This is another type of skin cancer, rare but important to know about.
As the image shows, these malignant T-cells are attracted to the skin and can appear anywhere on the body surface. If it is mild, there will only be a rash; but if it is more severe, thick lesions called plaques can form. In some instances, the skin becomes red all over.
So what is Cutaneous T-cell lymphoma? It is a type of cancer of the T-lymphocytes (white blood cells) that affects the skin and the blood. Occasionally, it also involves the lymph nodes and internal organs.
If you have Cutaneous T-cell lymphoma you should know that the course is unpredictable. Some patients progress slowly, some rapidly, and some not at all. The good news is that most patients will only experience skin symptoms without serious complications. About 10% of people diagnosed with CTCL will experience a progression with lymph node and internal involvement or other serious complications. Most patients live normal lives while they treat their disease, and some are able to remain in remission for long periods of time.
The first question our patients ask, of course, “Is there a cure?” While there is no cure, research is ongoing. Patients diagnosed early (disease involving less than 10% of the body) will live a normal life expectancy.
A little history about Cutaneous T-cell lymphoma (CTCL). It is a rare disease—five to ten persons per million are affected. The cause of CTCL remains unknown, but research continues. Here are some interesting facts about CTCL:
- it is not contagious
- it is not inherited
- men are affected more than women
- it is more common after the age of 50
There are many types of CTCl, all of which differ in appearance, progression, and treatment. The two main types are mycosis fungoides and Szary syndrome.
Mycosis Fungoides — This is the most common type of CTCL, which primarily affects the skin. Generally, it has a slow course and often remains confined to the skin. Mycosis fungoides have three phases: patch, plaque, and tumor. The patient may have one or all of these phases, which can appear anywhere on the skin. Patches are usually flat, red, and scaly. They are often mistaken for eczema or dermatitis because they may itch. Plaques are thicker, raised lesions. Tumors are larger lesions that can ulcerate and become huge and mushroom shaped (fungoides). The disease is NOT a fungal infection.
Szary Syndrome — This is the advanced form of of red skin, a large number of tumor cells found in the blood (leukemia), and larger-than-normal lymph nodes. Often referred to as the “red-man disease,” patients with Szary syndrome often are red from head to toe and complain that their skin is hot, sore, and itchy. There may be intense skin flaking, itching and burning; loss of hair; thickening of the palms, fingernails, and soles; drooping eyelids; loss of eyelashes; and difficulty closing the eyes.
How do we diagnose CTCL? And how do we treat it? It is not easy to diagnose and it may take years to actually pinpoint an accurate diagnosis. Dermatologists use the following methods to diagnose it:
- the patient’s medical history
- per forming a physical examination
- obtaining blood tests
- skin biopsies may be needed in order to make the correct diagnosis.
The goal is to control symptoms such as itching and burning and to make the patches and skin tumors go away. Treatment is based on the type of CTCL, patient’s health, age and lifestyle and the extent of the disease. Different treatments include application of creams and ointments to the skin, oral medication, light therapies (phototherapy), inter feron injections, and radiation. Different types of biological therapies that use the body’s own immune system to fight the cancer are being tested in clinical trials.