What Mr. T's Story Can Help Us Understand About T-Cell Lymphoma

What began as a sore on an ear

In an interview published by Coping with Cancer magazine, Mr. T described noticing a small sore on his ear in September 1995 while taking out an earring. He waited two weeks, then saw his doctor, who sent him to a dermatologist. A biopsy showed a rare type of T-cell lymphoma.

He described a CT scan and a bone marrow test to find out how far it had gone. The answer was that it was confined to the ear. He had radiation five times a week for four weeks and was told the cancer was gone.

Eleven months later it returned, this time as sores on his arms, back, legs, and stomach. He described six weeks of high-dose chemotherapy, then interferon for a year and a half, then low-dose chemotherapy, more radiation, and more chemotherapy again as the disease persisted over several years.

That account is his own. This page does not add to it, and it says nothing about his health now. What follows is the disease.

A lymphoma that lives in the skin

Cutaneous T-cell lymphoma is a cancer of T lymphocytes, a type of white blood cell. What makes it unusual is where it shows up. NCI's health-professional summary says these cancers usually carry the helper T-cell surface pattern and present first as skin involvement.

That is why it can look nothing like what people expect from the word lymphoma. There is often no swollen node. There is a rash.

Mycosis fungoides is the main type. Sézary syndrome is the related one in which the abnormal T cells are also circulating in the blood. Our page on cutaneous T-cell lymphoma covers the family in more detail.

Why it takes years to name

NCI is direct about the delay. The natural history is usually indolent, meaning slow. Symptoms can be present for anywhere from two to ten years before a biopsy confirms what they are, because the skin eruptions come and go.

Several harmless or slow skin conditions look like it. NCI advises consulting a pathologist with specific expertise in telling them apart.

How the extent is described

Staging here is mostly about skin.

NCI describes an eczema-like patch or plaque covering under 10% of the body surface as T1, a plaque stage covering 10% or more as T2, and tumors, which often break down and ulcerate, as T3. Sézary syndrome presents as erythroderma, meaning redness over almost the whole skin surface, which is T4, with abnormal cells in the blood.

Roughly 20% of people with stage I or II disease go on to stage III or IV. In one study following 1,422 people for a median of 14.5 years, only 3% moved from mycosis fungoides to Sézary syndrome.

What treatment involves

NCI states there is no curative therapy for stage I and II mycosis fungoides, and no clear difference in overall survival between the available options. The choice depends on local expertise and equipment.

The options NCI lists are light therapy, radiation, biological therapy, chemotherapy, other drug therapy, and targeted therapy.

Light therapy is often first. PUVA combines a drug called psoralen with ultraviolet A light and produces complete remission in 80% to 90% of people, best in early skin-limited disease. Narrowband ultraviolet B achieves similar rates. Both usually need maintenance sessions to hold the remission.

More is not better here. A randomized trial of 103 people compared total-skin electron-beam radiation plus combination chemotherapy against sequential topical treatments, with chemotherapy held back for symptomatic or resistant disease. The aggressive arm produced more complete responses, far more toxicity, and no difference in disease-free or overall survival.

What the outlook depends on

NCI ties prognosis to how much skin is involved and whether nodes, blood, or internal organs are affected.

The range is very wide. People with stage IA disease have a median survival of 20 years or more, and NCI notes that most deaths in that group are not caused by the lymphoma at all. More than half of people with stage III or IV disease die of it, with a median survival of about five years. Sézary syndrome carries a median survival of about four years.

A review of 1,275 people found four features that predict worse survival: stage IV disease, age over 60, large cell transformation, and a raised lactate dehydrogenase level.

These are group figures from past studies. They do not describe any one person, and the gap between the ends of that range is the point.

When to get checked

There is no screening test. NCI has no evidence-based screening or prevention advice for lymphoma, so this depends entirely on someone noticing a skin change and acting.

Show a clinician any of these:

• A red, scaly, eczema-like patch that has not cleared after several weeks of usual treatment
• A raised plaque or lump on the skin that grows or ulcerates
• Redness spreading over most of the body, with intense itching
• A sore that will not heal, anywhere, including on an ear

Ask specifically whether a skin biopsy is worth doing on a rash that keeps returning. Our page on changes in a mole or skin covers what a skin assessment involves.

One more thing NCI flags: during the tumor phase, a common cause of death is bloodstream infection from long-standing skin infection. Broken, weeping skin is not a cosmetic problem in this disease.

What this does not mean

• One person's account of treatment in the 1990s is not a guide to what is offered now. Several of the options NCI lists today did not exist then.
• Most persistent rashes are not lymphoma. The reason to get one biopsied is that a small number are, and they are easy to miss.
• Stage IA and stage IV sit at opposite ends of a very long range. An average across them describes nobody.
• No treatment listed for early-stage disease is curative, but for stage IA, NCI says survival with treatment can match that of people the same age and sex without the disease.

Sources

• Coping with Cancer magazine, Mr. T: The Ultimate Tough Guy Goes Head-to-Head with Cancer — https://copingmag.com/mr-t/
• NCI PDQ, Mycosis Fungoides and Other Cutaneous T-Cell Lymphomas Treatment (Health Professional Version) — https://www.cancer.gov/types/lymphoma/hp/mycosis-fungoides-treatment-pdq
• NCI, Lymphoma—Patient Version — https://www.cancer.gov/types/lymphoma

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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