We report a case of lymphomatoid papulosis (LyP) in a young woman who presented with unusual clinical and histopathologic features. The patient presented with a long history of relapsing necrotizing papular lesions located exclusively on the acral region. A first biopsy was interpreted as a vasculitic process, and the patient was subsequently lost to follow-up. She returned 2 years later with similar lesions, and specific features of LyP were present in 2 of 3 new biopsies. Hemorrhagic features were present in all 4 biopsies taken over a period of 2 years. Our case shows peculiar clinical and histopathologic features that do not fit within the types of LyP currently recognized (types A–E). This review addresses the clinical, histopathologic, phenotypic, and differential diagnostic features of LyP.