Skin Cancer

SKIN CANCER

Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control and crowd out normal cells. This makes it hard for the skin to work the way it should.

Cancer cells can spread to other parts of the body. Cancer cells in the skin can sometimes travel to the bone and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the skin.

Cancer is always named for the place where it starts. So when skin cancer spreads to the bone (or any other place), it’s still called skin cancer. It’s not called bone cancer unless it starts from cells in the bone.

illustration showing cross section of the skin including location of hair follicle, epidermis, dermis and subcutis with details of the epidermis showing squamous cells, melanocyte and basal cellsThere are many types of skin cancer. Some are very rare. Your doctor can tell you more about the type you have.  The two most common kinds of skin cancers are:

  • Basal cell (BAY-zul sell) cancer which starts in the lowest layer of the skin
  • Squamous cell (SKWAY-mus sell) cancer which starts in the top layer of the skin

Another kind of skin cancer is called melanoma (MEL-uh-NO-muh). These cancers start from the color -making cells of the skin (called melanocytes).

Questions to ask the doctor:

  • Why do you think I have cancer?
  • Is there a chance I don’t have cancer?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How does the doctor know I have skin cancer?
You may not know you have a skin cancer until it’s really big. Then it can itch, bleed or even hurt. But before it can be seen or felt you may notice changes on your skin.

Basal and squamous skin cancer may look like:

  • Flat, firm, pale or yellow areas that look a lot like a scar
  • Raised reddish patches that might itch
  • Rough or scaly red patches, which might crust or bleed
  • Small, pink or red, shiny, pearly bumps, which might have blue, brown, or black areas
  • Pink growths or lumps with raised edges and a lower center
  • Open sores (which may have oozing or crusted areas) that don’t heal, or that heal and then come back
  • Wart-like growths

The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to skin cancer, more tests will be done.

Skin biopsy
In a biopsy (BY-op-see), the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have cancer and what kind it is.

There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

In rare cases basal and squamous cell skin cancer can spread to the nearby lymph (limf) nodes. (Lymph nodes are bean-size sacs of immune system cells.) Ask your doctor if your lymph nodes will be tested.

Grading skin cancer
The cancer cells in the biopsy sample will be graded. This helps doctors predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from normal cells are given a higher grade (3) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.

Questions to ask the doctor:

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • Who can explain them to me?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?
If you have skin cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer through the skin. It also tells if the cancer has spread to other parts of your body that are close by or farther away. Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor:

  • Do you know the stage of the cancer?
  • If not, how and when will you find out the stage of the cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of the cancer, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?
There are many ways to treat skin cancer. The main types of treatment are surgery (SUR-jur-ee), radiation ( RAY-dee-A-shun), targeted therapy, and chemotherapy. Most basal cell and squamous cell cancers can be cured with surgery or other types of treatments that affect only the spot on the skin.

The treatment plan that’s best for you will depend on:

  • The stage and grade of the cancer
  • The chance that a type of treatment will cure the cancer or help in some way
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Surgery
Surgery (SUR-jur-ee) is the main type of treatment for most skin cancers. There are different kinds of surgery. The type that’s best for you depends on the kind of skin cancer, how big it is, and where it is. Ask your doctor what kind of surgery you will have and what to expect.  Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat skin cancer should be able to help you with any problems that come up.

Radiation treatments
Radiation (RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. Electron beam rays are used to treat skin cancer. This kind of radiation uses electrons which only go into the skin. This limits damage to the body parts under the skin where the treatment is given.

Radiation can also be used to treat skin cancer that has spread to other parts of the body.

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

  • Skin changes and hair loss where the radiation is given
  • Feeling very tired (fatigue, which is pronounced fuh-TEEG)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Other treatments that affect only the skin
There are ways to treat skin cancer without cutting into the skin. Some of these use freezing, chemo put right on the skin, and light therapy to kill cancer cells.

If you’re getting one of these treatments, talk to your doctor about how it works and what you can expect. Make sure you know what the treatment will be like and how your skin will feel and look after it.

