- How is lymphoma of the skin treated?
- Skin-directed treatments for skin lymphomas
- Whole-body (systemic) treatments for skin lymphomas
- Clinical trials for lymphoma of the skin
- Complementary and alternative therapies for lymphoma of the skin
- Treatment for specific types of skin lymphoma
- What if the lymphoma keeps growing or comes back after treatment?
- More treatment information for lymphoma of the skin
Treatment for specific types of skin lymphoma
Most of the time, the treatment of skin lymphoma is based on the type of lymphoma, as well as its location and its stage – how far it has spread in the body. But other factors, such as your overall health, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.
The treatments mentioned in this section are discussed in more detail in earlier sections of this document.
Many forms of treatment can be used for mycosis fungoides (MF).
Skin-directed treatments: For early stages of MF, treatments are aimed at the skin. Options may include:
- Phototherapy with ultraviolet (UV) light (either UVB light or UVA combined with drugs called psoralens, known as PUVA)
- Topical chemotherapy with BCNU or nitrogen mustard
- Topical corticosteroid ointments or injections
- Topical retinoid (vitamin A-like drug), such as bexarotene
- Topical imiquimod (Zyclara)
- Local radiation treatments if there is only one or a few lesions
- Total skin electron beam therapy (TSEBT) if MF covers most of the skin
In some cases, more than one type of skin-directed treatment may be used.
Systemic (whole-body) treatments: Mycosis fungoides may remain localized to the skin for many years. However, the disease can eventually become more advanced, and patients may need systemic treatments.
Several types of therapy may be used, such as:
- Retinoids (taken by mouth)
- Targeted drugs like vorinostat (Zolinza) or romidepsin (Istodax)
- Denileukin diftitox (Ontak)
- Low-dose methotrexate (a chemo drug)
Chemotherapy (usually with a single drug), bortezomib (Velcade), or alemtuzumab (Campath) may be other options, but they are often reserved for lymphomas that are no longer responding to other treatments. If single chemo drugs are not effective, combinations of drugs (similar to those used for other types of non-Hodgkin lymphoma) might be recommended. A stem cell transplant might be another option at this point.
More than one type of treatment might be used at the same time. This could include combinations of skin-directed and systemic treatments (such as TSEBT plus photopheresis) or multiple systemic treatments (such as an oral retinoid plus interferon).
Many patients can be helped by these treatments, sometimes for many years, but they rarely cure the lymphoma. In cases where other treatments are no longer working, a stem cell transplant may be an option. Newer treatments are also being studied. If current treatments are no longer effective, patients may want to consider entering a clinical trial.
The systemic treatments used for advanced MF are also used for Sezary syndrome. Since the disease has usually spread beyond the skin at the time of initial diagnosis, treatments directed only at the skin are less useful than in MF.
Photopheresis may be helpful in treating the disease, as may retinoids, such as bexarotene. The targeted treatments vorinostat and romidepsin might also be used, as might interferon or denileukin diftitox. Chemotherapy, bortezomib, or alemtuzumab can also be useful, but these are usually reserved for lymphomas that are no longer responding to other treatments. A stem cell transplant may be another option at this point.
As with advanced MF, these treatments are often helpful for a time, but they rarely produce a cure. Newer treatments are currently being studied, and patients may want to consider entering a clinical trial of one of these.
Primary cutaneous anaplastic large cell lymphoma (ALCL)
This lymphoma usually stays confined to the skin. It seldom spreads internally and rarely causes death. It can often be monitored closely without needing to be treated right away. The lymphoma may even go away on its own, without any treatment.
If treatment is needed, the choices are removing it (with surgery), radiation therapy, or topical chemotherapy. If this lymphoma comes back after treatment and spreads to lymph nodes or (rarely) internal organs, then chemotherapy is often used. Newer targeted drugs such as brentuximab vedotin (Adcetris) and crizotinib (Xalkori) have been shown help some patients with non-skin forms of ALCL. These might also be options for advanced cutaneous ALCL, although more research is needed.
This disease often comes and goes on its own and usually has such a good outlook that treatment is not needed right away. If treatment is needed, topical therapies are often chosen, such as nitrogen mustard or corticosteroids applied to the skin lesions. Rarely is there any need for systemic chemotherapy.
Subcutaneous panniculitis-like T-cell lymphoma
Patients with this type of lymphoma can live a long time and generally have an excellent outlook. Although chemotherapy and radiation have been used successfully in the past, the disease can also be controlled for long periods with the use of corticosteroids alone.
Primary cutaneous peripheral T-cell lymphoma, unspecified
Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphomas are usually fast growing and are treated with systemic chemotherapy.
Cutaneous gamma/delta T-cell lymphoma tends to grow and spread very quickly. It is treated with systemic chemotherapy or radiation therapy, but generally does not respond well to treatment.
Primary cutaneous CD4+ small/medium sized pleomorphic T-cell lymphoma may be removed with surgery or treated with radiation if there is only a single tumor. If there are many tumors, systemic chemotherapy is often effective. People with this lymphoma generally have a good outlook, especially if they have only one tumor.
Primary cutaneous peripheral T-cell lymphoma, unspecified, is treated with systemic chemotherapy. Although these lymphomas may respond to chemotherapy at first, they often come back later, and long-term survival is not common.
These lymphomas are often hard to treat effectively, so patients may want to consider clinical trials studying newer forms of treatment.
Primary cutaneous marginal-zone B-cell lymphoma
This type of lymphoma can sometimes be watched without treatment until problems develop. For lymphomas that are in one spot or only a few spots close together, initial treatment is usually radiation therapy or excision (surgical removal). If the lymphoma does not go away completely or keeps growing, further treatment may include surgery; radiation therapy; topical medicines such as corticosteroids, chemotherapy, bexarotene (Targretin), or imiquimod (Zyclara); or injected corticosteroids.
For lymphomas that have spread over larger parts of the skin, treatment options include rituximab (Rituxan), topical medicines (such as corticosteroids, chemotherapy, bexarotene, or imiquimod), radiation therapy, or injected corticosteroids. Systemic chemotherapy (sometimes with rituximab), like that used for other slow-growing B-cell lymphomas, can also be used if there are many lesions.
If the lymphoma has spread to lymph nodes or internal organs, it is treated like follicular lymphomas found in other parts of the body, typically with a combination of chemotherapy and rituximab (see our document Non-Hodgkin Lymphoma for more details).
Primary cutaneous follicle-center lymphoma
These lymphomas are treated the same way as primary cutaneous marginal-zone B-cell lymphomas (see above).
Primary cutaneous diffuse large B-cell lymphoma, leg type
These lymphomas may look like they involve only a small area of the skin at first, but the disease is often more widespread than it first appears. The treatment of choice is rituximab along with systemic chemotherapy. Often the regimen called R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is given, but other chemo combinations can also be used. If the lymphoma is in only one or a few areas, radiation therapy directed at the tumors is often used as well. For people who can’t tolerate chemotherapy, radiation therapy alone may be given.
If the lymphoma has spread to the lymph nodes or other organs, treatment is the same as that used for diffuse large B-cell lymphomas found in other parts of the body, which is usually R-CHOP, with or without radiation therapy (see our document, Non-Hodgkin Lymphoma, for more details).
Primary cutaneous diffuse large B-cell lymphoma, other (non-leg)
Patients with this type of lymphoma (which involves sites other than the leg) require systemic chemotherapy, similar to that used for primary cutaneous diffuse large B-cell lymphoma, leg type. This is most often the R-CHOP regimen (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone).
Last Medical Review: 03/14/2013
Last Revised: 02/11/2014