Cutaneous Lymphomas (CTCL) are rare lymphoid malignancies that start in the skin and have very unique biologic behaviors. Unlike systemic lymphomas, skin lymphomas are more likely to be of the T- cell subtype (unlike most forms of lymphoma which are usually B-cell diseases). Mycosis Fungoides is the most common type of CTCL but there are several other types as well. If CTCL cells are also present in the blood than the disease is called Sezary Syndrome. Unlike other types of skin cancer, CTCL is not linked to excessive exposure to the sun or UV radiation. Most patients with CTCL present with skin rashes in non-sun exposed areas of the body that will persist but tend to wax and wane in the initial stages. Early stages of CTCL can look like some common skin conditions like psoriasis or eczema. Specialists, even dermatologists, can sometimes find it difficult to make a correct diagnosis, and not uncommonly some patients require several biopsies to confirm the diagnosis. Over 90% of patients with CTCL have an excellent prognosis with a normal life expectancy. The lesions usually remain confined to the skin and don’t affect the internal organs. However, a small percentage of patients can exhibit a more aggressive course with extensive skin tumors, blood involvement and rarely involvement of internal organs that can be life threatening.
Due to the good prognosis of these diseases, early stage patients can be successfully treated with skin directed treatments that include light therapy, ointments and lotions, and biologic agents, thus eliminating the need for toxic chemotherapy. However, in more advanced cases, chemotherapy and even stem cell transplantation are performed to provide long term remission and cures for the disease. B-cell lymphomas can also occur in the skin and also carry an excellent prognosis. Cutaneous lymphomas are rare diseases and their management requires special expertise and collaboration between dermatologists and oncologists. It is best to find a physician who has expertise in the treatment of skin lymphomas for the best possible outcome.