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Dermatology Aspects of Cutaneous T-cell Lymphoma

Dermatology Aspects of Cutaneous T-cell Lymphoma. Dr. Raed Alhusayen MD, FRCPC Division of Dermatology Sunnybrook Health Sciences Centre Cutaneous Lymphoma Patient Education Forum April 14, 2012. Objectives .

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Dermatology Aspects of Cutaneous T-cell Lymphoma

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  1. Dermatology Aspects of Cutaneous T-cell Lymphoma Dr. Raed Alhusayen MD, FRCPC Division of Dermatology Sunnybrook Health Sciences Centre Cutaneous Lymphoma Patient Education Forum April 14, 2012

  2. Objectives • Brief description of cutaneous T-cell lymphoma (CTCL): focus on Mycosis Fungoides • The role of the dermatologist in CTCL • Treatment options for early stage disease

  3. CTCL Abnormal growth of T-lymphocytes (a type of blood cells) in the skin

  4. CTCL

  5. CTCL

  6. Skin lesions • patches of erythema and scaling • Slightly raised plaques (Majority of patients)

  7. Skin lesions • Tumors

  8. Skin lesions • Erythroderma

  9. Other skin presentations

  10. The role of the dermatologist • Making the diagnosis: • History and physical examination • Skin biopsy(ies) • Workup (staging): • Blood work • Radiological studies (if required):CXR, US, CT • Treatment

  11. Why does it take so long to diagnose MF? • On average it takes 3 years from the development of skin lesions • It is a rare disease • It mimics other common skin diseases • It could be asymptomatic limited disease • Even if suspected, the skin biopsies might not be diagnostic • Multiple biopsies over a period of time might be needed

  12. Staging of Mycosis Fungoides

  13. Staging of Mycosis Fungoides

  14. Treatment options “Rarely progresses, frequently relapses” • Active observation • Topical agents: • Topical steroids: symptomatic lesions • Imiquimod (Aldara): localized lesions • Topical Retinoids (Tazarotene): localized lesions • Intralesional steroids

  15. Aldara reaction

  16. Phototherapy • Performed at PERC • More than 500 CTCL patients (350 active) • NBUVB (3x/wk): very effective on patches and thin plaques, less toxicity • PUVA (2x/wk): thicker plaques, longer remission

  17. Systemic Isotretinoin • Vitamin A derivative • Especially helpful when combined with phototherapy • Very well tolerated at low doses • Does not suppress the immune system • TERATOGENIC • Need to monitor lipid profile and liver enzymes

  18. Steps to manage the itch • Bathing with lukewarm water followed by gently patting the skin dry • Using moisturizers on regularly • Topical steroids • Oral antihistamines: Benadryl, Atarax, Doxepin • Low dose oral prednisone

  19. St Johns Institute of Dermatology

  20. Cutaneous lymphoma team • Multidisciplinary Team: Dermatologist / Clinical Oncologist / Hematologist / NURSES • 50-60 patients (6-8 new) • Overall similar treatment approach (bexarotene notable exception) Interesting ideas: • Cutaneous lymphoma tumor board: reviewing all new cases and selected follow ups • Case manager: primary contact person for the patient • Low dose prednisone for symptom relief

  21. Resources • Cutaneous Lymphoma Foundation: http://www.clfoundation.org/

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