Non-Hodgkin lymphoma is one of the most common cancers in the U.S. Nearly 74,000 people will be diagnosed with it in 2018, according to estimates from the American Cancer Society. However, skin lymphoma (cutaneous lymphoma) is a rare form that commonly goes undiagnosed because of its strange-yet-vague symptoms.
Lymphoma starts in the lymphocytes, or the cells in the immune system that are normally found in the lymphatic system. If lymphocytes start growing out of control, they can build up and form a cancerous collection of cells in the skin that can lead to lymphoma. Patients with skin lymphoma might experience a variety of vague or unusual symptoms, including:
● Peeled skin
● Rash, which sometimes can itch
● Mushroom-like skin lesions
● Swollen lymph nodes, or painless lumps, in the skin
● Unexplained fevers and weight loss
Skin lymphoma usually is well behaved and doesn’t spread throughout the body. However, it has the potential to do so in approximately 15 to 20 percent of cases. At the specialized skin lymphoma clinic at UT Southwestern, we offer a range of treatment options to effectively beat the two specific types of skin lymphoma and their various subtypes.
Two types of skin lymphoma
Skin lymphomas can develop from either T-cells or B-cells, resulting in two types: cutaneous T-cell lymphoma and cutaneous B-cell lymphoma. This is a very uncommon disease, accounting for about 4% of all types of non-Hodgkin’s lymphoma.
1. Cutaneous T-cell lymphoma (CTCL)
CTCL is the most common kind of skin lymphoma, accounting for 75 percent of cases of lymphoma involving the skin. It typically looks like an eczema rash and can affect parts of the body outside of the skin, such as the blood or internal organs in some cases.
Mycosis fungoides (MF) is the most common T-cell lymphoma, accounting for more than half of all skin lymphomas of T-cell origin. It can occur at any age but most often is found in individuals older than 50. Most patients with MF experience one or more patches of itchy, red skin and sometimes develop raised tumors that look like mushrooms.
Sezary syndrome (SS) is another T-cell condition that is similar to MF, but it affects blood in addition to the majority of a patient’s skin rather than just patches. People with SS often have an itchy, red rash called generalized erythroderma, which can appear like a severe sunburn.
2. Cutaneous B-cell lymphoma (CBCL)
CBCL is less common and tends to cause lumps in the skin, often clustered in one or two areas of the body. The most common B-cell skin lymphoma is primary cutaneous follicle center lymphoma. The lesions typically are groups of red pimples that sometimes grow into nodules or plaques that form on the scalp, forehead, or upper body.
Primary cutaneous marginal zone B-cell lymphoma is another type of B-cell lymphoma. It appears as skin lesions – one or several – that look like large pimples, plaques, or bumps on the arms or upper body. It tends to occur most often in older adults.
Treating skin lymphoma
Most cases of T-cell skin lymphoma are very treatable if caught in the early stages. In fact, most patients who receive long-term treatment have the same life expectancy as people without the disease. Early stage treatments can include:
● Injections into the tumor site
If T-cell skin lymphoma spreads and is no longer in the early stages, treatment options can include medications, such as bexarotene, interferons; methotrexate, a chemotherapy drug; and photopheresis, a process to destroy cancer cells in the blood by irradiating them with specific wavelengths of light outside the body and then infusing the cells back.
Treatment for T-cell skin lymphoma that has spread is more extensive and can include immunotherapy, which kills lymphoma cells and boosts the body’s immune response against other lymphoma cells, and chemotherapy that’s injected or taken in pill form and often requires several clinic visits, anywhere from three to four weeks apart.
We have come a long way in skin lymphoma technology and treatment within the past 10 years. For example, new treatments for T-cell lymphoma such as brentuximab vedotin – which was approved by the U.S. Food and Drug Administration in 2017 to destroy skin lymphoma cancer cells – have significantly increased good outcomes. Improved therapies have led to dramatic remissions in patients who, although were doing well, weren’t in full remission. We are also excited about an antibody for T-cell skin lymphoma, called mogamulizumab, which was approved by the Food and Drug Administration in August 2018.
Seek expertise for skin lymphoma care
Skin lymphoma can mimic many other conditions, such as dermatitis or psoriasis. Because of this, some patients get diagnosed with the wrong condition and can go years or decades before their cancers are diagnosed. Patients should see a skin lymphoma specialist if they have symptoms or if treatments they’ve received don’t help. Skin lymphoma is fairly uncommon, and many doctors simply don’t have much experience diagnosing and treating it.
At UT Southwestern, patients have access to doctors from various disciplines who collaborate to properly diagnose and treat skin lymphoma. Dermatologists, oncologists, and radiation oncologists work together at our lymphoma clinic to treat patients with the most advanced techniques available.
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