Abstract
Primary cutaneous follicle center lymphoma (PCFCL) is an indolent subtype of primary cutaneous B-cell lymphoma that may present diagnostic challenges due to its variable clinical appearance and frequent overlap with benign inflammatory or neoplastic skin conditions. We report the case of a 79-year-old male patient who presented with a persistent pruritic and erythematous lesion involving the nasal dorsum and tip. Initial dermatologic evaluation and limited skin biopsy failed to establish a definitive diagnosis, and the lesion was managed conservatively without improvement. Given persistent symptoms and anatomical involvement, wide surgical excision with oncologic intent was performed after systemic staging excluded extracutaneous disease. Immediate reconstruction was achieved using a full-thickness skin graft harvested from an upper blepharoplasty performed in the same operative session. Histopathological examination of the excised specimen confirmed the diagnosis of PCFCL with tumor-free margins. Postoperative recovery was uneventful, and at 12-month follow-up, the patient demonstrated satisfactory functional and aesthetic outcomes with no evidence of local recurrence. This case highlights the potential for PCFCL to masquerade as a benign inflammatory condition, the limitations of small diagnostic biopsies, and the importance of adequate tissue sampling. It also underscores the role of surgical excision with tailored reconstruction as an effective diagnostic and therapeutic strategy in selected cases of localized PCFCL involving the nasal region.