Skin-Directed Treatments for Skin Lymphomas

For many skin lymphomas (especially early-stage lymphomas), the first treatment is directed at the skin lesions themselves, while trying to avoid harmful side effects on the rest of the body. There are many ways to treat skin lesions.

Surgery

Surgery is not usually the only treatment for skin lymphoma, but it can be helpful in some situations. Surgery may be used to biopsy a skin lesion, lymph node, or other tissue to diagnose and classify a lymphoma. It might also be used to treat some types of skin lymphomas when there is only one or a few skin lesions that can be removed completely. Even then, other types of treatment may be used as well.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. The treatment is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Treatment might be given in just one dose or on several days, depending on how much of the skin is being treated.

The type of radiation used most often for skin lymphomas is called electron beam radiation. The beam of electrons only penetrate as far as the skin, so there are few side effects to other organs and tissues. The main side effect of electron beam therapy is a skin reaction similar to sun burn. For mycosis fungoides and Sezary syndrome covering a large part of the skin, electron beam therapy is sometimes given to the entire body. This is called total skin electron beam therapy (TSEBT). Along with skin changes, this can sometimes cause loss of all hair on the body, and even the loss of fingernails and toenails.

Some thicker lymphomas that are not widespread (especially single lesions) are treated with high energy radiation (like x-rays or gamma rays) instead of electrons. This kind of radiation can penetrate deeper into the body. Because it can damage internal organs, the treatment is planned carefully so that most of the radiation goes only to the skin.

To learn more about radiation therapy, see Radiation Therapy.

Phototherapy (UV light therapy)

Ultraviolet (UV) light is the part of sunlight that causes sunburn and skin cancer. Phototherapy uses UV light to kill cancer cells in the skin. This is a useful treatment for some people with skin lymphomas that aren’t very thick.

Two kinds of UV light – ultraviolet A (UVA) and ultraviolet B (UVB) – can be used to treat skin lymphoma. Both UVA and UVB treatments are given with special fluorescent lamps like those used in tanning salons. But the light used for treatment is carefully controlled so your doctor knows exactly which wavelength and dose of light you are getting to minimize the risk of burns. Treatments are given several times a week.

When UVA is used, it is combined with drugs called psoralens. This combination is referred to as PUVA. Psoralens are given as a pill about 2 hours before the treatment. The drug travels through the blood to reach cells throughout the body (including cells of skin lymphoma). When these cells are then exposed to UVA light, the drug is activated, killing them. Psoralens can cause some nausea. They can also make the skin and eyes very sensitive to sunlight (increasing the risk of severe skin burns and cataracts), so it is important to protect yourself from sunlight as much as possible in the days after treatment.

UVB is given without any extra medicines, and is generally used for thinner skin lesions.

Just like the UV light in sunlight, these treatments can cause sunburn and may raise the risk of skin cancer later in life, so doctors try to avoid giving too much UV light.

Topical medicines

Treatment that applies drugs directly to the skin is called topical therapy. It can be very helpful in treating many early skin lymphomas. When a drug is placed on the skin, its effects are concentrated on that spot, with much smaller amounts reaching the rest of the body. This can help limit side effects, especially for strong medicines such as some chemotherapy drugs.

Topical corticosteroids: These are drugs related to cortisol, a hormone made naturally in the body that can affect immune cells such as lymphocytes. Corticosteroid pills and injections into the blood have long been an important part of treating lymphomas.

Topical forms of these drugs can also be applied directly to the skin as ointments, gels, foams, and creams (usually once or twice a day), or injected directly into skin lesions (on a less frequent basis). This can be very helpful in treating skin lesions. When applied on or injected into the skin, less of the drug is absorbed into the body, resulting in fewer side effects. Long-term use of topical corticosteroids may cause the skin in that area to become thinner.

Topical chemotherapy drugs: Chemotherapy (chemo) drugs are strong medicines often given by mouth or injected into a vein to treat more advanced cancers, including advanced skin lymphomas. See Whole-body (Systemic) Treatments for Skin Lymphomas.

Some chemo drugs can be used to treat earlier forms of skin lymphoma by putting them directly on the skin (usually in a cream, ointment, or gel). The drugs most often used to treat skin lymphoma include mechlorethamine (nitrogen mustard) and carmustine (BCNU). Possible side effects include redness, swelling, or irritation where the drug is applied, as well as an increased risk of other types of skin cancer in the area.

Topical retinoids: Retinoids are drugs related to vitamin A. They can affect certain genes in lymphoma cells that cause them to grow or mature.

Some retinoids, such as bexarotene (Targretin), come in a gel that can be applied directly to skin lesions. Possible side effects include redness, itching, irritation, and sensitivity to sunlight in the area where the drug is applied. These drugs can cause birth defects, so they should not be used by women who are or could become pregnant.

Topical immune therapy: Imiquimod (Zyclara) is a cream that causes an immune system reaction when applied to skin lesions, which may help destroy them. This drug is used mainly to treat some other types of skin cancers, but some doctors may also use it to treat early forms of skin lymphoma. It can cause redness, itching, and irritation at the site where it is applied.