Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?

I would add that it is important to have a reasonable overall plan with Heme-Onc agreed upon to increase the likelihood of a successful outcome. Ideally, chemotherapy is administered first. This allows "consolidation" RT to be customized based on response. For example, a lower dose is utilized in a ...

I‘ve faced a similar situation in a patient with a DLBCL of the lip and >90 years of age.
I treated with 5 x 4 Gy and the patient went on to receive chemotherapy afterwards, the lesion responded very well to RT.

These elderly patients often don't get systemic therapy for these cutaneous lymphomas and I have had great success with 300cGy x 10.