Additional dermoscopic presentation of haemosiderotic dermatofibroma

tern. They rarely express Bcl-2 and are not associated with the t(14;18) translocation, in contrast to nodal follicular lymphomas. Risk factors for the development of B-cell lymphomas are poorly understood. Briefly, there are reports of B-cell lymphoproliferative diseases with the presence of EBV, mainly in patients treated with immunosuppressive drugs such as methotrexate, and in patients with human immunodeficiency virus. However, in these cases, the pathology was different as these were not follicular proliferations, but rather diffuse infiltration of large B cells. Rarely, B. burgdorferi has been associated with the development of FCCL. We report a unique case of low-grade B-cell lymphoma that developed at the precise site of brachytherapy plus externalbeam radiotherapy for breast cancer. Oncogenic transformations due to the carcinogenetic effects of ionizing radiation are known complications of irradiated skin, but usually lead to carcinoma and sarcoma. Although a fortuitous association cannot be ruled out, the development of a rare condition—namely FCCL—on the precise site of an event known to be able to promote oncogenesis of other cell types suggests that radiation may be a risk factor for cutaneous lymphoma. Interestingly, a small number of single case reports of primary lymphoma involving the brain or the heart after radiation therapy have been described. The role of genetic alterations in Pten and p53 pathways in radiation-induced lymphoma development is suggested by some authors. In conclusion, a prolonged clinical surveillance of irradiated skin especially in patients with breast cancer is mandatory in order to establish an early diagnosis of carcinoma and sarcoma but perhaps also primary cutaneous lymphoma. C . BACHMEY ER K . KHOSROT EHRAN I* P . MOGUE L E T S . ARACT ING I* Service de Médecine Interne, *Service de Dermatologie and Service d’Anatomo-Pathologie, CHU Tenon (AP-HP), 4 rue de la Chine, 75020 Paris, France E-mail: claude.bachmeyer@tnn.aphp.fr

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