Cutaneous Lymphoma Program

Cutaneous lymphoma is an uncommon type of cancer. To understand what makes it so unusual, it’s helpful to know where and how it grows:

• As the name implies, cutaneous lymphoma is a type of lymphoma (cancer that grows in white blood cells called lymphocytes).
• There are many kinds of lymphoma, separated into two main groups: Hodgkin lymphoma and non-Hodgkin lymphoma. Cutaneous lymphoma is a type of non-Hodgkin lymphoma.
• Non-Hodgkin lymphomas develop in one of the two main kinds of lymphocytes, called T-cells and B-cells.
• Most T-cells and B-cells live within your lymphatic system. This system includes your lymph nodes and lymph vessels (tubes that carry an infection-fighting fluid called lymph). Most non-Hodgkin lymphomas begin in your lymphatic system. Symptoms usually include swollen lymph nodes, fever, unexplained weight loss and night sweats.
• A small number of these lymphocytes live in your skin. If they become cancerous, you have cutaneous lymphoma — which mainly affects your skin. Symptoms include pimple-like bumps, scaly patches of skin and widespread rashes.

Because the skin problems associated with cutaneous lymphoma resemble conditions like eczema and psoriasis, it’s often misdiagnosed. For many people, it takes years to find the right specialists and get the right treatments.

There are several kinds of cutaneous lymphoma, and the physicians at Baptist Health Miami Cancer Institute can treat them all.

Cutaneous T-cell lymphoma (CTCL)

If cutaneous lymphoma starts in your T-cells, it’s known as cutaneous T-cell lymphoma, or CTCL. Most CTCLs are slow-growing and aren’t life-threatening. However, without proper treatment, symptoms will keep getting worse.

The most common types of CTCL are:

• Mycosis fungoides (MF): About half of people with cutaneous lymphoma have MF. You may have lesions (scaly, red patches of skin), plaques (thick, raised lesions) and tumors (large skin lumps).
• Sezary syndrome: This type affects your skin, blood and lymphatic system. It causes a red rash that may eventually cover most of your body. It usually grows faster than MF and, because it spreads beyond the skin, it’s harder to treat.

We also treat other, less common subtypes of T-cell lymphoma of the skin. These subtypes include:

• Primary cutaneous anaplastic large cell lymphoma
• Lymphomatoid papulosis
• Subcutaneous panniculitis-like T-cell lymphoma
• Primary cutaneous peripheral T-cell lymphoma
• Primary cutaneous gamma/delta T-cell lymphoma

Cutaneous B-cell lymphoma (CBCL)

Cutaneous B-cell lymphomas, or CBCLs, start in your B-cells. These are the rarest of the rare and make up less than 25 percent of all cutaneous lymphoma cases.

The three main types of CBCL are:

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

There isn’t a one-size-fits-all treatment for cutaneous lymphoma. Each type needs different approaches. That’s why it’s so important to find experts who know how to tell them apart.

Make an appointment to consult with a dermatologist or medical oncologist from the Baptist Health Miami Cancer Institute if:

• You have skin problems that won’t go away. The visible signs of cutaneous lymphoma vary from person to person. However, they often include small, pimply bumps; scaly, reddened patches; thick, raised lesions; and a red rash that can appear anywhere on the body. You may also have severe itching.
• You’ve been diagnosed with a skin condition, but treatments haven’t helped. In its early stages, cutaneous lymphoma can be misdiagnosed as noncancerous skin conditions like eczema or ringworm. But the treatments for these conditions won’t work for cutaneous lymphoma. In fact, your symptoms will continue to get worse.
• You’ve developed added symptoms you can’t explain. Because some types of cutaneous lymphoma spread from your skin to your lymph system, you should seek care if you have skin problems plus more traditional signs of lymphoma. These signs include swollen lymph nodes, fevers and unexplained weight loss.

Unlike most other types of cancer, cutaneous lymphoma acts like a chronic disease. We can't cure it, but with the proper treatment we can control it.

