Collaborating With Dermatologists: Coordinating Skin-Directed Therapy and Follow-Up in CTCL

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Multidisciplinary CTCL care involving dermatologists and oncologists provides optimal patient outcomes through collaborative treatment planning and shared expertise. Combined clinics allow simultaneous patient evaluation and real-time treatment discussions, particularly beneficial for advanced stage patients requiring both skin-directed and systemic therapies. This collaborative approach helps bridge the communication gap between specialties, with dermatologists developing oncologic knowledge and oncologists gaining dermatologic expertise.

Radiation therapy plays important roles in both localized and generalized CTCL treatment approaches. Spot electron beam radiation effectively treats symptomatic individual tumors or refractory lesions while patients continue systemic treatments, providing excellent palliation for problematic areas. Total skin electron beam (TSEB) therapy is reserved for patients with extensive skin involvement who have failed topical treatments and experience significant symptoms.

Modern TSEB protocols utilize lower radiation doses (12 Gray) compared to historical high-dose regimens (36 Gray), reducing toxicity while maintaining efficacy and preserving retreatment options. The reduced dose approach allows for potential future radiation treatments when needed for symptom control. TSEB typically requires combination with maintenance therapies such as narrowband UVB, retinoids, or methotrexate to sustain remission, as radiation responses are often temporary. This combination strategy addresses the limitation of TSEB monotherapy and provides patients with durable disease control options.