Treating Cutaneous Lymphoma
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light) plus psoralen, a compound that makes UVA light
biologically active in skin cells. PUVA treatment penetrates
deeper into the skin and is helpful in managing patients with
thicker plaques or who have cutaneous lymphoma involvement
at the hair follicle level. Similar to UVB therapy, PUVA is
administered in a dermatology practice or hospital setting.
Patients take the prescribed psoralen medication 1 hour prior
to exposure to UVA light. Protective eyewear is worn for 12-24
hours after treatment ends. Once a patient has achieved clinical
improvement with PUVA, a gradual taper in the frequency of
treatments takes place with a goal of treatment delivery every 4-8
weeks.
Topical Chemotherapy
Mechlorethamine (Mustargen®), also known as nitrogen mustard, and
carmustine (BiCNU®) are cytotoxic (cell-killing) chemotherapeutic agents
that are used topically in early-stage cutaneous lymphoma. These drugs
have demonstrated very good results when used in patients with limited or
extensive skin involvement and recalcitrant disease after other skin-directed
therapies have been attempted. A specialty pharmacist, also known as a
compounding pharmacist, mixes the nitrogen mustard or carmustine.
The chemotherapeutic agent can be mixed in an aqueous, ointment, or gel
vehicle. Topical nitrogen mustard is not absorbed systemically, so it does
not cause nausea or hair loss.
Bexarotene (Targretin
®
) Gel
Bexarotene or Targretin® gel is a Vitamin A derived agent that belongs to
a larger class of medicines called retinoids. Retinoid X receptors (RXRs)
steer abnormal T-cells toward cell death. Targretin® gel is applied as a
topical agent in the management of stubborn earlier-stage lesions. During
the first few weeks of treatment with this agent, a topical corticosteroid is
often used together with Targretin® gel to decrease local site irritation.
Radiation Therapy
Radiation therapy shares a long history in the repertoire of treatments for
cutaneous lymphoma, dating back to the early 20th century. In the 1940s,
accelerated electrons replaced traditional photon-based radiation. Spot
electron beam therapy may be delivered as a localized (“spot”) short course
for a limited skin surface area. Typically spot electron beam therapy is
delivered anywhere from 2 to 15 treatments.
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