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Cutaneous T-cell lymphoma: Signs and symptoms


What are the signs and symptoms of cutaneous T-cell lymphoma?

With this type of cancer, what you see on the skin (signs) and what you feel (symptoms) tend to vary with:

  • The type of cutaneous T-cell lymphoma (CTCL)

  • How far the cancer has spread (stage)

Itch: A common symptom

Although signs and symptoms tend to vary, itch can be a problem for anyone who has CTCL. It’s is often the first symptom. Studies show that between 66% and 88% of people who have CTCL develop itchy skin.

Itchy skin tends to be more common if you have:

  • A more advanced stage of CTCL

  • Sézary syndrome

The following describes other signs and symptoms that you may experience.

Mycosis fungoides

This is the most common type of CTCL, and it tends to grow very slowly. The first sign is often a rash or scaly patch of skin, which can look the same for years or decades.

Earliest stage of mycosis fungoides

In its earliest form, mycosis fungoides often looks like a red rash (or scaly patch of skin). It begins on skin that gets little sun, such as the upper thigh, buttocks, back, belly, groin, chest, or breasts.

Patch stage of mycosis fungoides

In this stage, you may see one or a few flat, scaly patches. This sign can also last for years, causing it to be mistaken for eczema, psoriasis, or another common skin disease.

Patch stage of mycosis fungoides (light spots)

Instead of developing scaly patches, some people develop light spots on their skin. This is more common in children, teenagers, and people who have skin of color.

Plaque stage of mycosis fungoides

As the cancer spreads, raised and often itchy patches of thicker skin appear. The medical name for these raised patches is plaques.

Patches, plaques, and tumors on the skin

As the cancer worsens, a patient may have patches, plaques, and tumors, as shown here. Some patients only have tumors. If the tumors split open, they can look like sores.

Sézary syndrome

This type of CTCL is more aggressive than mycosis fungoides. When someone has Sézary syndrome, cancer cells are found in the skin and blood.

Not everyone who has Sézary syndrome develops widespread redness. In one study, about 75% of the patients who had Sézary syndrome developed patches on their skin that looked like eczema. These patients had thick, scaly patches of itchy skin, but their skin wasn’t red and swollen as shown in this picture.

Sézary syndrome

A red, itchy rash can cover most of the skin, which may be peeling.

When someone has Sézary syndrome, you may notice one or more of the following on the skin:

  • Widespread redness, often with severely itchy skin

  • Peeling skin

  • Swollen skin

  • Thickening skin on the palms, soles, or both

People who have Sézary syndrome can develop one or more of these signs:

  • Swollen lymph nodes (often in the neck, armpits, and groin)

  • Hair loss

  • Thickened fingernails, toenails, or both

  • Droopy eyelids

  • Hypothermia (inability to control body temperature)

When to see a board-certified dermatologist

Many of the signs and symptoms described here occur in people who have other conditions, such as eczema. If you have been diagnosed with eczema and treatment doesn’t help, make an appointment to see a board-certified dermatologist.


Images
Images 1, 3, 4: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Images 2, 5, 6: Used with permission of Journal of the American Academy of Dermatology:

  • 2 J Am Acad Dermatol 2017;77:489-96

  • 5 J Am Acad Dermatol 2014;70:205.e1-16

  • 6 J Am Acad Dermatol 2017; 77:719-27

References
Habif TP, Campbell JL, et al. “Cutaneous T-cell lymphoma.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Card 131.

Jawed SI, Myskowski PL, et al. “Primary cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome): Part I. Diagnosis: Clinical and histopathologic features and new molecular and biologic markers.” J Am Acad Dermatol 2014;70:205.e1-16.

Mangold AR, Thompson AK, et al. “Early clinical manifestations of Sézary syndrome: A multicenter retrospective cohort study.” J Am Acad Dermatol 2017;77:719-27.

Sahni D. “What’s new in cutaneous T-cell lymphoma.” In: Novel therapies for cutaneous malignancies: What's new and what's ahead.” 2018 Annual Meeting of the American Academy of Dermatology; 2018 February 16-20. San Diego, CA.

Yosipovitch G and Kwatra SG. “Cutaneous T-cell lymphoma.” In: Living with itch: A patient’s guide.” The Johns Hopkins University Press. United States, 2013: 52-5.

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