Epitheliotropic Lymphoma In Dogs

Updated November 28, 2020

Lymphoma in dogs is unfortunately quite a common cancer. It happens when the white blood cells called lymphocytes start growing and multiplying uncontrollably. They then spread to the lymph nodes, blood or internal organs.

A rare form that targets the skin is epitheliotropic lymphoma (EL), also called mycosis fungoides or cutaneous lymphoma. It has a very different appearance and outlook.

Signs Of Epitheliotropic Lymphoma

Epitheliotropic lymphoma is very difficult to diagnose and is often overlooked for some time. The lesions are not specific and look like any other severe skin disease. Signs may include:

  • Widespread red and scaly skin
  • Areas of raised red nodules and scaling
  • Ulcerated and depigmented patches
  • Severe itch

There is usually a very poor response to the first attempts to treat based on more common conditions. At this point, the diagnosis is usually made via a surgical biopsy.

Treatment of Epitheliotropic Lymphoma

Treatment options include:

  • Surgical removal of solitary lesions (not recommended for multiple sites)
  • Radiotherapy (not available in Adelaide, not always useful)
  • Chemotherapy (see below)
  • Retinoids (isotretinoin, acitretin) daily
  • Safflower oil (3mL/kg daily)
  • Soothing creams (we find Aloveen conditioner works the best)

Chemotherapy for EL has traditionally been the use of lomustine (also called CCNU) every 3 weeks. Recent evidence suggests that combination chemotherapy (called ‘VELCAP-EL’) may produce longer survival times, however side effects are also likely to be more common.

Prognosis Of Epitheliotropic Lymphoma

Current treatment does not provide a very good prognosis. Chemotherapy provides a much lower benefit than we see with other forms of lymphoma, but it does help to reduce signs of illness. Survival times with treatment are only around 6 months.

Chan, C. M., Frimberger, A. E., & Moore, A. S. (2018). Clinical outcome and prognosis of dogs with histopathological features consistent with epitheliotropic lymphoma: a retrospective study of 148 cases (2003–2015). Veterinary dermatology29(2), 154-e59.

Have something to add? Comments are welcome below and will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Andrew

16 Replies to “Epitheliotropic Lymphoma In Dogs”

  1. My 14 year old Golden Retriever was diagnosed by biopsy in July. She has about 12 lesions now but after starting steroids they are all flat again. The initial three were half dollar size and raised up. She then quickly got three tumors on her lips which grew dramatically within days, (before steroids). They are all shriveled now too. However, she is still getting more lesions on legs and new one on bottom of paw. She is chewing her wrists and forearms, one until it bled, and one back foot. Her skin on those three legs is turning black. I think she may have developed Cushing’s from the steroids? She also has intermittent blood in some stools. Her hind legs have gotten very weak and she slips and slides on floors without carpet. She drinks all the time and I have to let her out 10-12 times a day. She pants heavily all the time. Vet gave Gabapentin to see if it would help with itch and pain, (200 mg day), but not helping. Is it time to let her go? Is she suffering too much? Steroids is 20 mg day. Oh, and very good aggressive now..bit me bad Friday when trying to give her meatball with pill. My thumb was impaled by her canine tooth and couldn’t get it out for about a full minute. Had to get tetanus shot and antibiotics for myself..still hurts as it hit the nerve!
    Mary

    1. Hi Mary. I’ll give a few general comments and then a conclusion. Firstly, that dose of steroids is quite low and unlikely to cause Cushing’s. It’s even possible that more would improve her symptoms but I would call that a long shot. Secondly, the dose of gabapentin is also quite low and could easily increase with your vets guidance. Again, it may make very little difference.
      In essence, EL is a vale of tears and has very few good stories attached to it. In your case, yes, I think it’s time to let her go. Not just from your description, but from the aggression which I am sure is highly out of character and probably related to her discomfort.

  2. Hi there, my 11 year old labradoodle was diagnosed back in 2017 ( when she was 7) . I put her on a raw meat diet and add olive leaf extract to her meal every day. It’s four years later and even though the lesions are popping up at a faster rate now we are still managing them with comfrey ointment and occasionally paracetamol ( when they irritate her -it helps to stop her nibbling them ).
    I have seen them go from red/black,angry,painful ,weeping lumps to totally healed over with hair regrowth. Don’t give up!

    1. Hi Dawn. That’s amazing. In fact, so amazing that I need to ask – did she have surgical biopsies done to confirm the diagnosis?

