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Cutaneous T-Cell Lymphoma (CTCL)

Cutaneous T Cell Lymphoma (CTCL) is a rare type of lymphoma caused by cancerous growth of T-cells in the skin. It is most common in adults between 40 and 60 years of age.

There are a few sub-types of CTCL, the most common being:

Sezary syndrome:

Large areas of skin or lymph nodes are affected. People with this lymphoma may have redness of the entire skin surface and tumour cells which circulate in the bloodstream. This type of CTCL often follows an aggressive course.

Mycosis fungoides:

The general name given to the other types of CTCL when the blood is not affected. Often, several years of eczema-like skin conditions occur before the diagnosis is finally established. In advanced stages, the lymphoma can spread to lymph nodes and other organs.

What are the symptoms?

CTCL can appear as small, raised, red patches on the skin, often on the breasts, buttocks, skin folds and face. These patches often look similar to eczema or psoriasis and may be associated with hair loss in the affected area.

Patients in later stages may have ulcerating tumours that appear on the skin. Lymph nodes in the affected region may also be involved.

The diagnosis is made by skin biopsy of the area of affected skin. In the early stages of mycosis fungoides, biopsy may be difficult to interpret, and the correct diagnosis can only be made after observing the person over time.

How is it treated?

Many therapies are used to treat CTCL. They include:

PUVA:

PUVA consists of a medicine called psoralen plus ultraviolet A (UVA) light. Psoralen makes the skin more sensitive to the healing effects of the UVA light. The treatment is similar to sitting under a sunlamp and may be given several times a week and is generally used when the lymphoma is over large areas of the skin.

UVB therapy

Ultraviolet B (UVB) light slows the growth of the cancerous cells in the skin. This treatment does not include the use of a medicine to make the skin more sensitive. Treatment may be given several times a week.

Radiotherapy:

Local radiation may be used for early-stage CTCL if only one or two small areas of skin are affected. Radiotherapy may also be used to treat the entire surface of the skin if the CTCL is more widespread. This type of radiotherapy is called total skin electron beam treatment. It is only given once and then may be followed up with further PUVA treatments if needed.

Chemotherapy:

Chemotherapy medicines may be applied directly to the skin in the form of an ointment. Intravenous chemotherapy may be used if the CTCL is more advanced.

Monoclonal Antibodies and Targeted Therapies:

Monoclonal antibodies and targeted therapies. Monoclonal antibodies in combination with chemotherapy medicines and targeted therapies are also available for patients with CTCL.

Interferon:

Interferon is a naturally occurring protein in the body and is an important part of a healthy immune system. A synthetic form of interferon can be injected under the skin to help boost the immune response and fight the CTCL.

Photopheresis:

This treatment is used particularly for Sezary syndrome. It involves passing the person’s blood through a machine where it is exposed to ultraviolet light and a medicine before returning it back to the patient. This procedure takes around 3 hours to complete and can be given every month, every fortnight, every week or more frequently depending on the person's skin and their response to treatment.