Systemic Chemo
Chemo (pronounced KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THAIR-uh-pee) – the use of drugs to fight cancer. This treatment uses drugs that are put into a vein or taken as a pill. These drugs travel through the bloodstream to all parts of the body. Unlike chemo that’s put on the skin, chemo given this way can attack cancer cells that have spread to lymph nodes and other organs.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.  There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Targeted therapy for basal and squamous cell skin cancers
Targeted therapy drugs may be used for certain types of skin cancer. These drugs find and attack cancer cells while doing little harm to normal cells. Each drug works in different ways, but all change the way cancer cells grow, divide, or repairs themselves.

Clinical trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor:

  • Would you please write down the exact kind of skin cancer I have?
  • Has the cancer grown deep into the skin? Has it spread?
  • Will I need any other tests before we can decide on treatment?
  • Do I need to see any other doctors?
  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the cancer?
  • What will treatment be like? Where will it be done? How long will it take?
  • Will I be OK if the cancer is just removed with no other treatment?
  • What side effects could I have from these treatments?
  • Will I have a scar? What will it look like?
  • What are the chances that the skin cancer will come back? What would we do if that happens?
  • What are my chances of having skin cancer again?
  • Is there a clinical trial that might be right for me?
  • What about special vitamins or diets that friends tell me about? How will I know if they are safe?
  • How soon do I need to start treatment?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • Should I take special care to avoid sun exposure? How should I do that?
  • Are my family members at risk for skin cancer? What should I tell them to do?
  • What’s the next step?

What will happen after treatment?
You’ll be glad when treatment is over. Your doctor will want you to check your skin at least once a month. It will be very important to protect yourself from getting too much sun.

For years after treatment ends, you will see your skin cancer doctor. At first, your visits may be every 3 to 6 months. Then, the longer you’re cancer-free, the less often the visits are needed. Be sure to go to all of these follow-up visits. Your doctor will ask about symptoms and check you for signs of the cancer coming back or a new skin cancer. Other exams and tests may also be done.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.

illustration showing cross section of the skin including location of hair follicle, epidermis, dermis and subcutis with details of the epidermis showing squamous cells, melanocyte and basal cellsCancer can start any place in the body. Melanoma (pronounced MEH-luh-NOH-muh) is a kind of skin cancer that starts in skin cells called melanocytes (meh-LAN-oh-sites). Melanoma skin cancer starts when melanocyte cells grow out of control and crowd out normal skin cells. Melanocytes (meh-LAN-oh-sites) are cells in the skin. They make melanin (MEH-luh-nin), which makes the skin brown or tan.

Cancer cells can spread to other parts of the body. Melanoma can sometimes travel to the bone and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones that started in the melanocytes.

Cancer is always named for the place where it starts. So when melanoma spreads to the bone (or any other place), it’s still called melanoma. It’s not called bone cancer unless it starts from cells in the bone.

Are there different kinds of melanoma?
There are many types of skin cancer, but there’s one kind of melanoma. Your doctor can tell you more about the type of skin cancer you have.

Basal cell (pronounced BAY-zul sell) and squamous (pronounced SKWAY-mus sell) cell skin cancers are much more common than melanoma and don’t often spread to other parts of the body. Melanoma is more deadly because it can spread to other parts of the body.

Questions to ask the doctor:

  • Why do you think I have cancer?
  • Is there a chance I don’t have cancer?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How does the doctor know I have melanoma?

A new spot on your skin or a spot that’s changing in size, shape, or color may be a warning sign of melanoma. If you have any of these changes, have your skin checked by a doctor.

The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to melanoma, more tests will be done.

Biopsy: In a biopsy (BY-op-see), the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is. There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

Chest x-ray: This test may be done to see if the melanoma has spread to your lungs.

CT or CAT scan: Uses x-rays to make detailed pictures of your insides. This test may be used to see if nearby lymph nodes (limf nodes) are swollen or if organs like the lungs or liver have spots that might be from the spread of melanoma. If any spots are found, a CT scan might be used to guide a needle into the spots to do a biopsy.

MRI scan: Uses radio waves and strong magnets instead of x-rays to make detailed pictures of your insides. This test can help show if the cancer has spread.

PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera. If there’s cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if and where the cancer has spread.

Grading melanoma cancer
The cancer cells in the biopsy sample will be graded. This helps doctors predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from normal cells are given a higher grade (3) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.

Questions to ask the doctor:

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • Who can explain them to me?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?
If you have melanoma, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the melanoma through the skin. It also tells if it has spread to other organs of your body that are close by or farther away.

Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor

  • Do you know the stage of the cancer?
  • If not, how and when will you find out the stage of the cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of melanoma, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?
There are many ways to treat melanoma. The main types of treatment are surgery (SUR-jur-ee), immunotherapy(IM-yuh-no-THAIR-uh-pee), targeted therapy, chemotherapy (KEY-mo-THAIR-uh-pee), and radiation (RAY-dee-A-shun). Most early stage melanomas can be treated with surgery alone. More advanced cancers need other treatments.

The treatment plan that’s best for you will depend on:

  • The stage and grade of the cancer
  • The chance that a type of treatment will cure the melanoma or help in some way
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Surgery for melanoma
Surgery (SUR-jur-ee) is the main treatment for most melanomas. It can often cure early-stage melanomas. There are different kinds of surgery. The type that’s best for you depends on how large the melanoma is and where it is. Ask your doctor what kind of surgery you will have and what to expect.

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with melanoma should be able to help you with any problems that come up.

Immunotherapy for melanoma
Immunotherapy (IM-yuh-no-THAIR-uh-pee) is treatment that either boosts your own immune system or uses man-made versions of parts of the immune system that attack the melanoma cells. Many types of immunotherapy are used to treat melanoma. These drugs may be given into a vein, given as a shot, or taken as pills.

Immunotherapy can cause many different side effects depending on which drug is used. These drugs often make you feel tired, sick to your stomach, and cause fever, chills, and rashes. Most of these problems go away after treatment ends.  There are ways to treat most of the side effects caused by immunotherapy. If you have side effects, talk to your cancer care team so they can help.

Targeted therapy for melanoma
Targeted therapy drugs may be used for certain types of melanoma. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t. They may cause fewer side effects.

Chemo
Chemo (pronounced KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THAIR-uh-pee) – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. They kill cells that are fast growing cancer cells and good cells like blood cells and hair. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.  There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

Radiation treatments
Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. Radiation is not usually used to treat the main spot on the skin. But it may be used after surgery to help keep the melanoma from coming back.

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the part of the body that’s treated. The most common side effects of radiation are:

  • Sunburn-like skin changes where the radiation is given
  • Hair loss where the radiation enters the body
  • Feeling very tired (fatigue, which is pronounced fuh-TEEG)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Clinical trials
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor:

  • How far has the melanoma spread under my skin?
  • How thick is the melanoma?
  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, who will do the surgery?
  • What will the surgery be like?
  • Will I need other types of treatment, too?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • What can I do about side effects that I might have?
  • Is there a clinical trial that might be right for me?
  • What about special vitamins or diets that friends tell me about? How will I know if they are safe?
  • How soon do I need to start treatment?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

What will happen after treatment?
You’ll be glad when treatment is over. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You will have exams, blood tests, and maybe other tests to see if the cancer has come back.

At first, your visits may be every 3 to 6 months. Then, the longer you’re cancer-free, the less often the visits are needed. After 5 years, they may be done once a year.

Lymphoma is a cancer that starts in white blood cells called lymphocytes (LIM-fo-sites). Lymphomas can start almost any place in the body. When a lymphoma starts in the skin, it is called a skin lymphoma (or cutaneous lymphoma). Most skin lymphomas start in T cells.Lymphocytes are part of the body’s immune system, and normally they help the body fight infections. There are 2 main types of lymphocytes:

  • B lymphocytes (B cells)
  • T lymphocytes (T cells)

Are there different kinds of lymphoma of the skin?
There are many types of skin lymphomas. Many of these are very rare. Your doctor can tell you more about the type you have.

Here are the medical names for the most common types of skin lymphoma in the US.

