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Cutaneous T-Cell Lymphoma

CTCL (Cutaneous T-Cell Lymphoma) is a rare form of cancer. It is often identified only after repeated diagnoses of eczema and psoriasis. Unfortunately, with the long waits for appointments, obtaining an accurate diagnosis and treatment can be difficult. Now, you can say goodbye to the overwhelming frustration and anxiety caused by months-long waiting periods for appointments. The Trillium Clinic is proudly redefining the dermatologic care model, ensuring that every patient will be seen within 14 days of requesting an appointment. Step into a new era of patient-centered care, where the agony of waiting for appointments becomes a thing of the past.

What is Cutaneous T-Cell Lymphoma?

There are different subtypes of CTCL. Mycosis Fungoides is the most common type of CTCL, characterized by skin patches, plaques, and tumors that may resemble fungal infections. Sézary Syndrome is a more advanced form of CTCL that affects the skin and blood. It is characterized by widespread redness, scaling, and intense itching, along with abnormal lymphocytes in the bloodstream.

What are the symptoms of CTCL

The symptoms of CTCL can vary depending on the stage and subtype but commonly include:

  • Skin Changes: CTCL often presents as red, itchy, scaly patches or raised plaques on the skin. These may resemble eczema or psoriasis and may persist or worsen over time.

  • Itching: Intense itching, known as pruritus, is a common symptom of CTCL and can significantly impact quality of life.

  • Thickened Skin: In advanced stages, the skin may become thickened, hardened, or develop tumors.

  • Lymph Node Enlargement: In some cases, lymph nodes may become enlarged, especially in Sézary Syndrome.

How is CTCL Diagnosed

Diagnosing CTCL can be challenging, as it often mimics other skin conditions. A dermatologist or oncologist may perform a combination of tests, including:

  • Skin Biopsy: A small sample of affected skin is taken and examined under a microscope to identify abnormal lymphocytes and confirm the diagnosis.

  • Blood Tests: Blood samples may be taken to evaluate the levels of certain markers, such as abnormal lymphocytes or specific genetic mutations.

  • Imaging Studies: X-rays, CT scans, or PET scans may be conducted to assess the involvement of lymph nodes or internal organs.

How is CTCL Treated

Treatment for CTCL depends on the stage, subtype, and individual factors. It may involve a combination of the following:

  • Topical Medications: Steroid creams or other topical medications may be used to reduce inflammation and control skin symptoms.

  • Phototherapy: Light-based therapies, such as PUVA or UVB therapy, may be used to target cancerous cells and alleviate symptoms.

  • Systemic Medications: Oral or injectable medications, such as retinoids, methotrexate, chemotherapy, or targeted therapies, may be prescribed for more advanced or aggressive cases.

  • Immunotherapy: Immune-modulating medications, such as interferon or immune checkpoint inhibitors, may be used to stimulate the immune system’s response against cancer cells.

  • Stem Cell Transplantation: In rare cases of advanced CTCL, stem cell transplantation may be considered to replace damaged bone marrow with healthy cells.

  • Photophoresis, also known as extracorporeal photopheresis (ECP), is a specialized treatment option used for certain types of cutaneous T-cell lymphoma (CTCL), specifically mycosis fungoides and Sézary syndrome.

How is Photophoresis performed

  • Blood Collection: A small amount of the patient’s blood is withdrawn through a catheter or needle.

  • Separation: The blood is then processed in a machine called a cell separator, which separates the white blood cells from other components like red blood cells and plasma.

  • Exposure to Photosensitizing Agent: The isolated white blood cells, including T cells, are mixed with a photosensitizing agent called 8-methoxypsoralen (8-MOP). This agent makes the T cells more sensitive to light.

  • Ultraviolet A (UVA) Light Exposure: The treated blood is then exposed to ultraviolet A (UVA) light for a specific duration, usually about 1 to 2 hours. The UVA light activates the photosensitizing agent, leading to changes in the T cells.

  • Return of Treated Blood: The treated blood, now containing modified T cells, is returned to the patient’s bloodstream through another catheter or needle.

  • Mechanism of Action: The exact mechanism by which photophoresis works in CTCL is not fully understood. However, it is believed to have several effects:

  • Immunomodulation: Photophoresis is thought to modulate the patient’s immune system, resulting in a decrease in cancerous T cells and an increase in normal immune function.

  • Induction of Apoptosis: The activated photosensitizing agent and UVA light exposure may induce apoptosis (cell death) in cancerous T cells, leading to a reduction in tumor burden.

  • Modulation of Cytokines: Photophoresis may affect the production and release of cytokines, which are signaling molecules involved in immune responses and inflammation.

  • Treatment Schedule: Photophoresis is typically performed as a series of treatment sessions over several months. The exact frequency and duration of treatment vary depending on individual factors and response to therapy. Initially, treatments may be performed weekly or biweekly, and then gradually spaced out as improvement occurs.

  • Efficacy: Photophoresis has shown effectiveness in the treatment of CTCL, particularly in improving skin manifestations and reducing symptoms like itching. It may also have a positive impact on overall disease progression and quality of life.

  • Side Effects: Photophoresis is generally well-tolerated, and the side effects are usually mild. Common side effects may include temporary low blood pressure, temporary flu-like symptoms, and temporary redness or sunburn-like skin reactions.

  • It’s important to note that photophoresis is a specialized treatment and should be administered by healthcare professionals experienced in this technique. The treatment plan and suitability for photophoresis should be discussed with a dermatologist or oncologist specializing in CTCL.

Embark of your journey

It’s important to note that CTCL is a complex condition, and treatment plans should be personalized based on individual circumstances. Regular follow-ups and monitoring are essential to track the progression of the disease and adjust treatment as needed. As experts in the detection and treatment of CTCL, we invite patients from Chapel Hill, Carrboro, Raleigh, Hillsborough, Pittsboro, Mebane, Holly Springs, Durham, Burlington, Cary, and surrounding cities, who suspect they may have the disease, or have been diagnosed with it elsewhere, to schedule a consultation today. You can self-schedule here or contact us by phone and we will help you find a convenient appointment. Once you arrive, a member of our dermatology team will conduct a comprehensive evaluation of your skin and discuss any findings that may be concerning. Together, we will explore the various options so that we develop the treatment plan best suited for your specific situation. The are many great options, call us today to learn more.

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