A 54-year-old white man presented with a 2 ½-year history of periodic outbreaks of pink papules and nodules on his trunk. Six years before this visit, the patient developed a right inguinal mass that was found to be a completely effaced lymph node with large transformed lymphocytes, abundant eosinophilic cytoplasm, eccentrically located nuclei, and anaplastic features, surrounded by sclerosis. Large cells demonstrated staining for CD45 (weak), CD3 (weak), CD2 (weak), CD4, and CD30, but were negative for CD20, CD79a, ALK-1, CD5, CD7, CD8, CD56, CD57, T-cell restricted intracellular antigen (TIA-1), granzyme, and epithelial membrane antigen (EMA) (Figure 1). His staging workup at that time included bone marrow biopsy, positron emission tomography, and computed tomography, all of which were negative for involvement with the disease. The disease was classified as being stage I (Ann Arbor staging) ALK-1 –negative ALCL. The patient had received 6 cycles of the CHOP regimen (cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone administered in 21-day cycles) with a complete response as judged by continually negative findings on positron emission tomography. Field radiation therapy (30.6 Gy in 17 fractions) was also delivered to the right inguinal and pelvic region.