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What Is Skin Lymphoma?
Lymphoma is the given name for the variations of cancer that are caused by the growing number of white blood cells in the body. These white blood cells are also known as the body’s “immune cells”. Presently, there are three types of white blood cells, namely the B cells (or the B lymphocytes), the T cells (or the T lymphocytes), and the NK cells (which are classified as the natural killer lymphocytes). The B cells create antibodies to defeat infection, the T ones aid the B cells, and the NK lymphocytes attack viruses that include cancer cells.
The human body is made up of about 20% of lymphocytes, most of which are found in the lymphatic system — the network of vessels through which lymph drains from the tissues into the blood. The growth of lymphocytes in the body causes an abnormality that later will be classified as a disease. One of these categories is the skin cancer that’s otherwise known as skin lymphoma.
What are the causes of skin lymphoma? Scientists today are still learning about the exact gene changes that cause skin lymphomas. Although they have found some evidence, its main cause is still not clear for everyone and will need a lot more studies to have a proper scientific explanation to the public.
Other types of skin lymphomas respond very well to medications, but unfortunately, others do not. Advanced skin lymphomas are very difficult to cure, so medical doctors advise patients to undergo several treatments. When the lymphoma relapses, the patient is advised to undergo skin-directed therapies again. However, chances are, the more treatments a person has had, the less likely it is that the next treatment would be effective.
Different Types of Skin Lymphoma
Skin lymphomas are generally classified into two categories: the Cutaneous T-cell lymphoma and the Cutaneous B-cell lymphoma that are further subdivided into other primary subtypes. These are the different types of skin lymphoma according to their characteristics:
Cutaneous T-cell Lymphoma (CTCL)
This is the most common type of skin lymphoma, and it is usually mistakenly identified for eczema. About 75% of cutaneous T-cell lymphoma cases involve the skin. It may also affect the blood, internal organs, and lymph nodes. Its annual incidence includes 6 in 1,000,000 cases.
Mycosis Fungoides (MF)
This is the most common T-cell lymphoma, which accounts for more than 50 percent of skin lymphoma cases. The term is coined from the mushroom-like skin tumors that may develop. This may occur at any age, but people in their 50’s or 60’s are more prone to it. Patients may experience patches, and the growth of plaques will occur as well. Allogeneic stem cell transplantation is the best treatment.
Sezary Syndrome (SS)
Sezary syndrome is another T-cell type of disease, and it is slightly like those that of Mycosis fungoides. Patients may experience patches, skin tumors, and plaques. This syndrome drastically affects the blood and causes red rashes to appear all over the body. It is more commonly diagnosed in men than in women, and it usually occurs in older people.
Primary Cutaneous Gamma/Delta T-Cell Lymphoma
This T-cell skin cancer subtype grows rapidly in number and is very difficult to control once it is widespread. It is basically only treated through chemotherapy.
Primary Cutaneous CD8+ Aggressive Epidemiologic Cytotoxic T-Cell Lymphoma
Like the previous type, this cancer is treated with chemotherapy as well – and sometimes with radiation therapy. It grows quickly, and nodules may appear over time.
Primary Cutaneous Acral CD8+ T-Cell Lymphoma
Unlike the two other rare subtypes, this type tends to grow gradually. It can be treated without using radiation, and it is reoccurring but still curable.
Primary Cutaneous CD+4 Small/Medium T-Cell Lymphoproliferative Disorder
This subtype can go away on its own. Skin tumors may appear, and you can visibly see ones that have broken open. Treatments include surgery or injecting corticosteroids.
Primary Cutaneous Follicle Center Lymphoma
This is the primary type of cutaneous B-cell lymphoma, in which a group of red pimples (called lesions) may appear. These may also grow into plaques on the scalp.
Primary Cutaneous Marginal Zone B-Cell Lymphoma
The appearance of lesions can occur with this type of B-cell lymphoma, along with the appearance of lesions. It mostly occurs in older people.
Primary Cutaneous Anaplastic Large Cell Lymphoma (C-ALCL)
The good news is that this type usually stays confined on the skin and is rarely fatal. It seldom spreads throughout the body; however, it often reoccurs even after several treatments and medications.
Stages of Skin Lymphoma
Stages are used to classify how severe a patient’s disease is. In the case of skin lymphoma, stages are roughly designed to determine how widespread lymphoma skin cancer is so that one’s body to have proper treatment. This is also for patients to seek proper medications based on the signs and symptoms that they are experiencing, especially the ones in late stages where urgent medical attention is needed.
