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Learning The Basics
It can be very difficult to make a diagnosis of cutaneous lymphoma, and
this is largely because the signs and symptoms very often look like other
conditions such as eczema, allergies, or drug reactions.
Diagnosis of the many subtypes of cutaneous lymphomas can vary and
sometimes it takes a long time before it is confirmed. Regardless, the
process for diagnosis is similar for all types and may include a physical exam
and history; blood tests to identify antigens, or markers, on the surface of
cells in the blood; and a skin biopsy (removal of a small piece of tissue) for
examination under the microscope by a pathologist (a doctor who studies
tissue and cells to identify disease). In the presence of more advanced
disease, more testing may be done to determine if the cancer has spread.
A bone marrow biopsy may occasionally be necessary to verify complete
staging of the disease. This is more likely to be needed with cutaneous
B-cell lymphomas than cutaneous T-cell lymphomas.
Both cutaneous T-cell lymphoma (CTCL) and cutaneous B-cell
lymphoma (CBCL) require equal consideration and physician attention in
order to reach a proper diagnosis. A definitive diagnosis will help inform
treatment decisions and potentially yield better outcomes over time. One
of the key concepts for patients and caregivers to understand is that a clear
diagnosis may take time. While a prompt diagnosis should always be the
goal, and a late diagnosis always means deferred relief or resolution of
symptoms, it is also important to consider that, in many cases of cutaneous
lymphoma, how early a diagnosis is made does not have a major impact on
response to treatment and survival. The exceptions are Sézary syndrome
and primary cutaneous diffuse large cell lymphoma, leg type (PCLBCL-
LT) where a prompt diagnosis is very important. The best approach is to
collaborate and work with the healthcare team to confirm the disease type.
In milder cases of cutaneous lymphoma, ruling out non-cancerous reactive
rashes and lesions resulting from medication, external environmental
or drug exposure, or inflammatory conditions of the skin is crucial.
From there, physicians and patients can determine the appropriate
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Chapter 4
Getting a Diagnosis
