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Unusual skin presentation well controlled

Skin. It’s that time of year again when about a third of our consults are skin related, primarily itchy skin, with common sites being ears and paws. The causes of this often come down to a handful of common conditions – fleas, mites, allergic/sensitive skin (called allergic dermatitis) and other conditions such as fungal infections inc. ringworm, and surface skin infections (hot spots).

A less well know but very serious skin condition which can present in a multitude of ways is skin lymphoma, or cutaneous lymphoma. Lymphoma itself is a type of cancer, which is a word which has a large emotional pull on almost anyone that reads it. We can all relate to it in some way and often the very thought of our pets getting the C word makes us think they have very little time left. This is not always the case. In a lot of situations cancers of our animals can be controlled extremely well and the animals themselves can have perfectly normal happy lives for many more months or even years, longer than some initially less emotive conditions.

Petra is a lovely almost 12 year old crossbreed who originally came to us as her owners reported difficulty eating, a sore mouth and 2 recent lumps which had been noticed, one on the lip and one on the shoulder.  She was seen at our Wells practice and the lumps were both sampled and Petra was started on antibiotics and anti-inflammatories for ulceration present on the tongue. The samples came back the next day suggestive of lymphoma. Cutaneous lymphoma can present in a variety of ways; skin and oral nodules (as in this case), or diffuse skin disease including itchiness, scaling and hair loss which can often be mistaken for some of the more common skin issues seen at this time of year mentioned above.

Following this diagnosis we had 2 options for Petra. The first was continued use of steroids to shrink and keep the nodules at bay, which would give a rough survival time of 1-2 months on average. The alternative was a form of chemotherapy. Similar to the emotive response we often feel when hearing about a cancer diagnosis, a similarly strong response is often elicited when discussing chemotherapy often based on personal experiences of chemotherapy in humans. It should be realized that the goal of chemotherapy in animals is vastly different to the goal in humans. Whereas in humans often chemotherapy is used to cure people of cancer, in our patients chemotherapy is used to control the condition.

This difference is based on us wanting to provide a good quality life to our patients, where the side effects seen in human chemotherapy would be unacceptable. As such chemotherapy can be used to keep cancers at bay for months to years, with our pets enjoying life as normal. When chemotherapy is to be used, the 3 most common and biggest factors detrimental to the animal’s quality of life are nausea/sickness, pain, and inappetance. If any one of these 3 factors are present due to or in spite of treatment, then the quality of life achieved should be considered inadequate and must be addressed or the therapy stopped.

The chemotherapy protocol for Petra was fairly straight forward, a combination of steroids and an anti-cancer drug called Lomustine (CCNU), both given in tablet form. The steroids were to be given daily whereas the Lomustine is only given once every 3-4 weeks. The results were remarkable. Within 24 hours of treatment all nodules were almost completely gone and Petra has had no further issues with eating. Regular blood samples taken around once a month again at our Wells practice are all that is required to ensure no adverse effects from the medications and it has been 5 months since Petra’s diagnosis; as far as she’s concerned she’s as lively as ever!

In Petra’s case chemotherapy has provided a relatively straight forward treatment for what might initially sound like a hopeless condition, and she continues to be blissfully unaware, maintaining a quality of life much the same as before the diagnosis. Here’s to hoping for another symptomless 5 months.