I’m a 49-year-old male of Portuguese origin. Since the past five years I’ve been suffering from recurrent scaly patches and plaques of different sizes and shapes on my lower back, inner flanks, waistline and both upper hips. Initially, I was told it was eczema, later that it was psoriasis, then recently that it could even be some sort of skin cancer. Please advise.
The history of your skin complaints definitely indicate unusual/atypical skin lesions. The initial diagnoses were not entirely wrong. But since you’re worried it could be skin cancer, it’s necessary we rule out that suspicion as soon as possible. The most likely type of skin cancer that can clinically present in this way is cutaneous T-cell lymphoma (CTCL), which at its initial stage can deceptively be diagnosed as eczema or psoriasis.
In CTCL an advancing disease can turn these patches of abnormal activity into thick scaly plaques or even big-sized nodules. I can only assume that perhaps this was the diagnostic suspicion.
To rule CTCL out, we need to take a full thickness skin biopsy for normal histopathological examination to rule out eczema or psoriasis, and also stain the biopsy specimen with specialised immunohistocytochemical stains.
At the same time, we should also proceed with T-cell rearrangement studies. The CTCL or MF is a type of skin cancer where abnormally active white blood cells – lymphocytes (T-cells) – infiltrate the skin layers, and their continued activity turns the invaded area of skin into a cancerous patch or plaques.
There are several grades of activity that determine the potential threat to human life. The early stages, 1-2, are usually completely curable by available treatments. Stages 3 and 4 can be seen with concerns of carrying lymphoproliferative potential to spread to distant organs, as such becoming a systemic disease. But most skilled dermatologists catch CTCL/MF at an early stage, where it can be treated successfully.