Skin lymphoma is a malignant disease of tumor etiology, which has been rapidly developing in recent years.
According to data from the staff of the National American Cancer Institute, over the past two decades, the number of patients suffering from different forms of T-cell lymphoma of the skin has doubled. Thus, the annual increase in the incidence in the United States was about one hundred thousand cases.
Men suffer from this ailment twice as often as women, and middle-aged and older people get sick more often than younger generation. The cases of development of skin lymphoma in children are single.
The concept of skin lymphoma
Skin lymphoma is a whole group of malignant tumors formed as a result of uncontrolled division( proliferation) in it of a special group of white blood cells - lymphocytes.
Differences in the clinical course and morphology of lymphomas are due to the fact that in 65% of cases the cause of their formation is the division of T-lymphocytes .Such lymphomas are called t-cell.
25% of lymphomas are formed due to abnormal reproduction of the lymphocytes. In such cases, they speak of lymphoma in the -cellular. The remaining 10% of malignant neoplasms of the classification are not amenable.
Types of the disease
Depending on the proliferation of which lymphocytes led to the development of the tumor, lymphomas can be:
- T-cell;
- B-cell.
According to the clinical course and the level of malignancy, the lymphomas of the skin are assigned the following degrees:
- low-I;
- average - II;
- high - III.
The photo shows T-cell lymphoma of the skin
Skin lymphomas are also primary( at the initial stage of development, exciting the dermis region) and secondary.
Secondary lymphomas develop from leukocytes that migrated to the skin from tumor-affected lymphoid organs. Such organs in the human body are: thymus gland, bone marrow, lymph nodes.
Causes of development of
The cause of development of all types of lymphomas is the process of uncontrolled division of lymphocytes with subsequent migration to the skin. But what causes the mutation of the lymphocytes themselves - cells designed to protect the human body from the introduction of bacteriological agents and to destroy their own diseased and mutated cells - remains a mystery to this day.
There is a hypothesis linking the formation of malignant mutant cells with a malfunction of the immune system. To the factors that increase the likelihood of developing lymphomas, the specialists refer to:
- Elevated level of radiation.
- Influence of viral infections, culprits are: cytomegalovirus, causative agent of herpes simplex, Epstein-Barr virus, RNA-containing viruses.
- A number of production hazards accompanying the construction process, agricultural and chemical production.
- Exposure to solar radiation( insolation).
- Genetic predisposition.
- Consequences of taking certain medicines.
Symptoms of
Initial symptomatology manifests itself as a complex of the following symptoms:
- with general weakness and fast fatigue of the body;
- is not grounded in an apathetic state;
- increased anxiety and low stress resistance;
- significant increase in body temperature( usually within subfebrile values);
- pronounced night sweats;
- dynamic and significant weight loss;
- is a violation of normal digestion.
As the tumor process develops, the symptomatology is enriched:
- formation of polymorphic eruptions( plaques, blisters and ulcers);
- by the appearance of a sensation of constant itching;
- increased regional lymph nodes;
- by changing blood characteristics;
- is involved in the inflammatory process of internal organs.
Clinical picture
For all types of skin malignant tumors, there are polymorphic rashes in the form of nodules, spots and plaques. Clinical symptoms can divide the lymphomas of the skin into three forms.
- knot form The initial stage of nodular form of lymphomas is characterized by the appearance on the surface of the skin of tiny flat knots, the size of which does not exceed the size of the millet grain. Located in groups, they have a bluish or yellowish color. They are characterized by a spontaneous disappearance, then an unexpected appearance.
- The second and third degree of development of a malignant tumor are accompanied by a significant enlargement of the nodules. Their light color changing, becomes dark cherry. With this variant of development, the disease soon ends with the formation of numerous metastases and death. With the nodular form of lymphoma from the initial stage of the disease to the formation of metastases can take two to four years.
Very seldom there are patients, in which a scattering of small nodules can merge into dense plaques. Of these plaques, over time large enough nodes are formed, which after a certain period are necrotic( die).
