Diagnosis & staging
Diagnosis
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 section.
Types and stages
Types
- 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.
StagesStaging 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:
-
T0
No skin involvement -
T1
Patches or plaques, covering <10% of the body surface -
T2
Same as above but covering >10% of the body surface -
T3
Tumors with or without patches or plaques -
T4
Generalized erythema -
NP0
No abnormal peripheral lymph nodes -
NP1-
Abnormal peripheral lymph nodes, biopsy negative
(i.e., dermatopathic lymphadenopathy) -
NP1+
Abnormal peripheral lymph nodes, biopsy positive -
NV0
No abnormal visceral lymph nodes -
NV1
Abnormal visceral lymph nodes (no information regarding biopsy) -
NV1-
Abnormal visceral lymph nodes, biopsy negative -
NV1+
Abnormal visceral lymph nodes, biopsy positive -
M0
No visceral organ involvement -
M1
Visceral organ involvement (on basis of histology) -
B0
<5% circulating Sézary cells and <250 Sézary cells per cc -
B1
>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