Recognizing and Treating a Lymphoma Rash

A lymphoma that affects the skin can cause a rash to develop. Lymphoma rashes and skin changes can appear differently on the body and may not all look the same. They can be flat, raised, or in lumps. Affected skin may be itchy, and the lesions may open up and leak fluid.

Lymphoma of the skin can be treated in multiple ways, such as topically with medications, through radiation or UV light therapy, or with infusions of chemotherapy or biologic therapy.

Each type of lymphoma may exhibit unique symptoms and require specific treatments. This article will review how lymphoma can affect the skin. 

Lymphoma Rash

A lymphoma affecting the skin can cause a rash to develop. The rash and skin changes can vary in different areas of the body, and may not look the same, even on the same person. 

The skin rash, or lesions,  can be described in multiple ways, such as:

• Patches (flat spots on the skin)
• Plaques (thickened areas of the skin)
• Papules (small bumps)

These skin lesions are often red or purple in color, can be scaly, and can often be itchy. They can occur in a variety of sizes, and some may even break open and leak fluid.

Other Symptoms

Although many of the symptoms of a lymphoma involving the skin are related to the skin, other symptoms may also be present.  These symptoms may include:

• Fever
• Unintentional weight loss
• Night sweats
• Chills
• Lumps in the neck, under the armpits, or in the groin area

Diagnosing Lymphoma

A diagnosis of lymphoma requires a biopsy of some of the abnormal skin lesions or rash. During this procedure, a sample of tissue is removed to be evaluated by a pathologist (a physician specializing in laboratory medicine) to determine the cause of the abnormality.

A skin biopsy can be done in multiple ways and is most often performed by a dermatologist (a physician specializing in diseases of the skin, hair, and nails):

Types include:

• Shave biopsy: In a shave biopsy, the top layer of the lesion or skin is removed with a surgical knife and sent to the lab for testing.
• Punch biopsy: A small round tool is used to “punch” out a piece of the skin. This special tool allows the dermatologist to get through multiple layers of the skin. Stitches may be required after the procedure.
• Lymph node biopsy: During this biopsy, a needle is placed into a lymph node, which is under the skin. A lymph node biopsy can detect cancer that has spread into enlarged lymph nodes.

Determining the exact type of skin lymphoma can be difficult at times. The pathologist evaluating the specimen may need to run specialized tests to determine the type of cancer. These tests can look for abnormal chromosomes (the structures that carry genetic material) or the presence of certain proteins that may suggest the type of cancer.

Most often the type of skin lymphoma that is found is in the group of T-cell lymphomas. Examples of T-cell lymphomas include:

• Mycosis fungoides
• Sezary syndrome
• Adult T-cell leukemia-lymphoma
• Primary cutaneous anaplastic large cell lymphoma

Although not as common, skin lymphomas can be B-cell lymphomas as well, and examples include:

• Primary cutaneous marginal zone B-cell lymphoma
• Primary cutaneous follicle center lymphoma
• Primary cutaneous diffuse large B-cell lymphoma

In addition to knowing the cause of the rash, especially if it is found to be cancerous, imaging studies need to be done to determine the exact locations of lymphoma in the body, to determine if it has spread outside of the skin. Imaging studies can include:

• Computed tomography scan (CT): Uses X-rays to produce a detailed cross-sectional image
• Positron-emission tomography (PET) scan: Detects active cells using a radioactive sugar
• Magnetic resonance imaging (MRI): Uses strong magnetic fields to produce detailed images
• Ultrasound: Uses sound waves to produce images

Treatment 

Lymphoma of the skin can be treated in multiple ways, some of which target just the skin lesions specifically while others treat the entire body. 

Skin Treatment Options

Surgery: Surgical removal of the skin lymphoma may be possible, especially if there aren’t many areas of rash and if it’s possible for them to be completely removed.

Radiation: Radiation treatments use high-energy beams directed at the skin to kill cancer cells. Treatments are typically given five days a week for a period of time determined by the radiation oncologist.

Ultraviolet (UV) light therapy: This treatment uses ultraviolet light beams similar to a tanning bed. In some instances, the UV light is able to treat lymphoma.

Topical medication: Some types of  steroids, chemotherapy, and immune therapy are available in topical treatments that are applied directly to the skin lesions or rash. These medications may be used in some types of skin lymphoma, especially if it is caught early.

Systemic Treatment

Chemotherapy: This treatment uses medications that kill cells as they are dividing. It is typically given as an intravenous (IV) infusion, though some medications are topical. The chemotherapy can travel throughout the body, killing any fast-growing cells as they are dividing. Some healthy cells can be affected by chemotherapy as well, which leads to side effects.

Targeted biologic therapy: These medications can be given to target specific proteins on the lymphoma cells, to help the immune system fight them off and destroy the cancer.

Photopheresis: Blood is removed and passed through a machine that separates out the lymphocytes. The lymphocytes are treated with psoralen (which sensitizes them to UV light) and UV light. They are mixed with the rest of the blood and infused back into the body. This kills some lymphoma cells and sensitizes the immune system to fight lymphoma cells.

When to See a Healthcare Provider

It’s not uncommon for someone to develop a rash on their skin at some point in their lives. Rashes can occur for many, noncancerous reasons. If the rash doesn’t go away after self-treatment, or if any of the additional symptoms listed above develop, see your healthcare provider. 

They may refer you to a dermatologist who can perform a biopsy of the rash and determine what is going on. 

Summary 

A lymphoma rash can appear in a variety of ways on the skin. It can be flat, raised, or in lumps. The skin that is affected is often very itchy, and some of the lesions may even open up and leak fluid. 

Lymphoma of the skin is often a T-cell lymphoma. It can be treated topically with medications, through radiation or UV light therapy, or through infusions of chemotherapy or biologic therapy. 

A Word From Verywell

If you’re concerned that a rash that’s been on your body is getting worse or may not be a simple rash, see your healthcare provider, specifically a dermatologist. They can do a thorough skin examination, and get a biopsy of any of the rash areas.

It is important to remember that just because there is a rash, doesn’t mean it will be cancer. Rashes can be caused by a variety of reasons.