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Hopkins Health
Cutaneous T-Cell Lymphoma: The Great Imitator
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| The lesions on patient Arnold Coley’s back have all but disappeared, notes dermatologist Eric Vonderheid. |
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For 20 years, physicians thought the red, dry and scaly patches covering Arnold Coley’s body were the work of a chronic skin condition like eczema or psoriasis. But the topical ointments they prescribed had no effect on the inflammatory patches or the relentless itching. Worse, his doctors didn’t know that the disease he actually had, a slow-growing skin cancer called cutaneous T-cell lymphoma, or CTCL, was at a stage where it could take a life-threatening turn and spread to internal organs. Finally, when the patches covered more than 80 percent of Coley’s body, one of his physicians suspected what it was and referred him to dermatologist Eric Vonderheid, M.D.
“We call CTCL the great imitator because it can mimic several other disorders,” says Vonderheid. He adds, “This is one of those areas where an early referral to someone who knows this disease is extremely helpful.”
Vonderheid is one of those physicians. He’s been studying this lymphoma for more than 25 years. This is a different type of skin cancer, one that’s not caused by ultraviolet rays from the sun. Ultraviolet exposure, in fact, may inhibit CTCL, which explains why it tends to first appear on the buttocks, hips and breasts as flat lesions called patches. It then moves to a plaque phase with thicker lesions and ultimately, nodules and tumors. Untreated, the disease can involve the lymph nodes. “The time course for this disease is typically measured over decades,” Vonderheid says. “But it has a very nasty tendency of changing into a higher-grade lymphoma.”
The tip-off to diagnosing the condition, Vonderheid says, are lesions of varying size, shape and color on non-sun-exposed skin. A biopsy must be ordered, though results may be inconclusive because malignant cells in CTCL tend to hide among normal cells. Also, explains dermatopathologist J. Margaret Moresi, M.D., under the microscope CTCL resembles many other cutaneous inflammatory diseases. But because of their significant experience with such cases, along with their use of special markers, Hopkins dermatopathologists like Moresi have been able to accurately diagnose even the most ambiguous cases. “Most labs don’t have the volume of cases nor the variety of markers we have here,” Moresi says.
Fortunately, Coley’s disease was diagnosed just in time. And by treating it with a chemotherapy called nitrogen mustard, Vonderheid was able to control its spread. Today, only a small percent of Coley’s skin is affected, mostly on his back. Today his life expectancy is close to normal.
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