Cutaneous T-Cell Lymphoma

1 What is Cutaneous T-cell Lymphoma?

Cutaneous T-cell lymphoma, one of the types of non-Hodgkin's lymphoma, is a rare cancer of white blood cells that affects your skin.

Red rashes on skin are the common signs. In few cases, cutaneous T-cell lymphoma can lead to skin cancer.

Skin creams, light therapy, medications and radiation therapy may be used to treat this skin condition.

Among the several types of cutaneous T-cell lymphoma, the most common types are mycosis fungoides and Sezary syndrome.

2 Symptoms

The signs and symptoms of Cutaneous T-cell lymphoma can vary according to the type and extent of the condition.

Signs and Symptoms of classic mycosis fungoides

There are three sequential steps in the development of signs which include:

  • Patch

In this stage, red, scaly patches appear on trunk and buttocks. These patches may be slightly itchy or non-itchy.

  • Plaque

Severely itchy plaques develop from the patches and lymph nodes may be swollen.

  • Tumor

Tumors start appearing on the skin and are likely to get ulcerated.

Signs and Symptoms of Sézary syndrome

The major signs to look for include erythroderma (rashes distributed throughout the body) and presence of cancerous T-cells.

  • Swelling of skin
  • Swollen lymph nodes (lymphadenopathy)
  • Palmar and/or plantar hyperkeratosis (thickened skin in palms of hands and soles of feet)
  • Hair loss (alopecia)
  • Nail dystrophy (damaged nail plates)
  • Ectropion (outward turning of lower eyelid)
  • Swollen liver and spleen (Hepatosplenomegaly)

Vision problems may be seen in advanced cutaneous T-cell lymphoma.

3 Causes

It’s not clear what causes cutaneous T-cell lymphomas. A combination of genetic and immunologic factors, and environmental factors such as exposure to ultraviolet rays, certain chemicals is thought to cause specific types of cutaneous T-cell lymphoma.

Certain viral and bacterial skin infections, diet, and stress may also play contributing role. DNA mutations cause “out-of-control” growth and multiplication of T-lymphocytes (a type of white blood cell), which result in accumulation of these abnormal lymphocytes in the skin and occasionally other organ systems of the body.

4 Making a Diagnosis

Diagnosis of cutaneous T-cell lymphoma is done by a group of health care team including

  • dermatologists,
  • hematologists,
  • pathologists,
  • adiologists
  • and other experts.

Following tests are performed to diagnose cutaneous T-cell lymphoma:

Physical exam

It involves examination of your skin to detect red patches or hard bumps. Your doctor may check lymph nodes for swelling.

Blood tests

Blood tests are performed to check for presence of lymphoma cells. Advanced laboratory tests, such as flow cytometry and polymerase chain reaction (PCR) may also be carried out if necessary.

Skin biopsies

A sample of skin (biopsy) is obtained for laboratory analysis to find out if it contains cancerous cells. Multiple skin biopsies may be performed to confirm the diagnosis.

Imaging tests

Such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), are performed to check if the cancer cells have metastasized (spread) to other parts of the body.

5 Treatment

Treatments available for cutaneous T-cell lymphoma are:

Medications to apply on the skin

Various skin creams, ointments, foams and gels containing corticosteroids are prescribed to relieve skin redness and itchiness. In some cases, your doctor may recommend using preparations that contain chemotherapy drugs and retinoids.

Treatment using light

In light therapy, either ultraviolet A or ultraviolet B light is used to treat cutaneous T-cell lymphoma. Sometimes, a medicine may be given to sensitize the cancerous cells to light.

Radiation therapy

Radiation therapy uses high energy beams to destroy cancer cells. Electron beam radiation is a specialized radiation therapy that can be used to target a precise point or all of the skin.

Biological therapy

Biological therapy medications that activate your immune system, may be given to destroy cancer cells.

Chemotherapy

It uses chemical drugs to kill cancer cells.

Targeted therapies

It uses medicines that attack specific molecules present in cancer cells thereby blocking their growth.

Extracorporeal photopheresis

This procedure is approved by US Food and Drug Administration to treat advanced form of the disease. Your blood is drawn out and treated with medicine that increases sensitivity of the cells to light. The blood treated with medicine is exposed to ultraviolet light, which kills the cancer cells. The blood is then re-injected into your body.

Stem cell transplant

In stem cell transplant, your diseased bone marrow is replaced by healthy bone marrow from a donor.

Clinical trials

Clinical trials are the experiments that are conducted to find out new drugs or treatment approaches for a disease or a condition. The cure is not guaranteed. You may consult your doctor if you are interested in being a part of any trial.

6 Risk and Complications

Risk factors for Cutaneous T-cell lymphoma are:

  • Sex: Males are more prone to this condition. The risk in male is almost two times that in female.
  • Race: Individuals of African-American descent are at greater risk (two times) compared to those of European or Asian descent.
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