A Patient’s Guide to Understanding
Cutaneous Lymphoma
48
presentation of psoriasis, eczema or atopic dermatitis), physicians must
consider the possibility of mycosis fungoides. The challenges of diagnosing
and treating such complex and often ambiguous diseases are magnified by
parents’ concerns, expectations, and a child’s own level of understanding.
It has only been in the last several years that investigators have truly begun
to understand the characteristics of pediatric presentations of cutaneous
lymphoma as more data has become available.
Treatment decisions for pediatric patients are difficult to make because
younger patients are more sensitive to the adverse effects of certain
therapies. Of particular concern, given their young age, pediatric patients
have more time to develop and experience the long-term adverse effects
of anti-cancer therapies. When treated with oral/topical psoralen plus
ultraviolet A (PUVA) or narrowband UVB phototherapy, local radiation
therapy, or total skin electron beam therapy, younger patients are inherently
subject to greater risk for developing skin cancers because they have a
longer expected lifetime ahead of them.
Similarly, pediatric patients in need of systemic chemotherapy may develop
leukemia later on in life, and patients taking retinoids such as isotretinoin
(Accutane®) are at risk of premature stunting of bone growth. Topical
corticosteroids and nitrogen mustard may be among the safer treatments
for early-stage disease with less cancer risk. In the end, proper treatment for
pediatric cutaneous lymphoma is individualized to the unique occurrence
and needs of each patient.
Although rare, some younger adults are diagnosed with cutaneous
lymphoma. For patients newly-married or in the dating scene, this can be a
devastating diagnosis. The hardest part, say some patients, is the physical
presentation of the disease – especially if you’re in an active workplace or
dating. A facial rash or other obvious outbreak can make you self-conscious.
“You feel like you’re a broken individual,” one patient said, “like you’re not
whole anymore.”
