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Cutaneous T-cell Lymphoma
Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma that affects the skin.
Like all lymphomas, CTCL starts with lymphocytes, which are an important part of the immune system. They are immune cells that are made in the bone marrow and found in the blood and in lymph tissue. Lymphocytes move throughout the body reacting to bacteria and viruses. Lymphoma develops when lymphocytes become abnormal and grow and multiply uncontrollably, possibly forming tumors.
CTCL typically develops as a scaly, itchy, red rash that can become thick or develop into tumors on the skin. In some patients, the lymph nodes may also be swollen. Cutaneous T-cell lymphomas often grow slowly, but for a small number of people they can grow quickly and spread to the lymph nodes or other internal organs.
CTCL accounts for 2% to 3% of all non-Hodgkin T-cell lymphoma cases. It is the most common kind of skin lymphoma. CTCL subtypes include:
- Mycosis fungoides
- Sézary syndrome
- Anaplastic large T-cell lymphoma
- Primary cutaneous CD8+ T-cell lymphoma
- Subcutaneous T-cell lymphoma
Most CTCLs are chronic lymphomas; they are treatable, but not curable and usually not life-threatening. Mycosis fungoides, the single most common type of CTCL, grows slowly. As a result, about 70% of patients have early-stage cancer when diagnosed. According to research, when patients begin treatment in the early stages, they have a normal life expectancy. Only a small percentage of people with CTCL develop advanced forms of the disease.
While doctors don’t know the exact cause of skin lymphomas, there are some factors that increase a person’s risk of developing the disease, including:
- Age: In general, skin lymphomas appear in older adults, but they can affect other age groups, including children.
- Race: Cutaneous lymphoma (specifically mycosis fungoides) is more often diagnosed in African Americans than other demographic groups.
- Sex: Skin lymphomas are more likely to affect men than women.
- Compromised immune system: People with weakened immune systems are at higher risk.
The symptoms of cutaneous T-cell lymphoma can vary according to the stage of the cancer. The symptoms can also mimic those of other skin conditions, such as eczema and chronic dermatitis, Because of this, the diagnosis of CTCL is often delayed. Generally, cutaneous T-cell lymphoma symptoms can include:
- Larger, pimple-like spots
- Flat, scaly lesions that look like a rash
- Thicker, raised lesions
- Tumors in the skin
- Erythroderma: A severe and usually widespread reddening of the skin due to inflammatory skin disease. It is also called generalized exfoliative dermatitis.
Some patients may also experience weight loss, fever, sweating and severe itching.
Treatment options for cutaneous T-cell lymphoma include:
Topical creams or gels
Many patients, especially with small, localized skin lesions will respond to creams or gels applied to the affected areas. Examples include topical steroids, which are anti-inflammatory medications, or topical chemotherapy, which helps kill cancer cells.
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Radiation therapy for CTCL uses skin-directed, low doses of radiation to kill cancer cells and shrink tumors. Total skin electron beam therapy (TSEBT) may be used to treat skin lymphoma while limiting radiation to other organs and tissues.
This treatment kills cancer cells by using ultraviolet light, sometimes enhanced with the addition of photoactivating creams or pills.
Extracorporeal photopheresis (ECP)
Using either an IV or a catheter, the patient’s blood is routed through a machine that separates some of the white blood cells and treats them with psoralen, which is a chemical substance from plants that is sensitive to light (or can be activated by light). The blood is then exposed to ultraviolet light and returned to the patient’s body.
Other medicines. These may include targeted therapy, immunotherapy, or other biologic agents, and innovative new treatments being tested in clinical trials.
Why choose MD Anderson for your Cutaneous T-Cell Lymphoma treatment?
Because cutaneous lymphomas are so rare, finding a multidisciplinary team with the expertise to properly diagnose and treat them is essential. The Ben Love/El Paso Corporation Melanoma and Skin Center at MD Anderson has a renowned Cutaneous T-Cell Lymphoma Clinic with highly experienced doctors who provide diagnosis, treatment and management for all forms of the disease.
Our cutaneous lymphoma patients receive top-ranked multidisciplinary care and access to molecular diagnostic testing and clinical trials for this rare disease. MD Anderson’s team of experts from dermatology, hematology oncology, radiation oncology, dermatopathology, hematopathology, and stem cell transplantation provide comprehensive evaluations. These experts also work together to develop a coordinated, personalized treatment plan for every patient they see.
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