2025 Clinician Corner - Solitary erythematous round nodule with a hemorrhagic crust on the posterior shoulder

Abstract 

Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoproliferative disorder (PCMS-TCL) is a rare skin condition. We present a 67-year-old patient with a growing lesion on the shoulder that was diagnosed as PCMS-TCL. The patient was otherwise healthy without systemic involvement. The lesion was surgically excised, and no recurrence occurred. PCMS-TCL has an excellent prognosis, unlike other cutaneous lymphomas. This case highlights the importance of crafting a comprehensive differential diagnosis that incorporates any possibilities of rare disorders like PCMS-TCL to avoid unnecessary treatment.  

Keywords:  B-cell lymphoma; lymphoma; pseudolymphoma; T-cell lymphoma

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on May 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Identify the key distinguishing features of PCMS-TCL, including its morphology, specific immunohistochemical profile, and clinical course, to differentiate it from other cutaneous lymphomas and pseudolymphomas. 
  • Recognize PCMS-TCL as a provisional entity with uncertain malignant potential according to the WHO classification, to prevent misdiagnosis as a more aggressive lymphoma. 
  • Apply appropriate conservative management strategies for PCMS-TCL patients, understanding that aggressive treatments like chemotherapy should be avoided given the excellent prognosis and high complete remission rates with conservative therapy. 

Key Points 

  • It is crucial to differentiate pleomorphic T-cell lymphoproliferative disorder (PCMS-TCL) from other cutaneous lymphomas and pseudolymphomas. The confined nature of the lesion, specific immunohistochemical profile, and benign clinical course are key distinguishing features. 
  • PCMS-TCL has an excellent prognosis, with most patients achieving complete remission after conservative treatment. Aggressive treatments like chemotherapy are typically unnecessary and should be avoided.  
  • PCMS-TCL is classified as a provisional entity with uncertain malignant potential in the World Health Organization classification of lymphoid neoplasms. Recognizing this entity is crucial to prevent overdiagnosis as a more aggressive lymphoma. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
05/01/2025
Course expires: 
05/01/2026
Cost:
$25.00
Rating: 
0
  • Promise Ufomadu, BSA - School of Medicine, Baylor College of Medicine, Houston, Texas, USA 
  • Soo Jung Kim, MD - School of Medicine, Baylor College of Medicine, Houston, Texas, USA and Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA 
  • Hafeez Diwan, MD - School of Medicine, Baylor College of Medicine, Houston, Texas, USA and Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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