Persistent skin nodules, unusual rashes and non-healing skin lesions are not always caused by common infections. Sometimes, they may indicate a rare underlying medical condition requiring specialist dermatological evaluation.
In a challenging case involving a 45-year-old male with multiple progressive skin tumours, Dr. Girishkumar M. Chalawadi, Dermatologist at G Square Skin, Hair & Plastic Surgery Clinic, Hubli, was called to the hospital where the patient had been admitted for a specialist skin examination.
The case ultimately led to a diagnosis of primary cutaneous non-Hodgkin lymphoma, a rare form of lymphoma involving the skin.
A Challenging Case of Multiple Skin Nodules
The patient presented with multiple nodular skin swellings that gradually enlarged into tumour-like lesions.
Clinical findings included:
Multiple progressive skin nodules and plaques
Thick crusting and scaling over some lesions
Reddish-to-purple skin discolouration
Slightly reduced sensation over the lesions
Left-sided foot drop
Despite previous medical consultations, the unusual presentation remained a diagnostic challenge.
During his hospital admission, Dr. Girish Kumar Chalawadi was called for a specialist dermatological opinion to help evaluate the possible causes.
When Skin Infections Resemble Skin Cancer
Several conditions can produce similar-looking skin lesions, making diagnosis difficult.
The important possibilities considered included:
Hansen's disease (leprosy): Particularly relevant when skin lesions are associated with sensory loss or nerve-related weakness.
Cutaneous tuberculosis: May produce persistent nodules, plaques or ulcerated skin lesions.
Cutaneous leishmaniasis: Can cause nodules or crusted lesions in patients with relevant exposure.
Deep fungal infections: Sometimes resemble chronic inflammatory or tumour-like skin lesions.
Primary cutaneous lymphoma: A malignant lymphoid condition that can present as progressive plaques, nodules or skin tumours.
This case highlights why persistent or unusual skin lesions should not automatically be treated as routine infections without appropriate evaluation.
Primary Cutaneous Non-Hodgkin Lymphoma: Understanding the Diagnosis
Primary cutaneous lymphoma is a group of lymphoid malignancies that involve the skin without evidence of systemic lymphoma at initial diagnosis.
Depending on the subtype, it may appear as persistent patches, plaques, nodules or tumour-like skin growths.
Establishing the diagnosis and subtype requires appropriate investigations, including:
Skin biopsy and histopathological examination
Immunohistochemistry
Additional investigations and systemic staging, as indicated
These investigations help distinguish lymphoma from chronic infections and determine the appropriate specialist treatment pathway.
The supplied case describes the final diagnosis as primary cutaneous non-Hodgkin lymphoma; the exact subtype and staging findings have not been specified.
The Importance of Specialist Dermatological Diagnosis
For Dr. Girish, this case emphasised an essential clinical principle:
Not every persistent skin lesion is a common skin infection. An accurate diagnosis is the foundation of appropriate treatment.
A dermatologist's evaluation can be especially important when skin lesions are progressive, atypical, unexplained or associated with neurological findings.
The patient's foot drop also required separate neurological consideration rather than automatically assuming that it was caused by lymphoma.
Dr. Girish Kumar Chalawadi – Dermatologist in Hubli
Dr. Girishkumar M. Chalawadi is an MD Dermatologist with a Fellowship in Dermatosurgery (FRGUHS) and serves as Chief Dermatologist at G Square Clinic, Hubli.
His clinical practice includes skin, hair and nail disorders, clinical dermatology, dermatosurgery and cosmetic dermatology.
This case reflects the importance of systematic clinical assessment, appropriate investigations and multidisciplinary collaboration when evaluating complex skin conditions.
Book a Skin Specialist Consultation in Hubli
Are you experiencing persistent skin nodules, unexplained skin growths, recurring rashes, non-healing lesions or unusual changes in your skin?
Consult Dr. Girish Kumar Chalawadi at G Square Skin, Hair & Plastic Surgery Clinic, Hubli for a professional dermatological assessment.
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Dr. Girish Kumar M. Chalawadi
Dermatologist | G Square Skin, Hair & Plastic Surgery Clinic