  3. My 10 year old golden retriever was diagnosed with Epitheliotropic cutaneous lymphoma in January after finding little tiny nodules on his back and his tail. He quickly started to lose pigment in his nose and he was extremely tired. We started the lomustin every 3 weeks – did 3 treatments over 3 months. First 2 worked; last one didn’t have any effect and he went downhill fast. When he was on the prednisone he had to be taken off the meloxicam for his arthritis and his arthritis got so bad. We had to put him down after he stopped eating, couldn’t get up, back legs no strength at all. It was terrible. It is a bad disease – and the one thing that bothers me is that before the 3rd treatment, his blood tests said he was doing fine – I’m not sure how that could be. I am heartbroken, loved him so much. This is a very serious cancer; are there any causes? It affects so few dogs.

    1. Hi Dee. Yes it’s a heartless disease. The cause isn’t known, and most dogs follow a similar course to yours. Blood tests often don’t show much even when it’s making the dogs feel quite unwell.

  4. Hi Andrew. Our 12 year old Whippet x fox terrier has just been diagnosed with EL after 5+ months of lesions which had been diagnosed by 3 vets as a food allergy. We have been treating her with low dose prednisolone (5-10mg daily for about 4 months) and the Canine anallergenic prescription food. She has hideous lesions on the anus, genital area, one nipple, face and a couple of other red patches over her skin, as well as marked and sudden onset of white spots on her limbs, on what has always been jet black fur.
    Her bloods were normal, she is otherwise well in herself – eating drinking, running around when not sleeping. She does lick the anal lesion quite a bit so we tell her not to (and she stops immediately) and we sometimes put nickers on her to prevent access.
    We think we would prefer not to engage her in chemo as we are worried about making her sick, and needing monthly visits to the vet 30 mins drive away to be poked and prodded. We have now been prescribed Prednisolone 15mg once daily for 2 weeks and then 15mg 2nd daily.
    What are your thoughts on us not opting for Chemo? I have not come across any scientific papers that evidence benefit from Chemo for this condition.
    Also what symptoms would likely indicate the end of life is near for her?
    Thank you for this blog. Kirstie

    1. Hi Kirsty. My experience with using chemotherapy for EL is limited to 2 dogs but having also looked at the literature and spoken to our local oncologist I think it is a reasonable decision to not pursue chemotherapy. EL is a horrible disease with poor response rates and so not using these drugs is not a case of depriving a dog of a cure. Yes, there is likely to be improvement in the survival time but this is measured in months. We have to weigh up the reasonably high chance of side-effects that will occur during treatment.
      Having said this, for most susceptible cancers I usually do go for chemotherapy but then stop it quickly if the dog is not coping well. In your case with the distance to travel that might swing the decision. As for the end of life, like with so many chronic diseases, it’s often best judged on your dogs attitude and joie de vivre. As long as they maintain their happy self and perform all their normal daily routines with the same gusto, no matter how bad the lesions look they are probably feeling fine. However, once they start withdrawing or becoming subdued I would worry a lot about proceeding.

  5. My sweet little dog was just diagnosed. As you indicated, he has been treated for numerous skin lesions, for many months, with no improvement. The results of his biopsy just came in and I am devastated. He is a nearly 10 year old pug and I can’t bear to watch him suffer. He has been given a steroid shot for itching, is taking antibiotics, and is on pain medication. I have opted not to do chemotherapy. I would welcome suggestions on, at what point, is euthanasia recommended? I don’t want him to suffer.

    1. Hi Kim. It’s reasonable to try chemotherapy, as a proportion do very well. However, euthanasia is best when there’s clearly no improvement or at the first signs of relapse. Without chemo, I would not persist for long at all as these poor dogs will inevitably worsen.

  6. My dog has some sort of a bit bloody smooth pink ball on neck. There is 2. It looks very bad..i can’t believe i didn’t notice it. It is outside of his body. Is it something really bad?

  7. Thank you for your info. Our 8.5 years old Border Collie has today been diagnosed with the C E L having had a huge lump removed from under the skin near his nose. He had no signs of this illness apart from the lump which appeared 3 months ago, until his lymph node was swollen. The first biopsy was unclear. Our Vet said we could think about chemo but he didn’t sound hopeful about it. He suggested we do our own research then get back to him.

  8. My Dog has some of these sores on her will she die from this and if so what can I do. Dogs name is Angel . Thank you

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