Meet our doctors: Christiane Querfeld on cutaneous lymphoma

March 6, 2015 | by Kim Proescholdt

Christiane Querfeld Christiane Querfeld discusses how new cutaneous lymphoma therapies and physician collaboration lead to better patient outcomes

Cutaneous lymphoma, a form of non-Hodgkin lymphoma, is a rare type of cancer that begins in the white blood cells and attacks the skin. It can cause rash-like skin redness and, sometimes, skin tumors. Although cutaneous lymphomas are rare, accounting for about 5 percent of all non-Hodgkin lymphomas, approximately 20,000 people in the United States are estimated to have cutaneous lymphoma.

Here, dermatologist/dermatopathologist and cutaneous lymphoma expert Christiane Querfeld, M.D., Ph.D., director of City of Hope’s Cutaneous Lymphoma Program, discusses how new therapy options and continued collaboration among physicians have contributed to better care and outcomes for cutaneous lymphoma patients, and helped many to return to a normal life.

What is cutaneous lymphoma and what causes it?

Cutaneous lymphomas, also known as lymphomas of the skin, are rare forms of cancer of the lymphocyte (a type of white blood cell that fights infection in the body) that primarily manifest in the skin, but may spread to the lymph nodes, blood and other organs. All cutaneous lymphomas are non-Hodgkin lymphomas.

Most cases of cutaneous lymphoma have no known cause, and therefore, they are difficult to prevent. Understanding why the lymphocytes on the skin become cancerous in the skin is a current research focus here at City of Hope.

Is cutaneous lymphoma contagious? Who is most at risk?

Cutaneous lymphoma is not contagious. It is not an infection and there are no infectious agents known to cause the disease. Those most at risk are those with weakened immune systems, and there seems to be a greater frequency among men than women. It is also more common after the age of 50.

What are typical symptoms of cutaneous lymphoma and how is it diagnosed? 
Because this is a skin disease, it is often noticed fairly quickly. Unfortunately, cutaneous lymphomas can frequently resemble other, more common diseases of the skin, such as eczema or psoriasis, often leading to delays in diagnosis especially with early disease. Symptoms can be debilitating and painful, even in earlier stages, so it is very important to get a diagnosis promptly and symptoms be addressed so as not to worsen. Typical symptoms of cutaneous lymphoma depend on the type you have, but may include:

  • Patchy, scaly red or purple patches, lumps or bumps on or under the skin
  • Widespread, itchy rash
  • Thickened skin
  • Red pimples, nodules or plaques on your scalp, forehead or body
Cutaneous lymphoma can only be diagnosed by a physician with proper testing that include skin biopsies, blood tests, imaging studies and/or other laboratory tests.

What treatments are available for cutaneous lymphomas? Any new therapies?

There is no cure for cutaneous lymphoma, but there are a variety of treatment options available and most patients are able to live normal lives with this form of cancer.

Treatments are either directed at the skin or the entire body (systemic). Skin-directed therapies include ultraviolet light therapy (PUVA, UVB, narrow-band UVB), topical steroids, topical chemotherapies such as topical nitrogen mustard, topical retinoids, local (spot) radiation or total skin electron beam therapy.

Systemic treatments include oral retinoids, interferons, antibodies, therapies, extracorporeal photopheresis and systemic chemotherapy. Sometimes skin-directed and system treatments are used together for the more complex and challenging cases.

If a patient doesn’t respond to either a skin-directed or systemic treatment, there are new investigational drugs known as immunotherapeutics that can potentially successfully treat and destroy the malignant cancer cells. As a National Cancer Institute-designated cancer center, City of Hope is one of the few institutions in the country that currently offer clinical trials available to help treat cutaneous lymphomas.

Why did you choose this area of expertise? What inspires you to do the work you do?

I find cutaneous lymphomas intriguing and fascinating. Initially during my dermatology training, I learned that every patient differed from the next; the rash was always different. While I was a fellow at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, I had the privilege of working alongside top-notch experts in a multitude of specialties that included oncology, skin pathology and dermatology, who all focused on treating cutaneous lymphoma. I learned something different from each and every member of that team and from every patient. This provided me with a well-rounded understanding of this very complex disease.

I feel fortunate that I can share this multidisciplinary thought process with my patients. This is what continues to inspire me each and every day — being able to put all of these pieces together, almost like a puzzle, to pinpoint the proper diagnosis and determine the right treatment regimen. At the end of the day, it is always about helping patients get better so they can go on to continue leading normal lives.

What advice do you have for patients recently diagnosed with cutaneous lymphoma?

I would always recommend to anyone diagnosed with cutaneous lymphoma to see a specialist with experience in treating this complicated disease. By doing so, patients can access the newest therapies available and get back to leading a normal life as quickly as possible. And a specialist can also work directly with their primary care provider, if that is what is preferred. The goal of treatment is assure that the patient gets better as quickly as possible.

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Visit our website for more information about lymphoma and our program.

Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.

 

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