The Cutaneous Lymphoma Multidisciplinary Clinic

Cutaneous lymphomas are a heterogenous group of lymphoproliferative disorders that present in the skin and are composed of malignant clonal T- or B-lymphocytes. Approximately 75-80% of all primary cutaneous lymphomas are cutaneous T-cell lymphomas (CTCL), with the remaining 20-25% representing primary cutaneous B-cell lymphomas (CBCL). The clinical course of most CTCLs is unpredictable and disease progression varies widely, with some patients demonstrating indolent clinical course for decades and others progressing rapidly to advanced-stage disease. Thus, patients with cutaneous lymphomas benefit from a multidisciplinary approach to management.

Multidisciplinary cutaneous lymphoma clinics are not only efficient means for delivering patient care, but also serve as an educational tool for trainees, a continuing education resource for referring physicians, and a conduit for translational and clinical research.

The Cutaneous Lymphoma Multidisciplinary Clinic (CLMC) at Moffitt, offers expert treatment for patients with cutaneous B and T-cell lymphomas, including mycosis fungoides, Sézary syndrome, CD30+ lymphoproliferative disorders, aggressive T- and B-cell lymphomas, and blastic plasmacytoid dendritic cell neoplasm (BPDCN). Patients with suspected lymphomas and/or biopsies with atypical lymphocytic infiltrates are also evaluated. It is a referral clinic for all of the Southeast region of the United States and it is one of only five institutions that offers multi-disciplinary care for patients with cutaneous lymphomas. The CLMC sees approximately 250 new patients and 550 established patients each year, for a disease with only 1,600 newly diagnosed cases a year in the United States.

The multispecialty cutaneous lymphoma treatment team can offer your patients comprehensive services, including:

• Consultations
• Diagnostic services
• Cutaneous lymphoma specific systemic therapies (e.g., interferon, methotrexate, bexarotene, vorinostat)
• Intralesional therapies (e.g., interferon, methotrexate, rituximab)
• Photopheresis
• Infusion therapies (e.g., brentuximab, romidepsin, mogamulizumab, pralatrexate, rituximab)
• Nb-UVB phototherapy
• PUVA phototherapy
• Local electron beam radiation therapy
• Total skin electron beam radiation therapy
• Chemotherapy
• Hematopoietic stem cell transplant program
• Clinical trials

The Cutaneous Lymphoma Multidisciplinary Clinic model facilitates multidisciplinary care for patients. 
Prior to each patient's first consultation, medical records, pathology slides and diagnostic imaging are requested and reviewed by dermatopathologists and/or hematopathologists with expertise in cutaneous lymphomas. Laboratory studies, including blood flow cytometry are obtained the day of the visit prior to the consultation.

All new patients are first evaluated by a collaborative team of dermatology, dermatopathology and hematopathology to formulate an assessment and individualized treatment plan for each patient. Patients are staged according to NCCN guidelines and utilizing comprehensive laboratory testing, blood flow cytometry, molecular tests, diagnostic imaging, biopsies for immunostainings and molecular tests. In clinic biopsies and tissue cultures are performed by the dermatology team. Moffitt also offers numerous patient support services such as social work and dietitian consultations. Review the full list of patient support services.

In addition to the multidisciplinary clinic model, the clinical and pathology teams host a bi-monthly tumor board conference. Medical oncologists, surgical oncologists and staff and trainees from different specialties attend the tumor board meeting. A diagnosis, treatment and/or follow-up plan is established for each patient and recorded in the EMR.

This multidisciplinary clinic operates Tuesday mornings and Thursday afternoons at the Moffitt McKinley Outpatient Center (located on the 4th floor in the Cutaneous Oncology Clinic). Secondary patient care sites include the photopheresis unit and infusion center located at the Moffitt Magnolia campus and the Radiation Oncology suites located at Moffitt at International Plaza. The phototherapy unit is located at the USF health Morsani center for Advanced Healthcare, Dermatology and Cutaneous Surgery Department clinics. USF and Moffitt Cancer Center have affiliation agreements. 

To provide patients with prompt access to the medical attention they deserve, our team emphasizes short referral times; nearly all referrals are responded to on the same business day in which they are received. To refer a patient to Moffitt’s Cutaneous Oncology Program, complete our online form or contact a physician liaison for assistance or support.