Background Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma that primarily affects the skin, caused by malignant T-cells accumulating in the skin and leading to symptoms like red, scaly patches, plaques, or tumors. The exact causes of CTCL are not known, and little research has been done studying patients who have CTCL and their exposures to environmental toxins from superfund sites and toxic release inventory sites. Superfund sites and toxic release inventory sites are EPA recorded contaminated sites that contain hazardous materials. This study aimed to determine whether CTCL cases aggregate near superfund and toxic release inventory sites by investigating the geographic distribution of CTCL from a medical center in Louisiana.

Methods Data was collected from the electronic medical record system, Epic, covering patients in Louisiana from 2019 to 2024. Eligible patients were identified as those with a confirmed diagnosis of CTCL, as indicated by specific ICD codes: 02.1, 116, 202.84, 709.8, C84.01, C84.04, C84.05, C84.06, C84.08, C84.09, C84.A1, C84.A4, C84.A8, C84.A9, and L98.6. A total of 378 individuals diagnosed with CTCL across 137 unique zip codes were included in the study. Geographic data on superfund sites and toxic release inventory (TRI) sites were obtained from the United States Environmental Protection Agency (EPA) database. Analysis was conducted using ArcGIS, a geographic information system (GIS) software, to map the geographic distribution of CTCL cases in Louisiana and calculate distances between zip codes and superfund or TRI sites.

Results and Conclusion A total of 378 individuals diagnosed with Cutaneous T-cell lymphoma (CTCL) across 137 unique zip codes in Louisiana were included in the study. Significant geographic clustering was observed particularly in zip codes 70115, 70119, 70003, and 70072. A Pearson correlation analysis revealed a statistically significant negative correlation (r = -0.7644, p = 0.038) between CTCL prevalence and distance to Superfund and Toxic Release Inventory (TRI) sites, suggesting a possible environmental influence on disease distribution. Demographic analysis showed that White patients represented the largest group (45.6%), followed by Black patients (35.0%). Notably, White patients were on average older at diagnosis (69.5 years), while Black patients were younger (60.2 years), and Hispanic patients were the youngest (52.3 years).

Differences in CTCL subtypes and skin-related diagnoses were evident across racial groups. White patients had higher rates of Mycosis Fungoides (30.2%), whereas Black patients had significantly higher rates of non-lymphoma skin disorders (26.5% vs. 9.3%). Both groups showed similar rates of non-Hodgkin lymphoma variants. These findings suggest potential racial differences in disease manifestation or diagnostic classification, as well as possible disparities in access to dermatologic care or referral patterns. Limited sample sizes for Hispanic, Asian, and Native American patients restrict broader generalizations, but initial trends point to variation in disease presentation across these groups as well. Overall, the results underscore a potential link between environmental toxin exposure and CTCL, as well as racial disparities in disease diagnosis and subtype distribution.

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2025
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