Ventura, Gerald L.

BSN IV-A
Journal
CUTANEOUS T-CELL LYMPHOMA

It is a cancer of the T-lymphocytes and most often occurs in people aged between 40 and
60.

Unlike other forms of non-Hodgkin lymphoma, CTCL mainly affects the skin. It is caused by
the uncontrolled growth of a type of white blood cell within the skin called a T-cell.

The most common types of CTCL are mycosis fungoides and Sezary syndrome. Sezary
syndrome is a specific type of CTCL in which large areas of skin or lymph glands are
affected, and abnormal T-lymphocytes are also found in the blood. Mycosis fungoides is the
general name given to the other types of CTCL when the blood is not affected.

CAUSES:
The causes of CTCL are unknown. CTCL, like other cancers, is not infectious and cannot be
passed on to other people.

HOW IT IS DIAGNOSED?:
The diagnosis is made by removing a small piece of affected skin and examining it under a
microscope for abnormal cells (this is called a biopsy).
This can be done under a local anaesthetic.

STAGES OF CTCL:
The stage of CTCL indicates how the disease is affecting the skin. There are three
recognisable stages of early CTCL, although the disease will not necessarily progress
through all three stages.

Premycotic or pre-tumour stage Small, raised, red patches appear on the skin –
commonly on the breast and buttocks, although they can appear anywhere. At this stage
the disease often looks like common skin conditions such as eczema or psoriasis.
Plaque or infiltrative stage Irregularly shaped red patches (plaques) form. Any part of the
body may be affected, but the buttocks, skin folds and face are particularly common places.
There may be permanent hair loss from the affected areas if the plaques are left untreated.

Tumour stage Only a small proportion of people progress to this stage (most people never
progress beyond the first stage). Raised lumps (tumours) appear on the skin. The tumours
and the red plaques may become deep sores (ulcerate). At this stage the cancer may also
have affected the lymph nodes. Rarely, it will affect major internal organs such as the liver,
lungs, and spleen.
Sezary syndrome CTCL is referred to as Sezary syndrome when large areas of the skin are
affected and large numbers of abnormal lymphocytes are also found in the blood. In some
people there are no plaques or tumours, but the whole skin can be red, thickened, swollen,
and sore (known as l’homme rouge). The skin may also be itchy and the surface may peel
off.

GRADING
For practical purposes, non-Hodgkin lymphomas are divided into one of two groups – low-
and high-grade. Low-grade lymphomas are usually slow-growing, and high-grade
lymphomas tend to grow more quickly.

CTCL is a low-grade lymphoma and usually develops very slowly. It may be many years
before it develops from one stage to the next. Most people never progress beyond the first
stage. Some people do not experience the first two stages; the appearance of a tumour
(stage 3) can be the first sign of their disease.

TREATMENT:
A number of treatments can be used for CTCL, either alone or in combination. Most
treatments can be used for any stage of disease. The chosen treatment often depends on
how much of the skin is affected.

PUVA
PUVA treatment (sometimes known as photochemotherapy) is suitable if large areas of the
skin are affected. It involves taking a drug called psoralen (P), which sensitises the skin to
the beneficial effects of ultraviolet light A (UVA). Once the drug has had time to collect in
your skin, you enter an enclosed air-conditioned cabinet that contains ultraviolet lights.
Having the treatment is like sitting under a sunlamp. The treatment may be given several
times a week.

UVB therapy
Ultraviolet light B (UVB) can help to slow down the growth of skin cells and may be used to
treat CTCL. The treatment is delivered in a similar way to PUVA, using an air-conditioned
cabinet containing ultraviolet lights. However, the treatment does not include the use of a
drug to make the skin more sensitive. Treatment may be given several times a week.

Radiotherapy
Radiotherapy is the use of high-energy rays to destroy cancer cells, while doing as little
harm as possible to the healthy cells. It may be used for early-stage disease if only one or
two small areas of skin are affected by CTCL.

Radiotherapy may be used to treat one or two small areas of skin affected by CTCL. It may
also be used to treat the whole skin surface if the lymphoma is more widespread but has not
penetrated below the skin surface. Treatment to the whole skin surface is called total skin
electron beam treatment (TSEB).

Chemotherapy
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. This may
be applied in the form of an ointment, directly on to the whole skin surface. Your doctor or
pharmacist will tell you how to do this. It is vital to follow instructions carefully, and to only
put the cream where you are told to.

GENERAL SKIN CARE

Skin moisturising creams can reduce skin discomfort. Other preparations can be added to
bath water to keep the skin supple and relieve irritation.
Your doctor may prescribe steroid creams or ointments that can help the skin to heal. Follow
your doctor or pharmacist’s advice and use them sparingly.i
i
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/LymphomanonHodgkin/TypesofNHL/
CutaneousT-cell.aspx