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DIAGNOSIS

A major challenge is that cutaneous lymphoma can present with a different clinical picture on the skin and be underdiagnosed or misdiagnosed e.g. as eczema or psoriasis. This shows the necessity of having a Special Center for Cutaneous Lymphoma, as the Expertise Center for Cutaneous Lymphoma Expertise which already operates in the 2nd Dermatological Clinic of the University Hospital “Attikon”.

The usual clinical picture includes patches, plaques, papules, nodules and / or tumors in more advanced stages.

Some patients experience the same symptoms for years, with or without itching, and may coexist with swollen lymph nodes, cervical, axillary, or inguinal. The diagnosis of cutaneous lymphoma sometimes takes some time to be confirmed. Confirmation is done by skin biopsy. In the biopsy, the doctor performs local anesthesia on the affected area and removes a small piece of skin. The results of the biopsy come out in 2-3 weeks.

The diagnosis of cutaneous lymphoma is not always simple and other skin biopsies may be needed, and several years before the final diagnosis. The pathophysiology of the disease and the different clinical picture of the different subtypes of cutaneous lymphoma can make your GP or physician take a long time to rule out other conditions and then refer you to a specialist. The specialist should be specialized in skin diseases (dermatologist) or diseases of the blood and lymphatic system (hematologist). At the Cutaneous Lymphoma Expertise Center that operates at the 2nd University Dermatology Clinic of the Attikon General Hospital, there are all the specialties that may be needed in collaboration, Dermatologists, Hematologists, Radiotherapists, either at the stage of diagnosis or at the stage of treatment, for a targeted and comprehensive treatment.

EXAMINATION

To stage the cutaneous lymphoma, the patient first undergoes a complete clinical examination and hematological examinations.

During the clinical examination the doctor will look for swollen lymph nodes in the neck, armpits and groin.

Blood tests include a general blood test and measurement of the levels of certain indicators in the blood, such as lactic dehydrogenase (LDH). Additional testing depends on the type of lymphoma being diagnosed and the patient’s general health.

Imaging tests may be needed for the initial staging of the lymphoma or if other tests show lymphocytes in the blood or lymph nodes. The most common imaging test for cutaneous lymphoma is a chest and abdomen CT scan. Some patients may need to have an imaging test called a positron emission tomography (PET-SCAN).

Some people with suspected cutaneous lymphoma undergo osteomyelitis biopsy. During osteomyelitis biopsy, a small sample of bone marrow is taken from the hip with a needle.

If the lymph nodes are swollen, lymph node biopsy may be needed, with total surgical removal of the lymph node (under local or general anesthesia) or with a fine needle (FNA).

All of these tests are done to identify the parts of the body that are affected by the lymphoma and to confirm that the lymphoma is only found on the skin. Hematologically associated cutaneous lymphomas behave differently from cutaneous lymphomas and require other treatment. Having all the results, the medical team decides on the appropriate treatment.

STAGING

The stage of the lymphoma indicates how advanced the disease is. The stage guides the medical team to decide on the appropriate treatment. There are two ways to stage cutaneous lymphoma.

The first has four stages:

Stage 1: Lymphoma only affects the skin (patches or plaques)

In stage 1A less than 10% of the skin is affected.

In stage 1B, more than 10% of the skin is affected.

Stage 2:

In stage 2A there are patches or plaques on the skin and the lymph nodes are swollen but do not contain atypical lymphocytes.

In stage 2B there are one or more bumps or tumors in the skin and the lymph nodes may be swollen but do not contain lymphocytes.

Stage 3: Affects> 80% of the skin, with generalized redness, swelling, itching and in some cases pain. The lymph nodes may be swollen, but they do not contain atypical lymphocytes.

Additionally: In stage 3A there are few or no lymphocytes in the blood (erythrodermic MF). In stage 3B there is a moderate number of lymphocytes in the blood (Sézary’s syndrome).

Stage 4: In addition to dermatological problems:

In stage 4A there are several atypical lymphocytes in the blood (Sézary’s syndrome) or the lymph nodes contain atypical lymphocytes.

In stage 4B the lymphoma has progressed to other organs.

The stages can also be numbered with Latin numerals: I, II, III or IV.

Most patients are in the early stages of cutaneous lymphoma when they are diagnosed (up to 2A). Few have more advanced disease (stages 2B, 3 and 4). Blood is rarely affected at diagnosis (stages 3B or 4A).

TNMB Staging is a way of recording the stages of cancer in general and describes: how many are the affected areas of the skin, how large they are and where they are located (indicated by the letter “T” [tumor] and a number from 1 to 3), how many lymph nodes have been affected (if any) and who they are (indicated by the letter “N” [lymph node] and a number from 0 to 3), if other parts of the body have been affected (ie except the skin or lymph nodes, referred to by the letter “M” [metastasis] and the number 0 or 1), the degree to which the blood has been affected at diagnosis by Sézary cell circulation (referred to by the letter “B” [blood] and a number from 0 to 2). The TNMB system can detect a change in stage over time, which helps to monitor the patient’s condition and select the appropriate treatment.