Diagnosis & staging
These are tests that may be used to diagnose this type of cancer.
- A careful physical exam is done to look for signs of skin lymphoma, such as lumps, skin lesions, and any other symptoms.
- A biopsy is the only way to diagnose skin lymphomas such as mycosis fungoides.
- For a skin biopsy, affected skin cells are removed by minor surgery in the doctor's office and the sample will be examined under a microscope.
- Other tests to check the extent of the disease may include a blood test, or a CT scan of the abdomen and pelvis.
- If a lymph node biopsy is needed, some cells may be removed with a needle or in surgery, and will be examined under a microscope.
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests
Types and stages
- Skin lymphomas are often given a name based on the appearance of the lymphoma cells under a microscope.
- Mycosis fungoides is the most common cutaneous T-cell lymphoma (CTCL), which starts in cells called T-lymphocytes (white blood cells).
- Sézary syndrome is like mycosis fungoides, but the lymphoma cells are also found in the blood or the lymph nodes.
- Different kinds of T-cells can become cancerous. Other kinds of T-cell lymphoma which can affect the skin are:
- primary cutaneous anaplastic large cell
- lymphomatoid papulosis
- subcutaneous panniculitis-like T-cell lymphoma
- primary cutaneous peripheral T-cell lymphoma, a rare group including epidermotropic CD8+ cytotoxic, gamma/delta, or CD4+ small/medium sized pleomorphic.
- Cutaneous B-cell lymphoma starts with cells called B-lymphocytes, a white blood cell which makes antibodies. Some B-cell lymphomas are:
- primary cutaneous marginal-zone B-cell lymphoma
- primary cutaneous follicle-centre lymphoma
- primary cutaneous diffuse large B-cell lymphoma, leg type or non-leg.
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
T describes the site and size of the main tumour (primary)
N describes involvement of lymph nodes; NP describes peripheral nodes; NV is visceral nodes
M relates to whether the cancer has spread (presence or absence of distant metastases)
B (for skin lymphoma) describes whether lymphoma cells are circulating in the blood
Patients with biopsy-confirmed CTCL (cutaneous t-cell lymphoma) are staged according to the extent of their skin disease and treatment is determined by their stage. The staging system used is as follows:
No skin involvement
Patches or plaques, covering <10% of the body surface
Same as above but covering >10% of the body surface
Tumors with or without patches or plaques
No abnormal peripheral lymph nodes
Abnormal peripheral lymph nodes, biopsy negative
(i.e., dermatopathic lymphadenopathy)
Abnormal peripheral lymph nodes, biopsy positive
No abnormal visceral lymph nodes
Abnormal visceral lymph nodes (no information regarding biopsy)
Abnormal visceral lymph nodes, biopsy negative
Abnormal visceral lymph nodes, biopsy positive
No visceral organ involvement
Visceral organ involvement (on basis of histology)
<5% circulating Sézary cells and <250 Sézary cells per cc
>5% circulating Sézary cells, or >250 Sézary cells per cc
To determine the extent of the disease the following procedures may be requested:
- Immunological laboratory tests on blood
- Chest X-ray
- CT scan of the abdomen
- Examination of the blood for lymphoma cells and other blood tests