EDITOR

Dear Sir, We have read with interest the case report entitled 'Non-Hodgkin's lymphoma presenting as an isolated temporal soft tissue swelling' by Benson-Mitchell et al. (1996), but feel their report needs comment. The diagnosis of primary lymphoma in this case is very controversial, partially because its existence as a pathological entity can be questioned. The major controversy regarding this case lies in the difficulty of knowing whether it is a primary lesion, or an occult lymphoma with an initial manifestation in the soft tissue of temporal region, or a secondary from a lymphoma elsewhere. It is very likely to be the latter based on the nature of this disease. Furthermore, the case was insufficiently investigated, and not followed up long enough to substantiate the diagnosis. In the last few years, there have been detailed studies of the natural history and treatment of localized Non-Hodgkin's lymphoma of unfavourable histology (as this case). As a result, the role of surgery in the management of these cases has been sharply modified. Since malignant lymphoma is by nature a systemic disease, metastasizes haemotogenously, and chemoand radio-sensitive, surgery appears to be contra-indicated and should be used only after failure of chemotherapy and/or radiotherapy. This combined approach has been shown to be effective in localized aggressive lymphomas in improving disease free survival and overall survival (Miller and Jones, 1983; Connors et al., 1987).