Cutaneous T cell Lymphoma in Skin of Color: A Review.

People of color (POC) affected by skin cancer suffer disproportionately from worse morbidity and mortality. 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 manifestation of CTCL are highly variable in POC, and the predilection for clinical CTCL variants often differs with race, as well as severity of cutaneous involvement (BSA). Response to and type of treatment also differs among POC, 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 favorable prognosis. Currently, there is no definitive conclusion to account for differences observed in CTCL skin of color patients, however biologic and socioeconomic factors have been proposed as potential drivers. As POC comprise an increasing portion of our population, adequate physician awareness and knowledge of racial nuances in CTCL are necessary to begin addressing these disparities.