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In the new World Health Organization/European Organization for Research and Treatment of Cancer (WHO/EORTC) classification primary cutaneous B-cell-lymphomas are categorized in marginal zone B-cell lymphoma (PCMZL), follicle centre lymphomas (PCFCL), large B-cell-lymphoma leg-type (PCLBCL-LT) and other large B-cell-lymphoma (PCLBCLO) . While PCFCL and PCLBCL-LT show distinct characteristic presentations, clinical and pathological, PCLBCLO share characteristics of both categories. A 47-year old man observed a red macule on his right shoulder for some month. He assumed it as an acne skin lesion because he suffered from severe acne in his youth. Under suspicion of an infection with borrelia he underwent a systemic therapy with doxycyclin without any clinical improvement. A subsequent biopsy revealed the diagnosis of a follicle center cell lymphoma with a transition into a diffuse large B-cell-lymphoma. The patient was started on a modified therapy with R-CHOP (rituximab, cyclophosphamide, pegylated liposomal doxorubicine, vincristine and prednisolone) and experienced a good clinical response.