Background: Although most primary cutaneous B-cell lymphomas (PCBCL) are highly curable, leg-type PCBCL (PCBCL-LT) is a rare variant with high rates of extracutaneous relapse. Using the National Cancer Data Base (NCDB), cases of PCBCL-LT were evaluated to determine practice patterns and outcomes with the addition of chemotherapy (CT). Methods: Cases diagnosed from 1998-2012 with PCBCL-LT were identified. Information abstracted included age, Charlson-Deyo comorbidity score, disease status (AJCC stage, B symptoms) and treatment characteristics (CT use, type: single vs. multi-agent, surgical procedure and radiotherapy). Bivariate logistic regression was utilized to determine factors associated with CT use. Univariate and multivariable survival analyses were conducted using log-rank test and Cox proportional hazards modeling. Results: In total, 529 patients were identified with a median age of 77 years. Over half (54.6%) received CT, of which 85.5% received multi-agent regimens. CT use increased over time (52.5% 1998-2004 vs. 67.4% 2009-2012, p= 0.003). Older patients ( > 80 years) or those receiving radiotherapy were less likely to receive CT while patients with higher disease stage or B symptoms were more likely to receive CT. With 31.9-month median follow-up, the 3- and 5-year overall survival (OS) estimates were 56.0 and 39.9%, respectively. Receipt of CT resulted in a trend towards improved overall survival on univariate analysis (3-year OS 49.2 vs. 61.1%, p= 0.058). Highest survival rates were seen in those receiving CT-containing treatment regimens and with multi-agent CT. On multivariable analysis, along with lower age, lower stage and radiotherapy, multi-agent CT reduced the risk of overall mortality (HR 0.58, 95% confidence interval [CI] 0.39-0.85, p= 0.006) while single-agent CT trended towards a higher risk (HR 1.16, 95% CI 0.71-1.89, p= 0.546). Using a 4-month conditional landmark, multi-agent CT maintained a trend towards overall mortality risk reduction (HR 0.86, p= 0.323). Conclusions: Through use of a national hospital-based registry, this represents the largest published cohort of PCBCL-LT, confirming poor survival rates and a potential benefit to the use of multi-agent CT.