to treatment with fluconazole. However, by this time the patient was beginning to develop a cutaneous rash. This rash started with a large lesion on the thorax, which was red, asymptomatic and quickly faded. Thereafter many red, asymptomatic, macular and circular lesions spread across the rest of the patient's skin. It was thought that this solitary truncal lesion, preceding a more extensive rash, was a ‘herald lesion’. Accordingly, a provisional diagnosis of pityriasis rosea was made.