Cutaneous lymphoma therapy

Sometimes it is sufficient to treat the skin lymphoma locally. If the cancer has already affected other organs, we choose therapies that are effective throughout the entire body (systemic). We usually combine several treatments in order to increase the effectiveness of the treatment.

Sometimes the cutaneous lymphoma regresses on its own, for example in the case of lymphomatoid papulosis. In other cases, we opt for a wait-and-see strategy – initially only observing and controlling the skin lymphoma.

Treatment options for T-cell lymphoma

The following treatment options are available for T-cell lymphoma

• Glucocorticosteroids (“cortisone”) in early stages: The steroids are applied to the skin as a cream or ointment. However, they can also be injected directly into the skin nodules.
• Surgery: We remove the skin lymphomas surgically under local anesthesia. The procedure can be performed on an outpatient basis – you do not have to stay in hospital, but can go home afterwards.
• Phototherapy (PUVA, light therapy): Drugs are used which make the cancer cells sensitive to light, usually the substance psoralen. The light sensitizer penetrates the skin and reaches the cancer cells. We then irradiate the skin from the outside with UVA light and the cancer cells die. In some cases, UVB light with a wavelength of 311 nanometers (nm) is also used. It is called UBV-311-nm light therapy. Phototherapy can be combined with the body’s own messenger substance interferon-α or the vitamin A derivative bexarotene.
• Radiotherapy: Radiology specialists irradiate the affected areas of skin with X-rays.
• Bexarotene: The derivative of vitamin A causes cancer cells to die. Bexarotene is available as tablets.
• Targeted therapy: The drugs target specific features on the surface of the cancer cells and prevent them from multiplying. The antibody combination Brentuximab Vedotin or Mogamulizumab is used.
• Immunotherapy (immunomodulators): The treatment is not aimed directly at the cancer cells, but activates and sharpens the immune system. It is then supposed to act against the malignant tumor cells again and eliminate them. One example is treatment with interferon-α. An endogenous messenger substance that stimulates the immune system. We usually administer the medication as an injection.
• Chemotherapy: We use cell toxins (cytostatics, chemotherapeutics) which stop the cancer cells from multiplying and cause them to die. Chemotherapy is available in the form of creams or gels to be applied to the skin (e.g. the active ingredient chloromethine), as tablets (e.g. methotrexate as “mild” chemotherapy) or infusion via the vein (e.g. gemcitabine, doxorubicin). Sometimes we also administer several cytostatic drugs in combination in several cycles. In between there are breaks in which the body can recover.
• Extracorporeal photopheresis (for Sézary syndrome): We take blood and separate the white blood cells from the other blood components using a centrifuge. We then treat the cells in the laboratory with the light sensitizer psoralen, irradiate them outside the body with UV light and return them to the bloodstream. Extracorporeal photopheresis is a further development of PUVA. It can also be combined with interferon-α or bexarotene.

Treatment options for B-cell lymphoma

Many cutaneous B-cell lymphomas have a very good prognosis, which is why we initially take a less aggressive approach to treatment.

• Surgery: We try to remove the skin lymphoma as completely as possible as part of a surgical procedure.
• Radiotherapy: We irradiate the affected areas of skin with either fast electrons or soft X-rays.
• Glucocorticoids, for example triamcinolone as an injection into the affected skin area
• Interferon-α as an injection directly into the skin nodules or as an infusion
• Targeted therapy: The antibody Rituximab is used, which is directed against a specific structure on the surface of the cancer cells. Rituximab can be injected via the vein, but also directly into the skin nodes. The medication is suitable for several lumps in different places or if surgery is not possible.
• Chemoimmunotherapy called R-CHOP – for diffuse large B-cell lymphoma of the leg type: the active substances used are rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (“cortisone”)

Aftercare

Regular follow-up care is important after the initial treatment has been completed. We monitor your state of health, treat any side effects and complications and try to detect relapses. This is because in some cases the cutaneous lymphoma returns despite therapy. Discuss with your doctor how often the checks are necessary. Initially, they are closely meshed, about every three months. Without a relapse, the time intervals become longer and longer.

And: examine your skin yourself regularly for changes! If you discover any abnormalities that indicate a return of cutaneous lymphoma, seek medical advice immediately.