Cutaneous T-cell lymphoma in skin of colour: a review

Skin cancer generally causes disproportionate morbidity and mortality in people of colour. Although skin cancers occur most frequently in White individuals overall, cutaneous T-cell lymphoma (CTCL) is an exception. CTCL is a rare skin cancer comprising several subtypes of non-Hodgkin lymphoma; each contains a unique clinical profile that varies with race. Our aim is to review and compile the differences in epidemiology, clinical presentation, treatments and outcomes of the CTCL subtypes in Black, Asian or Pacific Islander (API) and Hispanic patients. The current literature supports that there are nuances in the course of CTCL that differ with race. Across multiple studies, racial differences in incidence patterns have been reported, with the highest rates among Black patients. Cutaneous manifestations of CTCL are highly variable in people of colour, and the predilection for clinical CTCL variants often differs with race, as well as severity of cutaneous involvement (body surface area). Response to and type of treatment also differs among people of colour and may be partially attributable to the varying CTCL subtypes experienced by certain races. Prognostic factors tend to vary with race, although Black patients consistently experience poor outcomes, while API patients may have a more favourable prognosis. Currently, there is no definitive conclusion to account for differences observed in patients with skin of colour with CTCL; however, biological and socioeconomic factors have been proposed as potential drivers. As the proportion of people of colour in our population continues to grow, adequate physician awareness and knowledge of racial nuances in CTCL are necessary to begin addressing these disparities.