Skin Cancer Cutaneous T-cell Lymphoma Treatment
The treatment for CTCL depends on the stage at which the disease is diagnosed. The prognosis is extremely variable and also depends on the stage at diagnosis. Early patch stage CTCL can be indolent, with no progression for years and the disease may be cured.
Treatment may be directed to the whole body so that undetected lesions will be treated. These lesions may temporarily become more apparent during therapy and then resolve. Treatments for patch and plaque stage disease include application of topical steroids, topical chemotherapy with nitrogen mustard, topical retinoids and PUVA.
PUVA is the combination of oral psoralen with UVA light phototherapy. The drug makes the skin more responsive to UVA rays. Patients receiving UVB or PUVA are treated 3 times per week, until remission is achieved. Treatments are tapered. Monthly maintenance therapy may be continued for years. Broad band and narrow band ultraviolet light B can also keep the disease in check and may prevent progression.
Topical nitrogen mustard can be used to treat patch or plaque stage disease. The medication is prepared as a liquid or cream and is applied by the patient. The amount is increased as tolerance develops. This therapy can induce long-term remission and even cures. Nitrogen mustard therapy can be used in combination with phototherapy or total body electron beam therapy to increase effectiveness.
Electron-beam therapy affects the skin only. Radiation does not penetrate to the internal organs. Whole body electron-beam radiation results in complete remission in about 84% of individuals. This therapy is usually reserved for patients who do not respond to other forms of treatment.
For advanced stages of the disease, total body electron beam radiation therapy is used alone or in combination with interferon. For erythrodermic or Sezary syndrome patients, extracorporeal photopheresis, interferon, methotrexate, and cyclophosphamide can be used in various combinations.
In many cases, despite these aggressive therapies, CTCL can be fatal.