Hi everyone. Today I want to talk about a type of skin cancer that is different from an abnormal mole or lesion. Moles or lesions can usually be removed surgically. Cutaneous T-cell lymphoma (CTCL), however, is a skin cancer that resembles a rash rather than a new abnormal growth.
Cutaneous T-cell lymphoma is almost like having “leukemia of the skin” in that there is an abnormal proliferation of blood cells that usually fight off infection (in this case, an expansion of the T-cells). Although there are various types of CTCL, the most common is known as mycosis fungoides. The cause of this condition is not known, although in some regions of the world, it has been linked to a virus known as human t-cell leukemia virus-1. Unlike other skin cancers, this cancer is in no way caused by too much sun exposure. CTCL affects approximately 5 people per million per year with men being affected twice as often as women. The condition tends to be found in older people, with the average person being about age 50 at the time of diagnosis.
So what does this cancer look like if it doesn’t look like a mole or growth that is changing? It usually looks like a nonspecific rash appearing around the lower trunk and buttocks (area usually covered by a bathing suit for example). It is often misdiagnosed as eczema because the skin can appear dry and scaly. Some people may also mistake it for a fungus, which is also usually found in the lower trunk area. This rash may itch, or it may be asymptomatic. In most cases, the rash persists for years and after trying different creams, several biopsies are usually done before the diagnosis is confirmed.
If the condition progresses, the rash tends to spread and small tumors can appear on the skin. In an aggressive form of the disease, a person’s skin can become red and scaly all over. The real danger of this type of cancer is its ability to spread to the lymph nodes and then possibly to other organs. As a result, there are more tests done for a person with more advanced CTCL, including blood work and radiological studies. At this point in the progression of the disease, an oncologist (cancer specialist) may be involved with the care.
Treatment for this condition depends on the stage at which it is diagnosed. A smaller rash can be treated with topical steroid creams, similar to how eczema or other rashes are treated. Light therapy (similar to the use of tanning beds), radiotherapy, and use of topical nitrogen mustard are other options. There are oral medicines and other newer medicines in development that can also be used. Surgery is usually not an option because this cancer tends not to appear as a single mass that can be excised. New and improved treatments are under development but because this cancer is not very common, there is not as much research being done to cure it. Because this condition usually persists for years before diagnosis, you should have any persistent rash checked by your dermatologist. The earlier you catch the condition, the more effective your treatment will be.
Kevin Berman is a dermatologist in Roswell, Georgia and is affiliated with multiple hospitals in the area, including North Fulton Regional Hospital and Northside Hospital. He wrote for HealthCentral as a health professional for Skin Cancer.