  • Mycosis fungoides
  • Sezary syndrome

Questions to ask the doctor:

  • Why do you think I have a skin lymphoma?
  • Is there a chance I don’t have a skin lymphoma?
  • Would you please write down the kind of skin lymphoma you think I might have?
  • What will happen next?

How does the doctor know I have lymphoma of the skin?
Lymphomas of the skin can be seen and felt. They often start out as a very itchy, red or purple rash, which can look like any of these:

  • Small pimples
  • Flat areas, which might be raised or lowered
  • Lumps or bumps under the skin

The lymphoma might affect only a small area of skin, or it might affect large areas of the body. Sometimes people with skin lymphoma have other symptoms, such as fever, weight loss, and sweating.

The doctor will ask you questions about your symptoms and your health, and will do a physical exam. The doctor will look closely at the skin, and might feel the nearby lymph nodes (bean-sized groups of immune cells) under the skin to see if they are affected. Skin lymphomas can sometimes spread to the lymph nodes, making them swollen or hard.

It can be hard for doctors to tell a skin lymphoma apart from other causes of skin rashes, so sometimes it takes a while to be sure. If the doctor thinks you might have a skin lymphoma, tests will be done. Here are some of the tests you might need:

Biopsy: In this test, the doctor takes out a piece of the skin to check it for cancer cells. This is often done with local anesthesia. This means you’re awake but the area where the biopsy is done is numb.

A biopsy is the only way to tell for sure if you have a skin lymphoma. There are many types of biopsies. Each type has pros and cons. The choice of which one to use depends on your own case. Ask your doctor what type you will need.  Sometimes biopsies might be done on other parts of the body as well, such as nearby lymph nodes or the bone marrow (the soft, inner part of some bones). This is to check if the cancer has spread there.

Blood tests: Certain blood tests can tell the doctor more about the types of cells and chemicals in your blood.

Chest x-ray: X-rays may be done to look for enlarged lymph nodes in the chest.

CT scan: This is a special kind of x-ray test that makes detailed pictures. It can be used to look for swollen lymph nodes or other organs.

MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make detailed pictures. This test isn’t often done for skin lymphomas, unless a CT scan can’t be done for some reason.

Ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen. Ultrasound can be used to look for swollen lymph nodes in places like your belly.

PET scan: In this test, you are injected with a special type of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the lymphoma has spread. Sometimes it is done at the same time as a CT scan (known as a PET/CT scan).

Questions to ask the doctor:

  • What tests will I need?
  • Who will do these tests?
  • Where will they be done?
  • How and when will I get the results?
  • Who will explain the results to me?
  • What do I need to do next?

How serious is my cancer?
If you have a skin lymphoma, the doctor will want to find out how far it has spread. This is called the stage of the cancer. Your doctor will want to find out the stage of your lymphoma to help decide what type of treatment is best for you.

The stage is based on the spread of the lymphoma on the skin, as well as if it has reached other parts of your body.

Some types of skin lymphoma are given as stage such as 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread farther. Be sure to ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor:

  • Do you know the stage of the lymphoma?
  • If not, how and when will you find out the stage?
  • Would you explain to me what the stage means in my case?
  • How does the stage affect my treatment options?
  • What will happen next?

What kind of treatment will I need?

Phototherapy, also known as UV light therapy: UV light can be used to treat some skin lymphomas. Treatment is given a few times a week with a special lamp, which is like those used in tanning salons. Sometimes a drug is taken as a pill before each treatment to help it work better. This type of treatment is called PUVA.

Just like when you are exposed to sunlight outside, treatment with UV light can cause sunburn. If pills are taken as part of PUVA, they can make the skin very sensitive to sunlight, so you will need to protect yourself from sunlight in the days after treatment.

Topical medicines: These are drugs that are put right on (or into) the skin. They treat the lymphoma while limiting side effects in other parts of the body.

