Cutaneous Lymphoma

Cutaneous T-cell lymphoma is a group of rare blood cancers that affects the largest organ in your body — your skin. These cancers cause symptoms like rash, very itchy skin (pruritus) or other skin issues that may look and feel like common skin disorders. Most cutaneous T-cell lymphomas grow very slowly and aren’t life-threatening, but some people may develop serious forms of the condition. Healthcare providers have treatments to ease symptoms, but they can’t cure the lymphomas.

Cutaneous T-cell lymphomas are part of a larger group of diseases called non-Hodgkin lymphoma. Non-Hodgkin lymphomas are cancers that start in certain white blood cells called lymphocytes. Two types of lymphocytes — CD4 and CD8 — help regulate your immune system. In cutaneous T-cell lymphoma, T-cell lymphocytes mutate, becoming cancerous cells that multiply uncontrollably.

Cutaneous T-cell lymphomas can look and feel like common skin problems like psoriasis, eczema or even an allergic reaction. Many people have symptoms for years before obtaining a diagnosis. The two most common subtype of cutaneous T-cell lymphoma are mycosis fungoides and Sézary syndrome. Each subtype may affect your body in different ways:

Mycosis fungoides: This is the most common type of cutaneous T-cell lymphoma. It accounts for 50% of all cases. It’s a slow-growing cancer. Typically, cancerous cells are only in your skin. About 10% of the time, however, cancerous cells may spread from your skin into your lymph nodes and/or internal organs such as your liver, spleen or digestive system, and cause life-threatening medical complications.
Sézary syndrome: This is the second most common type of cutaneous T-cell lymphoma. It represents about 15 % of all cases. In Sézary syndrome, cancerous lymphocytes (Sézary cells) are in your skin and your bloodstream. People with this syndrome may have widespread redness on their skin. Sometimes the condition may involve your lymph nodes and other areas of your body. Sézary syndrome is an aggressive disease, meaning it spreads fast. Treatment can help manage the effects of the disease, but there’s no cure.

Cutaneous Lymphoma Symptoms

Symptoms vary depending on the disease type and phase. For example, mycosis fungoides symptoms may begin as red rashes or red scaly patches on your body. Sézary syndrome also affects your skin but can spread to your bloodstream.

Cutaneous Lymphoma Causes

Healthcare providers and researchers don’t know exactly what causes cutaneous T-cell lymphomas happen. Here are two possibilities:

Acquired genetic mutations: Researchers have found some gene changes that cause these conditions.
Infections: Your immune system goes into overdrive when you have an infection. Your bone marrow reacts by creating more lymphocytes more quickly. Just like any production line, speeding up the process may lead to mistakes. In this case, the mistakes stem from DNA mutations that affect key genes in lymphocytes that eventually cause lymphoma. Researchers are investigating possible links between infections and cutaneous T-cell lymphoma.

Cutaneous Lymphoma Diagnostics

Your healthcare provider will review your medical history and do a physical examination. They’ll focus on any patches or plaques on your skin. They may ask if you have allergies.

Blood tests: Your doctor will check your blood to look at your blood counts, electrolytes, and kidney and liver function. They’ll do special tests to look for signs of lymphoma in your blood and count any lymphoma cells they find.
Biopsies: Healthcare providers do skin biopsies to establish a diagnosis. They may need to do several skin biopsies to accurately diagnose cutaneous T-cell lymphoma. They may also do lymph node biopsies and biopsies of any other parts of your body that may be affected by cutaneous T-cell lymphoma.
Imaging studies: Healthcare providers may use computed tomography (CT) scans and positron emission tomography (PET) scans to examine your lymph nodes and other organs.

Cutaneous Lymphoma Treatment

Skin-directed treatments: Healthcare providers may use topical ointments, creams, or light treatments for early-stage cutaneous T-cell lymphoma.
Phototherapy: This treatment is used for early-stage disease. In phototherapy, healthcare providers use ultraviolet A(UV-A) or B (UV-B) light to treat early-stage disease. They may combine UV-A with psoralen in what’s referred to as PUVA treatment. After taking the medication, healthcare providers expose the affected areas of your skin to UV light. The light activates the medication and kills cancer cells.
Extracorporeal photophoresis (ECP): This treatment involves ultraviolet light and psoralen. Providers take some of your blood so they can obtain white blood cells. They mix those cells with psoralen. This makes cancerous cells vulnerable to ultraviolet (UV) light. These cells are then exposed to UV light, killing the cancer cells. They then return the treated white blood cells to your bloodstream.
Radiation therapy: Providers target cancer cells with X-rays or other radiation sources, slowing cancer cell growth or killing the cells.
Immunotherapy: This treatment boosts your immune system with lab-made substances or your body’s substances. Immunotherapy helps slow cancer cell growth or eliminate cancer cells.
Chemotherapy: You may take chemotherapy as pills, via intravenous injection (IV) or as gels, creams or lotions that are directly applied to your skin’s affected areas.