Skin Cancer in Skin of Color

Porcia T. Bradford

Disclosures

Dermatology Nursing. 2009;21(4):170-77; 206. 

In This Article

Cutaneous T-cell Lymphoma

Cutaneous T-cell lymphoma (CTCL) is the largest group of cutaneous lymphomas, representing approximately 65% of all cutaneous lymphomas (see Table 4). There has been an increase in incidence and proportion of CTCL among all lymphomas, and Blacks are twice as likely to be affected as Caucasians (Criscione & Weinstock, 2007). The etiology of CTCL remains unknown and risk factors are poorly documented. The human T-cell lymphotrophic virus type I (HTLV-1), a virus that is endemic in the Caribbean, Japan, sub-Saharan Africa, and South America, has been associated with forms of CTCL (Verdonck et al., 2007). Numerous environmental agents, such as exposure to aromatic halogenated hydrocarbons, have also been associated with a small proportion of CTCL (Morales-Suarez-Varela et al., 2005), but the cause remains largely unknown.

Early CTCL typically presents with patches that are mildly erythematous, slightly scaling, annular, or arcuate and classically involve sunshielded areas, also known as a "bathing suit distribution" (Smith & Wilson, 2008) (see Table 4). A hypopigmented form of this disease is seen more frequently in darkerskinned people as opposed to Caucasians and is characterized by early onset and good response to therapy (Akaraphanth, Douglass, & Lim, 2000). Clinically, the lesions present as macules or patches with ill-defined borders and varying degrees of hypopigmentation, although not quite the complete depigmentation seen in vitiligo, with no or minimal scaling (Braverman, 1991). Up to 75% of patients with this variant may have a history of prolonged eczematous or psoriasiform dermatitis. These lesions may be confused with those of vitiligo, pityriasis alba, tinea versicolor, sarcoidosis, and postinflammatory hypopigmentation (Halder & Bridgeman-Shah, 1995).

In general, CTCL affects elderly patients and is a chronic disease. Hence, many patients die of other conditions rather than of CTCL. However, if lymph node involvement occurs, the prognosis is guarded and CTCL can be fatal. Palpable adenopathy is associated with a median survival of only 8 years, whereas patients without adenopathy have a survival of 22 years. If a patient has lymphadenopathy, tumors, or cutaneous ulceration, patients survive a median of 1 year (James, Berger, & Elston, 2006).

Treatment involves primarily topical steroids, topical nitrogen mustards or carmustine, photodynamic therapy with PUVA or narrow-band UVB (James et al., 2006). In one report on CTCL, it was stated that in the early stages of the disease (before the development or erythroderma and nodal involvement), patients are very responsive to treatment and the disease is potentially curable, whereas individuals in whom the disease is more advanced usually do not respond well to the usual therapeutic modalities (Braverman, 1991).

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