Stage I
- Only affects the outer surface of the skin
- Patches (flat lesions) are visible
- Plaques (thick and raised lesions) appear in certain body parts
- Red rashes may be a bit visible too
Stage I-A
- Not a severe stage yet
- The skin is affected by 10% of the signs
- Can be easily treated by injections or prescribed drugs
Stage I-B
- Affecting more than 10% of the skin
- Patches or plaques are more widespread
- Needs more attention than stage I-A
Stage II
- Patches and plaques are present
- Red rashes may occur
- Enlarged lymph nodes are the best classification criteria
- Definitely non-malignant
Stage II-B
- Plaques and patches appearance
- Lymph nodes are swollen
- Still non-malignant
- One or two tumors may appear
Stage III-A
- The surface is involved with red patches or plaques
- More than 80% of the skin appears red
- Quite non-malignant
- Erythrodermic mycosis fungoides occur
Stage III-B
- Showing abnormalities and characteristics of cancer
- Sezary cells in this stage are already occurring in the blood
- Needs immediate radiation therapy
- Topical chemotherapy is an option as well
Stage IV-A1
- All problems (patches, plaque, tumors) may appear in the skin
- There is a huge number of cancerous t-cells in the blood
- This phenomenon is called Sezary syndrome – an aggressive form of skin cancer
Stage IV-A2
- There are cancerous t-cells in the lymph vessels
- Swollen lymph nodes are observed
- Any amount of the skin surface is covered with patches, plaques, or tumors
- May be tested through blood smears
- Can be treated through radiation therapy
Stage IV-B
- The most dangerous stage
- The cancer has already spread to other organs of the body
- Needs immediate treatment
- The best option would be a chemotherapy
- Has a very high level of circulating Sezary cells
Symptoms of Skin Lymphoma
Signs of skin lymphoma appear on the skin, so it is usually found earlier than any other types of cancer. However, it is very difficult to diagnose it right away because they look like any other types of skin disease. Some people would mistake it for eczema, scabies, or psoriasis. To fully understand how it is different from other skin dilemmas, these are the signs and symptoms one should look out for: sunburn-like rashes all over the skin, scaly plaques, patches, skin tumors that may break open, severe itching, hair loss, shortness of breath, and drastic weight loss.
Factors of Skin Lymphoma
A risk factor is anything that increases one’s chance of getting a disease, in this case, skin lymphoma. Skin lymphomas may occur at any other ages. However, people in their 50s or 60s are more prone to getting the disease. Statistics show that most, but not all skin lymphoma cases all over the world are more commonly found in men than in women.
In general, having a weakened immune system will affect the body. In this case, if the immune system is suppressed, then most likely, one will be getting the disease. Infection with the human immunodeficiency virus (HIV) may increase a person’s risk of skin lymphoma as well. People who underwent liver, heart, or any other organ transplant are more prone to it. Infection with other viruses (like HTLV-1) is linked to having the disease too.
A rare subtype of Cutaneous T-cell lymphoma (CTCL) called the Hypopigmented Vitiliginous Mycosis fungoides are found in children with darker skin in the country of Africa, America, India, and the Middle East. This risk factor, however, is still under research to what is really the relationship of having dark skin with lymphoma.
How Is Skin Lymphoma Treated?
Treatments of skin lymphoma are based on its type and stage. For the not-so severe cases yet or the ones in the early stage, their option is to treat skin lymphoma with skin directed treatments like:
- Phototherapy – This is a type of medical treatment where the person is exposed to fluorescent light bulbs and any other lights like halogen lights or light-emitting diodes to identify a certain medical condition.
- Topical chemotherapy – The anti-cancer is put directly into the skin, usually in the form of ointments, creams, or gels rather than being swallowed or injected.
- Topical Imiquimod – This is an immune response modifier that treats skin problems by increasing the body’s immune system in the form of a cream.
- Local radiation treatments – These use ionizing radiation to treat cancer.
- Total skin electron beam therapy – This is a radiation treatment that treats the person’s damaged entire skin surface to treat Cutaneous T-cell lymphoma (CTCL)’s Mycosis Fungoides and Sezary Syndrome. This passes through the tumor side, and then continues straight through, exiting on the other side of the body, exposing everything to radiation so that the skin cancer cells would die.
- Topical Retinoids – They are an effective way to cure cutaneous T-cell lymphoma. Although there have been a number of clinical studies using retinoids for the treatment of cancers, they are most likely to be an effective treatment of hematologic malignancies like cutaneous T-cell lymphoma as well.
- Photopheresis – The medical treatment removes blood via a machine and isolates white blood cells to test it for skin cancer diagnosis.
- Chemotherapy – This is a drug therapy that uses powerful chemicals to kill fast-growing cells (like white blood cells) in your body, commonly used for cancer.
How Is Skin Lymphoma Diagnosed?
The diagnosis of skin lymphoma is very crucial and should be performed by a trusted dermatologist following a series of tests and procedures from physical examination, interrogations, and blood tests.
In worst-case scenarios, the dermatologist may request a skin biopsy on enlarged lymph nodes. This is the technique where the skin lesion is removed to be rendered under a microscope done under local anesthesia. Other available options are molecular tests, the very hurtful bone marrow biopsies, imaging tests (like computed tomography or CT, fluoroscopy, magnetic resource imaging or MRI, mammography, etc.) and Immunophenotyping wherein heterogeneous population of cells are analyzed for the purpose on understanding the presence of varying conditions such as antibodies that act as markers to determine its type and stage.
Should you have any concerns about skin lymphoma, you may contact All American Hospice – we can discuss how our service can make your life more comfortable.
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