Plaque form
- This form of a malignant tumor of the skin begins with the formation of fairly large plaques that do not have clear boundaries. The skin that tightens them can be yellowish.
- After a while, plaque resolution occurs: gradually flattening, they disappear, leaving atrophy and hyperpigmentation centers instead. The skin in the focus of atrophy becomes thinned and whitish, like a cigarette paper. On the hyperpigmented areas, on the contrary, dark spots are formed, which differ markedly from the natural color of the skin.
- The plaque form of the skin tumor, which has passed to the second stage of malignancy, differs in its stage development. First, pink spots begin to appear on the surface of the skin( the erythematous stage), which give way to plaques that have a constantly wet surface. The plaque stage is characterized by peripheral growth of future tumor lesions. The next( tumor) stage of the plaque form of lymphoma is characterized by the appearance of large nodes with necrotic patches along the very center.
Erythrodermal
This form of lymphoma is invariably accompanied by a long-term developing eczema. The affected skin becomes red, inflamed and flaky. Lymph nodes of a sick person become inflamed, hair falls out, dystrophy of nail plates develops.
Diagnostic methods
Diagnosis of a malignant tumor of the skin consists of several stages.
- At the first stage, a specialist, when examining a patient, carefully makes an anamnesis. At a physical examination, he should carefully study all the elements of skin rashes. After carefully examining and palpating the lymph nodes, the doctor can, if necessary, prescribe their ultrasound. During the initial examination, palpation of internal organs( spleen and liver) is mandatory. As an auxiliary method, photodocumenting can be applied.
- The stage of instrumental diagnostics includes the procedure of ultrasound examination of the abdominal cavity organs and the radiography of organs located in the chest( performed in two projections).
- Ancillary methods of computed tomography of the thorax and abdominal cavity may be used.
- The complex of laboratory tests includes the performance of a biochemical and general blood test with complete detailing of the picture, as well as a blood test that reveals the presence of antibodies to hepatitis B and C viruses. Urine analysis is mandatory.
- The patient's immune status is studied.
- A number of histological studies are under way to determine the type of lymphoma. A biopsy of affected tissues and inflamed lymph nodes is performed. In some cases trepanobiopsy or a sternal puncture is performed.
- In a clinic specializing in the treatment of cancer, a patient can undergo a procedure for oncoscreening the body.
Treatment and prognosis of
The tactics of treating skin lymphomas are determined by the degree of their malignancy, the level of manifestation of symptoms and the overall well-being of the patient.
- Polychemotherapy plays the leading role in the treatment of skin lymphoma. Lymphomas are sensitive to the effects of cytotoxic drugs( vincristine, cyclophosphamide, vinblastine), which inhibit or completely stop the process of uncontrolled division of lymphocytes. It is equally beneficial for patients to use hormonal drugs( such as prednisolone) and interferons.
- In the treatment of aggressive forms of tumors, chemotherapy is combined with a transplantation operation of stem hemopoietic cells.
- In the treatment of lymphomas, radiotherapy methods are widely practiced. Localized forms of the tumor of the B-cell type are treated with soft-ray X-ray therapy. More extensive lesions are subjected to more powerful effects. Some patients with mushroom mycosis are prescribed irradiation sessions with fast electrons.
- The technique of extracorporeal photophoresis, consisting of irradiating the patient's blood with ultraviolet rays, also yields good results. Before the session, the patient takes a special drug( photosensitizer), which increases the sensitivity of his body to light.
- A more progressive method of photodynamic therapy is to take a certain number of photosensitizers that accumulate in the tumor, help the rays to destroy the diseased tissues without exposing the adjacent areas of healthy skin to even the slightest risk of damage.
Prevention
Ways that could help to avoid such a serious disease, humanity has not yet invented. Specialists can only advise, if possible, to avoid the risk factors listed in the relevant section of our article.
In order, for example, not to get infected with hepatitis, herpes or HIV viruses, it is necessary to use individual shaving machines and personal hygiene products, disposable syringes and condoms during sex.
Video on the causes and diagnosis of skin lymphoma: