Diagnosis
Diagnosis of cutaneous B-cell lymphoma often begins with a physical exam. During the exam, a healthcare professional checks the skin for nodules, lesions or patches. The healthcare professional also may check for swollen lymph nodes in the neck, underarms and groin and check for an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing. Cutaneous B-cell lymphoma can closely mimic systemic lymphoma. Because of this, thorough testing is needed to confirm that the cancer is limited to the skin.
Skin biopsy
A biopsy is a procedure to remove a sample of tissue for testing in a lab. Your healthcare professional may remove a small piece of the affected skin. The sample is tested in a lab to look for lymphoma cells.
Blood tests
Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including HIV, hepatitis B virus and hepatitis C virus. The presence of a virus may affect treatment options. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with systemic lymphoma.
Bone marrow biopsy and aspiration
Bone marrow biopsy and aspiration are procedures that involve collecting cells from the bone marrow. The cells are sent for testing.
In a bone marrow aspiration, a needle is used to draw a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. The samples most often come from the hip bone. Your bone marrow may be tested to look for lymphoma cells.
Imaging tests
Imaging tests make pictures of the body. They can show if the lymphoma is only in the skin. Tests might include CT and positron emission tomography (PET) scans.
Testing lymphoma cells in the lab
Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to determine the type of lymphoma that you have.
To decide whether the cells are cutaneous B-cell lymphoma cells, the healthcare professionals in the lab look for:
- Proteins on the surface of the cancer cells. Cutaneous B-cell lymphoma cells have certain proteins on their surfaces that help identify them. These proteins are known as markers. These markers can help identify the type of cutaneous B-cell lymphoma.
- Changes in the cancer cell DNA. Cancer happens when cells have changes in their DNA. Lab tests can show which DNA changes are present in the lymphoma cells.
Treatment
Treatment for cutaneous B-cell lymphoma may include observation, radiation therapy and surgery to remove the cancer. Other treatment options may include skin-directed medicines, chemotherapy and immunotherapy. Which treatment is right for you depends on the type of cutaneous B-cell lymphoma you have, whether you have symptoms, the location of your cancer and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.
Observation
If your cutaneous B-cell lymphoma doesn't cause symptoms, you may not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition to see if your cancer progresses.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.
Radiation therapy may be used alone to treat cutaneous B-cell lymphoma. Sometimes it's used after surgery to kill any cancer cells that might be left. Radiation therapy may be used to treat lymphoma that has come back after treatment, called relapsed cutaneous B-cell lymphoma. It also may be used when other treatments haven't worked, called refractory cutaneous B-cell lymphoma. Radiation therapy also may be used to ease symptoms and improve quality of life in people with ongoing symptoms or lesions.
Surgery to remove the cancer
Your healthcare professional may recommend a procedure to remove the cancer and some of the healthy tissue that surrounds it. This might be an option if you have one or only a few areas of cutaneous B-cell lymphoma. Surgery might be the only treatment needed. Sometimes other treatments are needed after surgery.
Skin-directed medicines
Sometimes medicine can be applied to the skin or injected into the cancer. One example is steroid medicines. This treatment is sometimes used for cutaneous B-cell lymphoma that grows very slowly.
Chemotherapy
Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Chemotherapy medicines can be applied to the skin to treat cutaneous B-cell lymphoma. Chemotherapy also can be given through a vein. You may get a combination of chemotherapy medicines. Chemotherapy also may be combined with immunotherapy. This might be used if the cancer is growing quickly or has spread beyond the skin.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy may be used to treat cutaneous B-cell lymphoma that is limited to the skin. It is sometimes combined with chemotherapy. Immunotherapy also may be used on relapsed and refractory cutaneous B-cell lymphoma.
Monitoring after treatment
After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat biopsies and blood and imaging tests to check for relapse.
Preparing for your appointment
Make an appointment with a healthcare professional if you have any symptoms that worry you.
If your healthcare professional thinks you might have cutaneous B-cell lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of anything you need to do ahead of time. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down important personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you're taking and the doses.
- Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
For cutaneous B-cell lymphoma, some basic questions include:
- Do I have cutaneous B-cell lymphoma?
- What is the stage of my cutaneous B-cell lymphoma?
- Will I need more tests?
- What are the treatment options?
- How much does each treatment prolong my life?
- What are the potential side effects of each treatment?
- How will each treatment affect my daily life?
- What treatment options have shown the best results?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Do your symptoms happen all the time or do you have them now and then?
- How bad are your symptoms?
- What, if anything, seems to make symptoms better?
- What, if anything, seems to make symptoms worse?
- Have you noticed any lumps, patches or lesions anywhere on your body?
- What are your biggest worries about your diagnosis or treatment?
Coping and support
With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to:
Learn enough about cutaneous B-cell lymphoma to make decisions about your care
Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about cutaneous B-cell lymphoma, you may become more confident in making treatment decisions.
Keep friends and family close
Keeping your close relationships strong can help you deal with your cutaneous B-cell lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.
Find someone to talk with
Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.
Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute, the American Cancer Society, Blood Cancer United and the Lymphoma Research Foundation. Find support online through Mayo Clinic Connect, which is a community where you can connect with others for support, practical information and answers to everyday questions.