Importance of diagnostics and risk of secondary malignancies in primary cutaneous lymphomas.

Abstract

Primary cutaneous lymphomas (PCL) often strongly differ in clinical behavior and prognosis from systemic lymphomas of the same histopathologic type. The aim of the study was to investigate the distribution of PCL subtypes, the average time from disease manifestation to diagnosis, the importance of diagnostic procedures, the occurrence of secondary malignancies and the different treatment modalities. Retrospective analysis of 152 patients with PCL examined at the Department of Dermatology of the University Hospital Tübingen from 2010-2012. 105 patients with CTCL (69.1%) and 47 patients with CBCL (30.9%) were included. The average time from disease manifestation to diagnosis was four years. The most common diagnosed lymphoma was mycosis fungoides (MF) (47.4%). First-line therapies here include phototherapy only (psoralen-UV-A [PUVA], n=48; UVB 311nm, n=7) or combination therapies primarily phototherapy with systemic retinoids (n=18). Most frequent second-line therapy was interferon (INF)-α plus PUVA (n=15). The outcome was favorable (45.2% remission, 28.6% stable disease, 22.6% progressive disease). Malignant comorbidities were observed more frequently compared to a healthy control group. The diagnosis of lymphoma often takes several years. The value of staging procedures is still low and the treatment modalities for MF in earlier stages are mainly based on phototherapy.