Skin-Directed Therapy for Cutaneous T-Cell Lymphoma
Doctors at NYU Langone may use several skin-directed therapies—treatments that only target the skin—for cutaneous T-cell lymphoma. These are often the first forms of treatment used in people with cutaneous T-cell lymphoma, especially if the condition does not cover large areas of the body. This limited form of the condition is often seen in early stages of mycosis fungoides, one of the two most common forms of cutaneous T-cell lymphoma.
Skin-directed therapy may also be used in combination with whole-body therapy, which aims to kill cancer cells throughout the body. People with more advanced mycosis fungoides, in which the condition covers larger areas of the body, and Sézary syndrome, another form of cutaneous T-cell lymphoma, in which the lymphoma cells spread to the blood, typically receive both skin-directed and whole-body therapies.
Treatment can often lead to remission, meaning the signs and symptoms of the condition go away. Remission can last for months or years.
Often, people with T-cell lymphoma covering small areas of the body can be treated with only topical medications—creams, ointments, or gels placed directly onto the skin. Our doctors work with you to determine how often and how long these medications should be used. They are usually applied daily for several months.
Topical steroids are medications that can help to reduce the itching and redness caused by both cutaneous T-cell lymphoma and some of the other medications used to treat this condition, such as retinoids. Steroids can cause your skin to become thinner, so your doctor carefully manages the dosage and monitors the length of use.
Retinoids, which are made from vitamin A, can damage T-cell lymphoma cells on the skin, slowing cancer growth. They may cause increased redness and itching, usually relieved with topical steroids.
Mechlorethamine gel is a form of chemotherapy, a type of treatment in which medications are used to kill cancer cells. Applying the gel directly to the skin helps to destroy cutaneous T-cell lymphoma. This topical application helps you to avoid the nausea, vomiting, and other side effects that can result from systemic chemotherapy, in which the medications are injected into a vein through intravenous (IV) infusion or taken by mouth and then travel throughout the body.
Topical chemotherapy can cause inflammation and redness of the skin. If this happens, your doctor may recommend adjusting the dose of mechlorethamine or using topical steroids to manage these side effects.
Our doctors may use phototherapy—which delivers ultraviolet light, the same type of light that comes from the sun—to manage cutaneous T-cell lymphoma that does not respond to topical medications or that covers larger areas of skin.
Ultraviolet light helps to damage immune cells, such as T lymphocytes, that are found in the skin. The therapy may be combined with a medication called psoralen, which is taken by mouth beforehand to make the skin more sensitive to ultraviolet light.
Phototherapy sessions vary in length but rarely last longer than a few minutes. The length of the session depends on your skin type and the strength of the light chosen by your doctor. Doctors adjust the light dose based on how the cutaneous T-cell lymphoma is responding to therapy. Generally, several treatments are required each week for a few months.
Our doctors carefully adjust phototherapy doses to avoid burning the skin. Phototherapy can make you more sensitive to natural light, and so you may need to wear sunscreen, protective clothing, and sunglasses after a treatment session.
External Beam Radiation Therapy
People with cutaneous T-cell lymphoma that does not respond to topical medications or phototherapy may be candidates for external beam radiation therapy. For this treatment, doctors use a machine to deliver beams of tiny particles called electrons to treat the skin.
Radiation therapy may be directed at single tumors on the skin or at one or two small areas of the skin where cutaneous T-cell lymphoma is located. Radiation therapy may be directed to skin over the entire body if cutaneous T-cell lymphoma has not responded to other skin-directed therapies, if plaques are thick, or if tumors are located all over the skin. Our doctors carefully plan treatment so that it does not penetrate below the skin layers. This approach helps to prevent unwanted damage to healthy tissue and organs.
Treatments are given in fractions, meaning in doses given several days a week for several weeks and are based on the extent of the rash and plaques caused by cutaneous T-cell lymphoma. A common side effect is increased redness and itching of the skin, which can often be managed with steroid creams.
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