Recognizing the Signs & Symptoms of Skin Lymphoma

Skin (cutaneous) lymphomas often manifest as a skin rash. Although usually identified early, skin lymphomas can be mistaken for other skin conditions, delaying diagnosis.

Non-Hodgkin's lymphoma (NHL) occurs when lymphocytes called T cells and B cells become cancerous. Although there are many subtypes of lymphoma, skin lymphomas only make up about 4% of the total of all NHL.

This article will review the types of skin lymphomas and discuss their symptoms, diagnosis, and treatment.

Types of Skin Lymphomas

Skin lymphomas are derived from either B cells or T cells. B cells are an important WBC that fight infection by producing antibodies. These antibodies attach to germs and destroy them. In contrast, T cells have many functions, including directly killing germs or assisting other immune system cells in destroying germs. T-cell skin lymphomas are more common than B-cell skin lymphomas.

B-Cell Skin Lymphoma

B-cell skin lymphoma, also called cutaneous B-cell lymphoma (CBCL), occurs when a mutation develops in the cell. The mutation instructs the cell to divide rapidly and allows it to live longer than it should. Unfortunately, this process causes an accumulation of B cells, resulting in skin tumors and lesions.

Some CBCLs can be low grade (less aggressive), with an excellent prognosis, while others can be high grade (very aggressive) and require intense cancer treatment. High-grade CBCLs often recur (come back) even after treatment.

T-Cell Skin Lymphoma

T-cell skin lymphoma, or cutaneous T-cell lymphoma (CTCL), also occurs when a mutation develops in the cell that causes it to divide too quickly and stay alive too long. The accumulation of T cells forms tumors and lesions in the skin.

CTCL affects more men than women. Although CTCLs are more common than CBCLs, they can be difficult to diagnose. Some CTCLs are low grade (not aggressive) and require very little treatment, while others can be high grade (very aggressive) and need immediate treatment.

Skin Lymphoma Symptoms

Skin lymphomas often appear as a skin rash. In fact, they can easily be mistaken for other skin conditions such as dermatitis, psoriasis, eczema, or skin infections.

Here are some symptoms of skin lymphoma:

• Itchy skin
• Pimple-like lesions, red or purple in color
• Flat, scaly lesions, red or purple in color
• Raised bumps or tumors on the skin
• Ulcers (lesions that have opened)

In rare cases, skin lymphomas can travel to the lymph nodes causing a painless lump around the neck, armpit, or groin area. If these symptoms are accompanied by unexplained weight loss, drenching night sweats, fever, or severe itching, you should be evaluated by your healthcare provider.

Diagnosis

Skin lymphomas are usually identified in the early stages. However, diagnosis can be delayed since skin lymphomas mimic other skin conditions. Once a skin lymphoma is suspected, the steps to diagnosis include:

• Physical examination: Your healthcare provider will examine your skin and feel for enlarged lymph nodes. They may also ask about any new symptoms you may be experiencing.
• Blood tests: Lab values can be helpful in understanding how advanced skin lymphomas are. Blood tests can also determine if you have any bacterial or viral infections that could be linked to skin lymphoma.
• Skin biopsy: Partial or complete removal of the lesion is performed and sent for an evaluation by a pathologist (a doctor who examines fluids, tissues, and organs to determine diseases).
• Lymph node biopsy: A lymph node is removed for evaluation to see if the skin lymphoma has spread to the lymph nodes.
• Bone marrow biopsy: Bone marrow is removed and examined to detect if skin lymphoma is in the bone marrow (spongy part of the bones where red and white blood cells are made).
• Imaging: You may also undergo scans to check if skin lymphoma has traveled to your organs. These could include a CT (computed tomography) scan or a PET (positron-emission tomography) scan.

Although it's stressful waiting for the test results, it's important to know what type of skin lymphoma you have and if it has traveled to other parts of your body.

Treatment

Treatment for skin lymphoma depends on the type of lymphoma, what stage it is, your symptoms, your medical history, and your current state of health. Skin lymphoma treatments include:

• Topical creams
• Antibiotics
• Phototherapy (using natural or artificial light as treatment)
• Chemotherapy
• Immunotherapy (uses part of a person's immune system as cancer treatment)
• Radiation therapy
• Surgery
• Treatments obtained through clinical trials (research into new treatments)
• Allogeneic stem cell transplant (stem cells are transplanted from a donor to a recipient)

Summary

Skin lymphomas develop from cancerous white blood cells called B cells and T cells. Although skin lymphomas are usually identified early, they are often mistaken for other skin conditions, delaying diagnosis. Slow-growing skin lymphomas have an excellent prognosis, while aggressive types can be difficult to treat and often recur (come back).

Skin rashes are the most common symptom of skin lymphoma. Call your healthcare provider if you have unexplained weight loss, drenching night sweats, and enlarged lymph nodes accompanied by a new skin rash.

A Word From Verywell

The cause of skin lymphomas is still being studied. However, scientists have learned that certain mutations in a B cell's or T cell's DNA can change them into skin lymphoma. Weakened immune systems and certain infections also increase the risk of developing skin lymphomas. Although there is no known cause, having a healthy lifestyle may help prevent skin lymphoma. Exercising, eating well, staying at a healthy weight, and not smoking are ways you can reduce your risk of developing skin lymphoma.