A case report of primary cutaneous marginal zone lymphoma treated with intralesional steroids

Abstract

Importance: Primary cutaneous marginal zone lymphoma (PCMZL) is a low-grade malignant B-cell lymphoma that appears in the skin without any extracutaneous manifestations. Therapeutic mainstays for PCMZL have primarily included radiotherapy and surgery. Intralesional steroids have been found to resolve the lesions caused by PCMZL, but there is a dearth of literature regarding this therapy indicating that this is not a commonly favored treatment option. Observations:We present a case of 60-year-old woman who presented with PCMZL on her right eyebrow. Three years later, after two courses of radiation and one relapse, the patient presented with new lesions on both arms, consistent once again with PCMZL. At this time, therapy with nine rounds of intralesional triamcinolone was attempted. After each round of triamcinolone, gradual improvement of the lesions was noted until complete resolution occurred. Conclusions and Relevance:This case reminds practitioners that intralesional corticosteroids can be effectively and safely used to treat localized PCMZL. Intralesional steroids are less invasive, cheaper, and easier to administer than the majority of other recommended therapies for PCMZL. Thus, although they are often overlooked, intralesional corticosteroids should be more often considered when developing a treatment plan for localized PCMZL.

Treatment of Indolent Cutaneous B-Cell Lymphoma with Intralesional or Intravenous Rituximab

“…Patients were treated with a median of one cycle (one cycle = three injections; range 1-3 cycles) of ILR and six cycles of IVR (range of [6][7][8][9][10][11]. Seven patients (33%) were treatmentnaïve, while five (24%) had already received ILR and one had received (5%) IVR in the past.…”

“…There is a consensus that surgery and/or irradiation should be performed as first-line therapies in the case of well-demarcated circumscribed disease [2]. Various single reports about other therapies used, such as topical or intralesional glucocorticoids, interferon, or systemic antibiotics, can be found in the literature [3,[5][6][7]. In more extensive cases, systemic application of the monoclonal chimeric CD20-antibody rituximab has been successfully used to treat indolent B-cell lymphomas [8].…”

Pediatric Primary Cutaneous Marginal Zone Lymphoma Treated With Doxycycline

“…Treatment options include radiation therapy, excision, topical steroids, intralesional steroids, intralesional rituximab, and antibiotics. 2,[12][13][14] Case reports of pediatric patients have demonstrated improvement with excision, [15][16][17][18][19] intralesional steroids, 20,21 intralesional rituximab, 22 and clobetasol cream. 23,24 In asymptomatic patients, watchful waiting often is employed given the overall indolent nature of PCMZL.…”