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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Case Report

Dermoscopic and Reflectance Confocal Microscopic Features of a Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL) of the Eyelid: A Case Report with Histopathologic Correlation

by
Biagio Scotti
1,2,*,
Cosimo Misciali
2,
Martina D’Onghia
3,
Alberto Gualandi
1,
Sabina Vaccari
2,
Federico Venturi
1,2,
Elisabetta Magnaterra
1,2,
Elisa Cinotti
3 and
Emi Dika
1,2
1
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
2
Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
3
Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
*
Author to whom correspondence should be addressed.
Reports 2026, 9(2), 164; https://doi.org/10.3390/reports9020164
Submission received: 12 April 2026 / Revised: 19 May 2026 / Accepted: 20 May 2026 / Published: 21 May 2026
(This article belongs to the Section Dermatology)
Versions Notes

Abstract

Background and Clinical Significance: Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a CD30-positive T-cell lymphoproliferative disorder that can clinically resemble various non-melanoma skin cancers, making diagnosis challenging. Although histopathology remains the diagnostic gold standard, non-invasive imaging modalities such as dermoscopy and reflectance confocal microscopy (RCM) are increasingly used as complementary tools to support the differential diagnosis. To date, no data on RCM features of C-ALCL have been described. Case Presentation: We report the case of an 80-year-old man presenting with a rapidly enlarging nodule on the lateral aspect of his right eyelid, providing a detailed account of dermoscopic and RCM findings integrated with clinicopathological correlation. Dermoscopy revealed a red-orange homogeneous background with white streaks, and polymorphic vascular structures, while subsequent RCM (Vivascope 3000 probe) demonstrated marked architectural disarray of the epidermis and dermoepidemal junction, with prominent epidermal involvement characterized by aggregates of highly reflective cells. In the absence of alternative diagnostic patterns, these features raised suspicion for a cutaneous lymphoproliferative disorder, which was later confirmed by histopathological and immunohistochemical analyses. Conclusions: Our findings support the value of RCM as a practical tool in guiding differential diagnosis and biopsy, particularly for rapidly growing lesions located in anatomically sensitive areas.
Keywords: primary cutaneous anaplastic large cell lymphoma; C-ALCL; ALCL; pcALCL; dermoscopy; dermatoscopy; reflectance confocal microscopy; RCM; imaging; histology; histopathology primary cutaneous anaplastic large cell lymphoma; C-ALCL; ALCL; pcALCL; dermoscopy; dermatoscopy; reflectance confocal microscopy; RCM; imaging; histology; histopathology

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MDPI and ACS Style

Scotti, B.; Misciali, C.; D’Onghia, M.; Gualandi, A.; Vaccari, S.; Venturi, F.; Magnaterra, E.; Cinotti, E.; Dika, E. Dermoscopic and Reflectance Confocal Microscopic Features of a Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL) of the Eyelid: A Case Report with Histopathologic Correlation. Reports 2026, 9, 164. https://doi.org/10.3390/reports9020164

AMA Style

Scotti B, Misciali C, D’Onghia M, Gualandi A, Vaccari S, Venturi F, Magnaterra E, Cinotti E, Dika E. Dermoscopic and Reflectance Confocal Microscopic Features of a Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL) of the Eyelid: A Case Report with Histopathologic Correlation. Reports. 2026; 9(2):164. https://doi.org/10.3390/reports9020164

Chicago/Turabian Style

Scotti, Biagio, Cosimo Misciali, Martina D’Onghia, Alberto Gualandi, Sabina Vaccari, Federico Venturi, Elisabetta Magnaterra, Elisa Cinotti, and Emi Dika. 2026. "Dermoscopic and Reflectance Confocal Microscopic Features of a Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL) of the Eyelid: A Case Report with Histopathologic Correlation" Reports 9, no. 2: 164. https://doi.org/10.3390/reports9020164

APA Style

Scotti, B., Misciali, C., D’Onghia, M., Gualandi, A., Vaccari, S., Venturi, F., Magnaterra, E., Cinotti, E., & Dika, E. (2026). Dermoscopic and Reflectance Confocal Microscopic Features of a Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL) of the Eyelid: A Case Report with Histopathologic Correlation. Reports, 9(2), 164. https://doi.org/10.3390/reports9020164

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