Scalp Involvement in Primary Cutaneous Lymphomas: An Update on Clinical Presentation, Diagnostics, and Management

May 2025 in “ Cancers ”

Karol Kołkowski, Martyna Sławińska, Beata Zagórska, Roman Nowicki, Jerzy Jankau, Małgorzata Sokołowska‐Wojdyło

primary cutaneous lymphomas scalp involvement B-cell PCLs T-cell PCLs primary cutaneous follicle center lymphoma mycosis fungoides alopecia non-scarring focal alopecia scalp lymphomas B-cell lymphomas T-cell lymphomas follicle center lymphoma focal hair loss

Studysummary This review analyzed literature on primary cutaneous lymphomas involving the scalp, finding that scalp involvement in these cases often leads to non-scarring focal alopecia and may indicate more aggressive disease.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

This review examines the involvement of the scalp in primary cutaneous lymphomas (PCLs), analyzing 1482 patients and identifying 1096 cases of B-cell PCLs and 384 cases of T-cell PCLs. Hair loss, primarily non-scarring focal alopecia, was observed in 69% of patients. The study highlights the importance of recognizing scalp involvement due to the potential aggressiveness of some lymphomas in this area. It notes a male predominance and a mean age of onset in the fifth decade for T-cell lymphomas and the fourth decade for B-cell lymphomas. The document emphasizes the need for thorough physical examinations and the use of trichoscopy to guide biopsies, as well as the importance of psychological support for patients. Early detection is crucial for improving outcomes, although the pathogenesis remains unclear and treatment recommendations are not specifically tailored for scalp PCLs.

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Research cited in this study

16 / 16 results

research Treatment of Diseases Associated with Cicatricial Alopecia

January 2022 in “Przegla̧d dermatologiczny”

This article reviews various treatment options for diseases associated with cicatricial alopecia but reports no new clinical results.

research Pili Torti: A Feature of Numerous Congenital and Acquired Conditions

9 citations , August 2021 in “Journal of clinical medicine”

This review discusses pili torti, a rare hair shaft disorder, and reports no new clinical results; it emphasizes the need to investigate underlying conditions in affected individuals.

Characteristics Associated with Significantly Worse Quality of Life in Mycosis Fungoides/Sézary Syndrome from the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) Study

research Characteristics Associated with Significantly Worse Quality of Life in Mycosis Fungoides/Sézary Syndrome from the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) Study

67 citations , May 2019 in “British Journal of Dermatology”

In this study, newly diagnosed women with mycosis fungoides or Sézary syndrome and those with alopecia experienced significantly poorer health-related quality of life.

research Rare Presentation of Disseminated Follicular Lymphoma as an Ill-Defined Reticular Patch Over the Scalp and Forehead

1 citations , April 2019 in “JAAD case reports”

This case report presents a rare manifestation of secondary cutaneous B-cell lymphoma as erythematous macules coalescing into reticular patches on the scalp and forehead.

Unusual Clinical Presentation of a Primary Cutaneous Follicle Center Lymphoma on the Scalp of a Middle-Aged Female: Case Report and Review of the Literature

research Unusual Clinical Presentation of a Primary Cutaneous Follicle Center Lymphoma on the Scalp of a Middle-Aged Female: Case Report and Review of the Literature

3 citations , January 2019 in “Skin appendage disorders”

This case report describes a patient with primary cutaneous follicle center lymphoma who developed an alopecic atrophic patch potentially due to pressure, following rituximab treatment.

research How to Discern Folliculotropic Mycosis Fungoides From Follicular Mucinosis Using a Pediatric Case

15 citations , January 2018 in “Journal of Cutaneous Medicine and Surgery”

This case report presents a 6-year-old boy with both folliculotropic mycosis fungoides and primary follicular mucinosis, providing insights on differentiating the two conditions in pediatric patients.

research Alopecia and Associated Toxic Agents: A Systematic Review

26 citations , January 2018 in “Skin appendage disorders”

This review summarizes existing studies on toxic agents that can cause alopecia, with thallium and colchicine having the most established links, while others like botulinum toxin A need further investigation.

research Hair Pull Test: Evidence-Based Update and Revision of Guidelines

36 citations , December 2016 in “Journal of The American Academy of Dermatology”

In this study, researchers evaluated the hair pull test and found that normal values should be reduced to two hairs or fewer, with no significant impact from hair washing, brushing, or lifestyle factors such as hair texture and medication use.

research CD8-Positive Mycosis Fungoides Clinically Masquerading as Alopecia Areata

8 citations , August 2016 in “Journal of Cutaneous Pathology”

This case report highlights a rare instance of CD8-positive hypopigmented mycosis fungoides causing alopecia areata-like changes, emphasizing the necessity of scalp biopsy in such presentations.

Atypical Clinical Presentation of Primary and Secondary Cutaneous Follicle Center Lymphoma on the Head Characterized by Macular Lesions

research Atypical Clinical Presentation of Primary and Secondary Cutaneous Follicle Center Lymphoma on the Head Characterized by Macular Lesions

18 citations , July 2016 in “Journal of The American Academy of Dermatology”

This study reported that both primary and secondary cutaneous follicle center lymphomas can present with atypical scalp or forehead lesions, leading to potential misdiagnosis as other skin conditions.

research Alopecia Universalis Associated with Cutaneous T Cell Lymphoma

15 citations , January 2014 in “Dermatology”

This case report describes alopecia universalis-like hair loss occurring in two patients with cutaneous T cell lymphoma, providing clinical, dermoscopic, and pathologic features to help differentiate it from alopecia areata universalis.

research How to Diagnose Hair Loss

27 citations , September 2012 in “Dermatologic Clinics”

This review outlines a systematic method for diagnosing hair loss and presents no new findings; the authors emphasize the importance of biopsy in cicatricial alopecia cases.

research Hodgkin's Lymphoma Presenting as Alopecia

14 citations , January 2012 in “International Journal of Trichology”

This case report highlights the importance of suspecting underlying malignancy, such as Hodgkin's lymphoma, in patients with diffuse hair loss and other cutaneous symptoms.

Primary Cutaneous Follicle Centre Cell Lymphoma of the Scalp Presenting with Scarring Alopecia