How should I approach the initial investigation of a patient with suspected Cutaneous T-Cell Lymphoma?

Initial investigations for suspected cutaneous T-cell lymphoma (CTCL) should include a skin biopsy to confirm diagnosis and exclude other serious differential diagnoses. A skin biopsy is essential because CTCL, such as mycosis fungoides, may present with persistent unexplained itch or skin lesions that can mimic other conditions ¹,².

Referral to a specialist dermatologist is recommended for assessment and biopsy, including possible use of Wood's light examination to evaluate lesion extent and activity. This helps differentiate CTCL from other pigmentary or inflammatory skin disorders ².

Additional investigations may include blood tests and imaging if systemic involvement or lymphadenopathy is suspected, but initial diagnosis relies primarily on histopathological confirmation from biopsy. Specialist assessment is important to guide further staging and management ⁴,⁷.

In summary, the approach is:

• Clinical assessment and history focusing on persistent or unexplained skin symptoms, especially itch ¹.
• Skin biopsy for histological diagnosis to confirm CTCL and exclude other causes ¹,².
• Referral to dermatology for specialist evaluation and possible Wood's light examination ².
• Consider further haematological and imaging investigations if systemic lymphoma is suspected, guided by specialist advice ⁴,⁷.