Snapshot A 60-year-old patient is at his dermatologist’s office for follow-up of his eczematous dermatitis. He has tried topical steroids with no improvement. He complains of increasing itchiness. On physical exam, he has multiple confluent and well-demarcated pink patches on his buttocks and legs with some scaling. His dermatologist suspects that this may not be eczematous dermatitis but something that mimics like it. He also has prominent inguinal lymph nodes. Prior skin biopsies have been undiagnostic, but his dermatologist decides to do one more skin biopsy. This time, the biopsy reveals classic Sézary cells. Introduction CD4+ helper T-cell lymphoma of the skin Two variants of cutaneous T-cell lymphoma (CTCL) login to view 5 more bullets Other less common variant login to view 1 more bullet Epidemiology Older patients (median age 55-60) More common in male patients More common in black patients etiology Associated conditions login to view 4 more bullets Presentation Symptoms login to view 1 more bullet Physical exam login to view 11 more bullets IMAGING Imaging if leukemia suspected login to view 1 more bullet studies Physical exam to assess for lymphadenopathy and organomegaly Labs login to view 2 more bullets Differential Diagnosis Adult T-cell leukemia-lymphoma (ATLL) Atopic dermatitis Psoriasis Drug eruption (SJS) diagnosis Diagnosis usually made by clinical exam and history Diagnosis confirmed with skin biopsy login to view 4 more bullets Treatment Stage-dependent login to view 10 more bullets Complications Intense pruritus Secondary cutaneous bacterial or viral infection Prognosis Stage-dependent Mycosis fungoides typically indolent login to view 1 more bullet Sézary syndrome typically aggressive login to view 1 more bullet