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SYMPOSIUM EDITORIAL
Year : 2017  |  Volume : 62  |  Issue : 2  |  Page : 135-136
Cutaneous lymphomas in India: Prospects and limitations


Consultant Dermatologist, Tata Medical Center, Kolkata, West Bengal, India

Date of Web Publication9-Mar-2017

Correspondence Address:
Tanumay Raychaudhury
Consultant Dermatologist, Tata Medical Center, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_72_17

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How to cite this article:
Raychaudhury T. Cutaneous lymphomas in India: Prospects and limitations. Indian J Dermatol 2017;62:135-6

How to cite this URL:
Raychaudhury T. Cutaneous lymphomas in India: Prospects and limitations. Indian J Dermatol [serial online] 2017 [cited 2017 Mar 26];62:135-6. Available from: http://www.e-ijd.org/text.asp?2017/62/2/135/201770


The diagnosis of cutaneous lymphomas (CLs) in India has been difficult as the plethora of hypopigmentary disorders such as Hansen's disease and vitiligo mimic the most common variant of CLs, hypopigmented mycosis fungoides (MF). Paradoxically, while erythrodermic patients almost always undergo ruling out Sezary syndrome, not a single case has been reported from this population. The multitude of patients and limited biopsies performed in most outpatient departments mean that clinicians can miss out on diagnosis, given that lymphomas have been differentials more often than primary diagnosis. That trend has changed over the years in the past two decades, almost since the first case series was reported by George et al .[1] in 1999 with 31 cases over 10 years (1990–99) at Christian Medical College, Vellore. In the year 2012, from the same center, Burad et al .[2] published a case series of peripheral T-cell lymphomas over a 2-year study period with 61 cases of CL.

In the past 2 years, more than thirty case reports, series, or reviews have been published in Indian and international journals, a few of which will be highlighted in this discussion. A large retrospective series was published in 2011 by Doshi and Khopkar [3] from Mumbai with 131/141 cases being cutaneous T-cell lymphomas (CTCLs) over 5 years. MF was most common of all CLs. Similar results are reported by Khader et al . from Kozhikode, Kerala, with 20/35 patients with MF in 2016 in a 6-year retrospective study.[4]

A blessing in disguise is the fact that early stage of these conditions is indolent and often responds to topical steroids or phototherapy offered for suspected vitiligo. The problem of diagnosis of lymphomas in early stage has been difficult.[5] Several papers in Indian journals have helped make this clear while it remains an exercise with every suspected patient.[6],[7] In an extensive and categorical review, Charli-Joseph et al . have discussed when to consider lymphoma in a biopsy with atypical lymphoid infiltrates in this journal earlier in 2016 which remains one of the most exhaustive reviews on this rather difficult yet common problem.[8]

In this symposium, we were privileged to have Professor Martine Bagot discuss the latest management options for CTCLs from the center that has pioneered therapy and research and even had the term “MF” coined by an ex-director of the same department, Professor Alibert, at the Hospital Saint-Louis, Paris. She is the national referral person for CLs in France and is a world leader in CLs, being on board for EORTC/ISCL consensus teams. Dr. Roberta La Selva et al . and her colleagues including Professor Pietro Quaglino who is the Chair for Cutaneous Lymphoma Task Force for EORTC, kindly consented to do an exhaustive review on cutaneous B-cell lymphoma, a topic in which knowledge and expertise is wanting since the number of cases from our country is small yet significant. We have also tried to put up strategies on the management of MF with a simple algorithm, issues with the treatment options, and a basic risk-based stratification. We have a non-MF series of CTCLs from Mexico by Dr. Yann Charli-Joseph et al ., where the environment and skin colors are similar to that of India.

Finally, while we have made giant strides in diagnostics, we do have limited centers that have facilities for immunohistochemistry, T-cell receptor gene rearrangement studies for clonality, positron emission tomography-computed tomography scan, or total skin electron beam therapy when necessary for selected patients. We are in the process of creating a database for the same so that patients can be referred as and when needed. Since data are small and centers are sparse, we need a national registry to find more about the epidemiology, risks, and results of therapy in India. The biggest hurdle in the absence of epidemiological data is making the latest drugs in the management of lymphomas available to our patients. We do not have drugs such as bexarotene, pralatrexate, vorinostat, romidepsin, or alemtuzumab which are gradually becoming the standards of first-line management for advanced stage disease across the world. Creation of a registry for collection of national data is imperative, and referral centers need to be specifically identified for the benefit of clinicians and patients for the best possible treatment. Our clinical suspicion for lymphomas is higher than before leading to a rise in incidence or better disease identification, but our management strategies in the present day still remain limited. Liaising with our colleagues across the world with greater experience has helped us garner knowledge and improve our approach. One can only hope that, with a persistent interest from focused clinicians and patients, we will have better strategies and a larger armamentarium of therapeutic options for these conditions. I wish you all a pleasant and informative read in this novel symposium from Team IJD, with special thanks to Dr. Koushik Lahiri, Editor, who conceptualized this.

 
   References Top

1.
George R, Bhuvana S, Nair S, Lakshmanan J. Clinicopathological profile of cutaneous lymphomas – A 10 year retrospective study from South India. Indian J Cancer 1999;36:109-19.  Back to cited text no. 1
    
2.
Burad DK, Therese MM, Nair S. Peripheral T-cell lymphoma: Frequency and distribution in a tertiary referral center in South India. Indian J Pathol Microbiol 2012;55:429-32.  Back to cited text no. 2
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3.
Doshi BR, Khopkar US. Retrospective study of spectrum of cutaneous lymphoma presenting to dermatology. Indian J Dermatol Venereol Leprol 2011;77:512-5.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Khader A, Manakkad SP, Shaan M, Pillai SS, Riyaz N, Manikoth PB, et al. A Clinicopathological analysis of primary cutaneous lymphomas: A 6-year observational study at a tertiary care center of South India. Indian J Dermatol 2016;61:608-17.  Back to cited text no. 4
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5.
Panda S. Mycosis fungoides: Current trends in diagnosis and management. Indian J Dermatol 2007;52:5-20.  Back to cited text no. 5
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6.
Inchara YK, Rajalakshmi T. Early mycosis fungoides vs. inflammatory mimics: How reliable is histology? Indian J Dermatol Venereol Leprol 2008;74:462-6.  Back to cited text no. 6
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7.
Sarveswari KN, Yesudian P. The conundrum of parapsoriasis versus patch stage of mycosis fungoides. Indian J Dermatol Venereol Leprol 2009;75:229-35.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Charli-Joseph YV, Gatica-Torres M, Pincus LB. Approach to cutaneous lymphoid infiltrates: When to consider lymphoma?. Indian J Dermatol 2016;61:351-74.  Back to cited text no. 8
[PUBMED]  [Full text]  




 

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