Rare, pigmented variant of a progressive periocular and perioral dermatosis with delayed systemic associations

A 76-year-old man developed slowly progressive periocular and perioral hyperpigmentation over 10 years. Histology revealed a xanthogranulomatous infiltrate with prominent haemosiderin deposition, and subsequent follow-up identified IgG kappa paraproteinaemia and chronic lymphocytic leukaemia. This case illustrates the diagnostic challenges of early necrobiotic xanthogranuloma and the need for long-term surveillance due to delayed systemic associations.