Primary cutaneous marginal zone lymphoma presenting as a violaceous forearm plaque

A woman in her late 80s with a history significant for chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, hypertension, hypercholesterolaemia, heart failure with reduced ejection fraction, atrial fibrillation on coumadin and prior stroke presented with a painless, firm, violaceous, 3×3 cm plaque on the left forearm for 6 months ( figure 1A). She denied any inciting events, “B symptoms” (fevers, night sweats or weight loss) or relevant family history. Physical examination revealed no palpable cervical or axillary lymphadenopathy. Two 3 mm punch biopsies were sent for histopathological evaluation.