Atlas of Skin Lymphoma: A Diagnostic Guide to Mycosis Fungoides, Sezary Syndrome, Cutaneous T-Cell a

No single finding makes the diagnosis. That is the central difficulty of cutaneous lymphoid disease, and it is the premise of this atlas.

A cutaneous lymphoma diagnosis is assembled from the pattern of the infiltrate, the cytology of its cells, the architecture they build, the immunophenotype they express, the clonal signal they carry, and the clinical setting that frames all of it. The features separating a trivial reactive process from a lethal one are frequently quantitative rather than absolute. Atlas of Skin Lymphoma is organized around that reasoning, presenting each entity as the reader actually meets it: a pattern to recognize, place against its mimics, confirm by ancillary study, and then manage.

Terminology has moved, and the book addresses it directly. The 2018 WHO-EORTC update named entities that previously had none, among them primary cutaneous acral CD8-positive lymphoproliferative disorder and EBV-positive mucocutaneous ulcer. In 2022, the fifth edition WHO classification of haematolymphoid tumours and the International Consensus Classification appeared in the same year, refining boundaries and disagreeing with each other in places. Primary cutaneous marginal zone disease is now segregated from the MALT lymphomas and treated as a lymphoproliferative disorder. This atlas is built on the current frameworks, states plainly where they diverge, and supplies crosswalk tables so older reports and current language can be reconciled at a glance.

Every entity chapter follows the same path: clinical features, histopathology with immunophenotype and molecular genetics, differential diagnosis, then treatment and prognosis. Easily confused entities are grouped and resolved through comparison tables and decision pathways rather than prose alone.

Eight sections, following lineage and clinical context:

• T-cell and NK-cell disease: the parapsoriases and early patch disease, mycosis fungoides, Sezary syndrome, CD30-positive lymphoproliferative disorders, subcutaneous panniculitis-like T-cell lymphoma, the aggressive and cytotoxic lymphomas, extranodal NK/T-cell lymphoma nasal type, the indolent lymphoproliferative disorders, peripheral T-cell lymphoma NOS, and adult T-cell leukemia/lymphoma
• B-cell disease: primary cutaneous follicle center lymphoma, marginal zone lymphoproliferative disorder, diffuse large B-cell lymphoma leg type, intravascular large cell lymphomas, and plasma cell neoplasms
• Immune deficiency and dysregulation, including EBV-driven lymphoproliferations
• Leukemia cutis and systemic disease: chronic lymphocytic leukemia, myeloid neoplasms, blastic plasmacytoid dendritic cell neoplasm, lymphoblastic lymphomas, Hodgkin lymphoma, composite lymphomas, and non-neoplastic cutaneous signs of systemic lymphoma
• Childhood and adolescent disease
• Pseudolymphomas, nonlymphoid mimics, and the atypical lymphoid proliferation

Appendices consolidate the master diagnostic algorithms, immunophenotype quick-reference panels, classification crosswalk tables, and staging and response criteria.

On the grey zone: it does not close, and the book does not pretend otherwise. Some infiltrates resist every criterion. What this atlas offers for them is a disciplined way of saying what is known, what is not, and what should happen next.

Stacey M. Archibald has written for the diagnostician standing at the microscope without an answer yet, as much as for the one seeking confirmation.