Cutaneous Lymphoma

Recognized by U.S. News & World Report

UT Southwestern Medical Center has earned a "High Performing" rating from U.S. News & World Report for treatment of leukemia, lymphoma, and myeloma, placing us among the nation’s top hospitals for this procedure.

Whether our patients require aggressive treatment or a watch-and-wait approach, UT Southwestern Medical Center’s cutaneous lymphoma team offers expert, patient-focused care. Our goal is to restore the overall well-being and appearance of every patient we treat.

As the only National Cancer Institute-designated comprehensive cancer center in North Texas, we deliver the best cancer care available today and push to discover new treatments. NCI designation means we offer patients the ability to participate in the broadest possible range of clinical trials, with access to potential therapies not available at other facilities.

Expert Evaluation, Sought-After Treatments

Cutaneous lymphoma includes a variety of non-Hodgkin lymphomas that arise in the skin. Also called skin lymphomas, these rare cancers make up only about 5 percent of all non-Hodgkin lymphoma cases. 

UT Southwestern is home to a specialized, multidisciplinary team that expertly diagnoses and treats cutaneous lymphoma. The region’s only cutaneous T-cell lymphoma referral center, we’re unmatched in our ability to diagnose the many varieties of lymphoma and target treatments to specific variations of the disease – treatments that sometimes aren’t available anywhere else. 

These treatments include many types of phototherapy (including the only UVA1 phototherapy unit in the Southwest), total skin electron beam therapy, and photopheresis. 

We also offer the most current evidence-based chemotherapy drugs, both skin-directed and systemic (whole-body); immunotherapy agents such as rituximab and brentuximab; and combination therapies. 

In cutaneous lymphoma cases that require bone marrow transplantation, UT Southwestern has a track record of success. Recognized as one of the leading programs of its kind in the U.S., our Bone Marrow Transplant Program stands out among regional competition for treating hematologic malignancies (blood cancers) such as lymphoma. 

In addition to our advanced cutaneous lymphoma treatments, UT Southwestern is at the forefront of conducting research into the causes of and cures for all types of lymphoma. 

Types of Cutaneous Lymphoma

Cutaneous lymphoma is cancer of the white blood cells (lymphocytes) that mainly involves the skin. The type of lymphocytes affected determines which of the two main categories of cutaneous lymphoma is present:

• Cutaneous T-cell lymphoma (CTCL): Diagnosed when T lymphocytes are affected, CTCLs make up approximately 75 percent of cutaneous lymphoma cases. One of the two subtypes of cutaneous T-cell lymphoma is Sézary syndrome, an advanced leukemic variant of mycosis fungoides.
• Cutaneous B-cell lymphoma (CBCL): Diagnosed when B lymphocytes are involved, CBCLs comprise about 25 percent of cutaneous lymphoma cases. 

Symptoms

Cutaneous lymphomas typically appear as skin lesions that can be scaly, itchy, and red to purple. These lesions can arise anywhere on the body – frequently on areas without sun exposure – and take one or more of these forms:

• Small, pimple-like lesions (papules)
• Flat lesions (patches)
• Thick, lowered, or raised lesions (plaques)
• Lumps or bumps under the skin (nodules or tumors) 

Some types of cutaneous lymphoma can appear as a large rash called erythroderma. 

Diagnosis and Staging

Accurate, early diagnosis and staging of cutaneous lymphoma is crucial to providing the most effective treatments and helping our patients achieve the best possible outcomes. 

Cutaneous lymphoma can be difficult to diagnose, because symptoms can mimic those associated with other skin conditions. UT Southwestern takes accurate diagnosis to the highest level with a multidisciplinary clinic, where medical oncologists and dermatologists see patients and work with specialized hematopathologists, who are pathologists uniquely trained to identify all types of cutaneous lymphoma. 

Cutaneous lymphoma is diagnosed and staged with a combination of a physical examination; a review of the patient’s symptoms, health status, medical history, and family history; and tests such as:

• A tissue sample (biopsy) of the skin can detect cutaneous lymphoma cells in a suspicious lesion.
• In select cases, a lymph-node biopsy can detect cutaneous lymphoma cells in the lymph nodes.
• Blood analysis is used to evaluate and quantify the types of blood cells and other components in the blood to help determine the stage of the disease.
• Imaging studies, such as magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), bone scans, and positron emission tomography (PET), help clinicians visualize tumors and perform guided biopsies and other procedures.
• In select cases, bone marrow aspiration and biopsy can help determine whether cutaneous lymphoma has spread to the bone marrow.
• Assessments of heart and lung function help clinicians evaluate patient suitability for certain treatments. 

Treatments We Offer for Cutaneous Lymphoma

Treatment for cutaneous lymphoma depends on its type and stage, as well as the patient’s overall health, preferences, and goals.

UT Southwestern’s cutaneous lymphoma specialists offer some of the most advanced treatments available. We work with patients to determine the most appropriate evidence-based treatment for their unique cancer. 

In addition, our team members are sensitive to the emotional impact that skin cancers such as cutaneous lymphoma can have on patients’ lives, and we strive to minimize any visible reminders of the disease. 

Cutaneous lymphoma treatments are divided into two broad categories:

Those that target only the skin, such as:

• Phototherapy (UV light therapy): This advanced technology includes many types, such as UVA1 phototherapy, all of which use ultraviolet light to treat cutaneous lymphoma and a number of other skin conditions.
• Radiation therapy: This commonly used treatment has good cosmetic results because it causes minimal scarring.
• Topical medications: These include topical chemotherapies such as nitrogen mustard. 

Those that can impact the entire body:

• Total skin electron beam therapy (electron beam radiation): This sophisticated type of radiation therapy affects only the outer layers of the skin.
• Photopheresis: Also known as photoimmunotherapy and extracorporeal photopheresis (ECP), this leading-edge treatment targets the white blood cells that cause disease.
• Whole-body (systemic) chemotherapy: These cancer-fighting medications travel through the bloodstream to reach all parts of the body.
• Immunotherapy drugs, such as rituximab and brentuximab: These agents help the body fight cutaneous lymphoma and other diseases.
• Systemic retinoids: Typically made with natural or synthetic vitamin A, these pills are used to treat a number of dermatologic conditions.
• High-dose chemotherapy with bone marrow transplantation, also called stem cell transplantation: High-dose chemo can damage bone marrow, so combining this treatment with stem cell transplantation allows doctors to give higher doses of chemotherapy because the stem cells restore bone marrow. 

Clinical Trials

Patients with cutaneous lymphoma might also be eligible to participate in clinical trials of promising new protocols aimed at improving diagnosis, treatment, and outcomes of the disease. Patients should speak with their doctors about clinical trial opportunities. 

Support Services

UT Southwestern offers many patient support services for patients with cutaneous lymphoma. Our whole-patient approach to care means that, in addition to taking care of a patient’s physical condition, clinicians also strive to help with issues such as pain management, nutrition, psychosocial adjustments, and cancer’s impact on their families.