  • Topical steroids: These drugs affect immune cells (like lymphoma cells), and they can be very helpful in treating some skin lymphomas. They can be put on the skin as ointments, gels, foams, and creams, or they can be injected into skin.
  • Topical chemotherapy: Chemotherapy (chemo) drugs are strong medicines used to treat cancer. Some chemo drugs can be put right on the skin (usually in a cream, ointment, or gel) to treat skin lymphomas that have not spread. Side effects can include redness and swelling in places where the drug is used.
  • Topical retinoids: Retinoids are drugs related to vitamin A. They can affect certain genes in lymphoma cells that cause them to grow or mature. Some retinoids come in a gel that can be put right on the skin. Side effects can include redness, itching, swelling, and sensitivity to sunlight in places where the drug is used.
  • Topical immune treatment: Imiquimod is a cream that causes an immune reaction when applied to skin lymphomas, which may help destroy them. This drug is used mainly to treat some other types of skin cancers, but some doctors might also use it to treat early forms of skin lymphoma. It can cause redness, swelling, and itching in the place where it is used.

Treatments that affect the whole body:
These treatments are most useful for skin lymphomas that are widespread or are growing quickly.

Photopheresis, also known as ECP: This treatment can kill lymphoma cells, as well as help the body’s immune system attack them.

For each treatment, the person’s blood is collected from a vein. It goes into a special machine that separates out the lymphocytes (including lymphoma cells). The cells are mixed with a drug that makes them sensitive to light, and then they’re exposed to UV light. They are then mixed back in with the rest of the blood and put back into the patient through a vein. The treatment usually takes a few hours.

This treatment can make the skin very sensitive to sunlight, so you will need to protect yourself from the sun in the days after treatment.

Chemotherapy (chemo): Chemo drugs that are taken as a pill or injected in the blood can reach all parts of the body. Chemo may be used if the lymphoma in the skin is more advanced and no longer getting better with other treatments, or if it has spread to other parts of the body.

Many different chemo drugs can be used. Often a single drug is tried first, but sometimes more than one drug is used. Chemo is given in cycles or rounds, which last a few weeks. Each round of treatment is followed by a break.

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. These problems tend to go away after treatment ends. Some chemo drugs can have other side effects. There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

Targeted drugs: Targeted drugs work by aiming at parts of cancer cells that make them different from normal cells. These drugs don’t work the same way as chemo drugs. They can sometimes help when chemo drugs don’t, and they often have different side effects. Some are given into a vein, while others are taken as pills.

The side effects depend on which drug you are taking. Talk to your cancer care team to learn more about which side effects you might have.

Immune treatments: Some drugs work by helping the body’s immune system attack the cancer cells. These drugs are given into a vein.  The side effects depend on which drug you are taking. Talk to your cancer care team to learn more about which side effects you might have.

Retinoids: These are drugs related to vitamin A. They can be taken in pill form for skin lymphomas that are widespread. Side effects can include headaches, feeling sick to your stomach, fever, thyroid problems, and eye problems. Some retinoids can cause more serious side effects, like fluid buildup in the body.

Stem cell transplant: This treatment (also known as a bone marrow transplant) might be an option if other treatments are no longer working. It lets doctors give higher doses of chemo than they normally could (because of the severe side effects it would cause).

First, a person gets high doses of chemo. This can destroy the bone marrow, where new cells are made. To help with this, the person then gets an injection of stem cells (which most often come from another person). The stem cells go to the bone marrow, where they start to make new blood cells.

A stem cell transplant is a complex treatment that can cause major side effects, and you might need to stay in the hospital for a long time. It should only be done at a center that has a team of doctors who are experts in this treatment.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

Clinical trials are one way to get the newest cancer treatment. They are one of the best ways for doctors to find better ways to treat cancer. But they might not be for everyone. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

What about other treatments that I hear about?
When you have a skin lymphoma you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these might help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor:

  • Will I need to see any other types of doctors?
  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the lymphoma?
  • Will I need other types of treatment, too?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • What can I do about side effects that I might have?
  • Is there a clinical trial that might be right for me?
  • What about special vitamins or diets that friends tell me about? How will I know if they are safe?
  • Do I need to start treatment right away?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

What will happen after treatment?
Some people might keep getting treatment, while others might be finished at some point. You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. You might have exams, blood tests, and scans to see if the cancer has come back. At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed.

* Information on this page is from American Cancer Society (www.cancer.org)

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