Skin lesion on face. Should he irradiate it

[LovecuresCLL]

I have friend with skin lesion on his face who has a follicular B-cell lymphoma. On skin histology it is dense infiltrate of small lymphocytes. a mixed population of half T cells and half B cells. On FISH bcl6 is negative and IGH/bcl2 is negative . They want to irradiate the lesion. The lesion is the size of a dime. He has been treated with CD20 B cell immuno therapy. On radiology his nodes shrunk but this skin lesion popped up.

What should I tell him to do? It doesn’t respond to steroids. I say conservatively excise it

No radiation unless it grows to the size of a quarter

What say you?

[AussieNeil Partner Administrator]

While we are encouraged to share our experiences in this forum, that can't extend to providing advice, even more so for different blood cancers than CLL/SLL. Even if we were medically trained, we'd need to have access to the person's medical history, including matters that neither you or he are aware are relevant, to provide useful advice. While skin lesions from CLL/SLL are fairly rare, I think you may get some useful replies from members who have had experiences with their blood cancer specialist, that you can pass onto your friend to help him.

I hope he finds a good specialist with relevant experience,

Neil

[LovecuresCLL in reply to AussieNeil]

Thanks. I will withdraw the question then.

[AussieNeil Partner Administrator in reply to LovecuresCLL]

By all means you can ask for other's experiences, but the problem is how relevant the replies will be for someone with a different blood cancer. The best value this community can offer is in possibly providing suggestions on blood cancer specialists with a great deal of knowledge on associated skin lesions. lankisterguy might be able to help in this regard and Jm954 has professional experience beyond CLL.

Where does your friend live? (You might want to lock your post if you consider it necessary to protect his privacy. Just select 'Edit' from the 'More v' option below your post and change the selection to "Who can see my post").

[LovecuresCLL in reply to AussieNeil]

Neil did you see this one:

nejm.org/doi/pdf/10.1056/NE...

[AussieNeil Partner Administrator in reply to LovecuresCLL]

Lots of interest in this combination as evidenced by nearly 2,000 posts found in a community search: healthunlocked.com/cllsuppo...

You should be able to find information that's not paywalled in many of them

[LovecuresCLL in reply to AussieNeil]

I see that! Great work. I think I may call you AussieCLLHero!

[PlanetaryKim]

Topical cream (5FU chemo) is an option for treating a skin cancer lesion on face. Don't know if it would be relevant in this situation. Worth asking about.

[LovecuresCLL in reply to PlanetaryKim]

would it penetrate deep enough to get into the deep dermis? That’s used mostly to treat keratinocytic lesions not lymphomas. If you injected it ....it may cause necrosis. This is a pseudolymphoma probably suped up some immune reaction to a bug bite.

[PlanetaryKim in reply to LovecuresCLL]

I don't know how deep it goes, It is used to treat squamous cell & basal cell carcinoma on face and elsewhere. Don't know if it can be used for lymphoma lesion on face. But could always ask the doctor about this.

[Jm954 Administrator]

Hi, this is a situation which is not very common and your friend will need to have confidence in his lymphoma specialist and the advice he is offering as only he has all the clinical and lab information to make an informed decision.

The T cells are probably reactive around the B cells and not part of the tumour. AntiCD20 immunotherapy may keep FL under control but is more about quality of life than remission induction.

Irradiation has the potential to to eradicate this lesion without causing systemic damage to your friend. Why do you say "conservatively excise it, No radiation unless it grows to the size of a quarter"

Jackie

[LovecuresCLL in reply to Jm954]

My two cents: Because radiation can cause other cancers like squamous cell carcinoma . If excising it takes care of it .....why not? It is one lesion that’s half T cells....gene rearrangement FISH was negative for both bcl6 and bcl2/IGH.....one can conclude ALL B-cell lymphomas including FL have been eliminated and it didn’t look like T-cell lymphoma or Hodgkins on histology. It’s a pseudo-lymphoma. So they are irradiating something benign. Yes you can have false negative result. All they can do it repeat the test.

[Jm954 Administrator]

Wait then and do nothing, it will reveal itself and it's nature sooner or later.