CTCL

Diagnosis

Cutaneous T-cell lymphoma can be difficult to diagnose because its symptoms often resemble other skin conditions such as eczema or psoriasis. A healthcare professional may perform a combination of physical examinations, blood tests, skin biopsies, and imaging studies to confirm the diagnosis.

Physical exam

A healthcare professional carefully examines the skin for scaly patches, rashes, or unusual growths. The lymph nodes may also be checked for swelling, which can indicate that the lymphoma has spread.

Blood tests

A complete blood count (CBC) and other blood tests may be performed to detect abnormalities. In some cases, cancer cells may appear in the blood, which is more common in a specific type of cutaneous T-cell lymphoma called Sézary syndrome.

Skin biopsy

A skin biopsy involves removing a small sample of skin tissue for laboratory testing to check for the presence of cancer cells.

• Punch biopsy: A circular cutting tool is used to remove a small, deep section of skin.

• Excisional biopsy: For larger lesions, a small surgical knife is used to remove the entire affected area.

Because early biopsies may not always detect cancer cells, multiple biopsies might be needed over time to confirm the diagnosis.

Imaging tests

If there’s concern that cancer has spread to other areas, imaging tests may be recommended, such as:

• CT (computerized tomography) scan

• PET (positron emission tomography) scan
  These scans help identify whether lymphoma cells have spread beyond the skin.

Treatment

Treatment for cutaneous T-cell lymphoma depends on the type, stage, and extent of the disease. Common treatment options include medicines, light therapy, radiation, and bone marrow transplant.

Skin creams and ointments

Certain medications can be applied directly to the skin in the form of creams, gels, or ointments, including:

• Steroid medicines: Help reduce inflammation, rash, and itching.

• Chemotherapy creams: Deliver cancer-fighting medication directly to the skin to destroy cancer cells.

Light therapy

Light therapy (phototherapy) uses specific wavelengths of light to kill cancer cells on the skin. Treatment sessions are usually scheduled several times per week for a few weeks. In some cases, a photosensitizing medicine is given beforehand to make cancer cells more sensitive to the light — a method known as photodynamic therapy.

Radiation therapy

Radiation therapy uses high-energy X-rays or electron beams to destroy cancer cells. It can be directed to:

• A small, specific area of the skin, or

• The entire skin surface (known as total skin electron beam therapy).

Medicines in pill form or through a vein

For more widespread disease, systemic therapies may be prescribed, including:

• Chemotherapy: Uses strong medicines to kill cancer cells throughout the body.

• Targeted therapy: Attacks specific proteins or pathways that cancer cells rely on to grow.

• Immunotherapy: Helps the immune system recognize and destroy cancer cells by unmasking them from immune defenses.

Bone marrow transplant

A bone marrow (stem cell) transplant replaces damaged or destroyed bone marrow with healthy stem cells. This treatment is typically considered for advanced or recurrent cases of cutaneous T-cell lymphoma when other therapies have not been successful.