An oncologic dermatologist explains how cancerous immune cells lead to this rare type of skin cancer.

Published: June 27, 2019 | Updated: January 17, 2020

Why does a blood cancer start in the skin?

Lymphomas are cancers of the immune system, which generally arise in lymph nodes and other lymphatic tissue.  The immune system consists of white blood cells, the spleen, lymph nodes and other areas throughout the body.

“In many ways, our skin can be considered our largest immune organ,” said Jae Jung, M.D., oncologic dermatologist with Norton Cancer Institute. “It is designed to defend constantly against viruses, bacteria, and other microbes. When the special immune cells that reside in the skin become cancerous, it can lead to cutaneous lymphoma, a rare type of skin cancer.”

Signs and symptoms of skin lymphoma

Often there are signs and symptoms of skin lymphoma that can be seen or felt. A skin exam by a medical provider helps determine the severity of the cancer. Some of the signs that may be seen or felt on the skin include:

• Patches: may be flat or elevated
• Plaque: can be elevated lesions or a deep thickening of the skin
• Tumor: a solid or rounded lesion greater than 1 centimeter in diameter that has spread deep into the skin
• Erythroderma: widespread, intense reddening of the skin
• Hypopigmentation: patches on the skin that are lighter than your skin tone
• Granulomatous slack skin: loose skin, especially in the body folds
• Pagetoid reticulosis: usually appears as a scaly plaque on the extremities such as the hands or feet
• Leonine facies: extreme thickening of the skin on the face

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Treatment options for skin lymphoma

There are a variety of treatment options for skin lymphoma that may be used alone or in combination with other treatments. These include:

• Medications that are applied directly to the skin
• Radiation treatment
• Chemotherapy
• Immunotherapy, which uses a person’s immune system to fight cancer
• Clinical trials for new treatments

While the signs and symptoms of skin lymphoma may be noticed quickly, they can resemble other conditions; so, diagnosis is done through a skin biopsy, a procedure where a sample of your skin tissue is removed and viewed under a microscope, or other lab tests.

Always discuss unusual skin issues with your doctor.

“The best treatment of cutaneous lymphomas is complex, involving both skin-directed therapies (applied directly to the skin) and systemic therapies (treatment that travels throughout the body),” Dr. Jung said. “Ideally, patients should be treated in a multidisciplinary clinic that includes medical oncology, radiation oncology, dermatology, rehabilitation and social services. Fortunately, most cutaneous lymphomas progress slowly and can be treated conservatively with lasting remissions. Although prognosis for patients with aggressive and widespread disease historically has been very poor, new targeted and immune-directed therapies are extremely promising.”