What Is Cutaneous T-Cell Lymphoma (CTCL)?

A rare groups of lymphomas affecting the skin

T-Cell Lymphoma. Credit: Biophoto Associates / Getty Images

Cutaneous T-Cell Lymphoma (CTCL) is a lymphoma of the skin. CTCL arises from T-cells, a type of lymphocyte or white blood cell. CTCL is not a single disease, but a group of different lymphomas that affect the skin primarily including mycosis fungoides, Sezary syndrome, reticulum cell sarcoma of the skin, and a number of other rare lymphomas.

Lymphoma commonly involves the lymph nodes. However, lymph cells or lymphocytes are present in all organs of the body.

Some T-cells naturally migrate to the skin for protection against infection. The cancer cells of cutaneous T-cell lymphoma also migrate to the skin. Most of the features of CTCL are related to lesions they produce on the skin.

Cutaneous T-cell lymphoma represents a group of rare types of Non-Hodgkin Lymphoma (NHL). CTCL accounts for only about 1 in 40 newly diagnosed NHL patients.

Risk Factors Related to Cutaneous T-cell Lymphoma

CTCL affects men more commonly than women. Individuals with CTCL are usually in their fifties or sixties. Children are rarely affected. There has been a striking increase in the number of individuals affected by skin lymphoma over the last 3 decades.

Not much is known about the cause of CTCL. Unlike some other types of lymphomas, there is no association with known viruses. Research is underway to determine what causes CTCL. 

What Are the Symptoms of Skin Lymphoma?

The first symptoms of skin lymphoma include dry or scaly skin, red rashes, and itching.

The rashes are more common in areas that remain covered with clothes. Some individuals may first notice red or dark patches on the skin. These symptoms are not specific for lymphoma and most people are often treated for more common skin conditions before lymphoma is suspected.

As the disease progresses, the red patches may become elevated, These elevated patches are known as plaques.

Plaques may later turn into nodular or bumpy tumors. In advanced disease, ulcers can develop on top of these lesions. CTCL may also spread to the lymph nodes or other organs. Most people with CTCL only have skin symptoms. About 10 percent of late-stage cases progress to develop serious complications. 

How Is CTCL Diagnosed?

A skin biopsy is required to diagnose CTCL. The biopsy sample will be examined under a microscope to identify lymphoma cells. A number of other tests including tests for lymphoma markers (immunohistochemistry) and lymphoma genes are required to find out the type of lymphoma. CT scans or other imaging tests may be done to locate the extent of the disease.

Treating Cutaneous T-cell Lymphoma

Treatment of skin lymphoma is quite different from the way other lymphomas are treated. Your treatment strategy will depend on the extent of skin involvement, the type of skin lesion, and the involvement of nodes or other body organs. 

Many types of treatment are used:

  • Chemotherapy agents applied on the skin
  • Total skin electron beam therapy – a type of radiation treatment
  • Psoralen and ultraviolet A rays
  • Ultraviolet B rays
  • Bexarotene – both as a gel as well as tablets
  • Denileukin Difitox
  • Interferon alpha
  • Chemotherapy by injections or pills

Most recently, the U.S. Food and Drug Administration (FDA) approved mechlorethamine gel (Valchlor) for on the skin treatment of mycosis fungoides, the most common type of CTCL. Before its approval, mechlorethamine was only approved for intravenous treatment.

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