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Approach to the patient with a diagnosis of atypical lymphocytic infiltrate of the skin

Jeffrey Zwerner, MD
Section Editor
John A Zic, MD
Deputy Editor
Rosamaria Corona, MD, DSc


The clinical and histologic diagnosis of cutaneous lymphoproliferative disorders is one of the most vexing issues in dermatology and dermatopathology, despite significant advances in their classification, pathogenesis, and treatment [1]. The average delay between initial presentation and the ultimate diagnosis of mycosis fungoides, the most common primary cutaneous T cell lymphoma, is six years [2]. During this period, patients typically undergo numerous skin biopsies, which, in the absence of definite histopathologic criteria for early mycosis fungoides, may be interpreted by the pathologist as "atypical lymphocytic infiltrate" or "atypical lymphocytic proliferation." This nonspecific but potentially serious diagnosis is often a source of anxiety and frustration for both the patient and the clinician.

This topic will discuss the definition of atypical lymphocytic infiltrate, the difficulties in differentiating reactive lymphocytic infiltrates from early lymphoma from the pathologist and clinician perspective, and the management of patients who receive this ambiguous diagnosis. Mycosis fungoides and other cutaneous lymphoproliferative disorders are discussed separately.

(See "Clinical manifestations, pathologic features, and diagnosis of mycosis fungoides".)

(See "Clinical presentation, pathologic features, and diagnosis of Sézary syndrome".)

(See "Primary cutaneous marginal zone lymphoma".)

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Literature review current through: Oct 2017. | This topic last updated: Jun 12, 2017.
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