Our team has the experience it takes to diagnose your condition and provide the most effective treatments. Together, we can improve your symptoms — along with your confidence and quality of life.

We offer the full range of treatment options, including:

• Topical medicines. Creams or gels applied to the skin include steroids to reduce inflammation and retinoids to slow skin cell growth. We also offer topical chemotherapy (chemotherapy cream), which kills cancer cells in the top layer of your skin.
• Systemic medicines. Certain oral (taken by mouth), injectable and IV medications attack cancer cells inside your body or help calm your immune system. These include biologics, which slow or stop inflammation, and immunotherapy medicines that help your immune system fight cancer. We also offer traditional chemotherapy medicines that kill cancer cells.
• Light therapy. With this treatment, also called phototherapy, we use ultraviolet (UV) light to kill the cancerous cells in your skin. This treatment works especially well because the cells that cause cutaneous lymphoma are sensitive to UV light.
• Radiation therapy including total skin electron beam (TSEB). Different types of radiation kill cancer cells. Many people with cutaneous lymphoma benefit from a type of radiation treatment called total skin electron beam therapy. With this procedure, we use a machine to send radiation beams to targeted areas of your skin.
• Photopheresis. During this procedure, we remove blood from your body and treat it with a special medicine that’s activated by UV light. We expose the blood containing this medication to UV light, then return it to your body.
• Stem cell transplant for severe cases of CTCL. This procedure targets stem cells (cells that help your body create new blood cells). We replace your cancerous stem cells — or stem cells damaged by cancer treatments — with healthy ones. These healthy new stem cells make your immune system stronger.
• Clinical trials. We’re currently recruiting patients for clinical trials of new treatments for severe, refractory (hard to treat) CTCL.

The number of treatments and how often you’ll need them depends on several factors. These include the type of cutaneous lymphoma you have and whether or not it’s spread beyond your skin. We also assess the type and severity of your symptoms.

For many patients, we start with frequent or aggressive treatments, then taper them down as symptoms begin to improve. Over time, you may shift to routine maintenance treatments that help keep your symptoms from flaring up.

The earlier physicians diagnose cutaneous lymphoma the better. For most people, CTCL is not curable. But with treatment, you may slow disease progression and live with the cancer for many years. Some people even show no evidence of disease during this time.

Most people with CBCL have a very good prognosis when CBCL is slow-growing. However, it’s not uncommon for the cancer to return after treatment. More aggressive cancers are more challenging.

Talking with your physician is the best way to learn about what your diagnosis may mean for you.

Survivorship Program

With an emphasis on healing, recovery, wellness and disease prevention, Miami Cancer Institute’s Survivorship Program team is right there with you as you move into the next phase of your life.

Learn More

We see people from all over Florida — and beyond — who are seeking cutaneous lymphoma care. We also treat patients whose physicians recommend they receive their care here.

We’re known for providing:

• Team-based care. Most people with cutaneous lymphoma need several different treatments to manage their condition — and these treatments must be performed or prescribed by different specialists. Here at Baptist Health Miami Cancer Institute, you’ll find all the specialists and services you need under one roof. Our team includes medical oncologists, dermatologists, radiation oncologists and more. We work together to make sure you receive the safest, most effective treatments available.
• Diagnostic expertise. Our team includes dermatologists with special expertise in identifying rashes, and surgeons who perform biopsies (removing tissue or fluid to examine under a microscope). For example, we can perform a skin biopsy, bone marrow biopsy or lymph node biopsy — or a combination of all three. We also have pathologists experienced in reading these biopsies and pinpointing the type of cutaneous lymphoma you have.
• Pharmacy support. We have the expertise it takes to recommend, dispense and help you manage the various medicines for cutaneous lymphoma (most of which you won’t find at the usual retail pharmacies). For example, our medical oncologists are skilled at choosing the right therapy for the right patient. Our pharmacists have a deep understanding of these medications and can teach you about side effects or complications. They can also work with your health insurance provider to make sure you’re covered before you start using them.