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

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 di-agnostic gold standard, non-invasive imaging modalities such as dermoscopy and re-flectance 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. Herein, 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 ho-mogeneous background with white streaks, rosettes, and polymorphic vascular struc-tures, while subsequent RCM (Vivascope 3000 probe) demonstrated marked architectural disarray of the epidermis and dermoepidemal junction, with prominent epidermal in-volvement characterized by aggregates of highly reflective cells. In the absence of al-ternative diagnostic patterns, these features raised suspicion for a cutaneous lym-phoproliferative disorder, which was later confirmed by histopathological and im-munohistochemical analyses. Overall, 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.