In those without or only minimal symptoms watchful waiting is generally appropriate.CLL is treated by chemotherapy, radiation therapy, biological therapy, or bone marrow transplantation. Symptoms are sometimes treated surgically (splenectomy – removal of enlarged spleen) or by radiation therapy ("de-bulking" swollen lymph nodes).Initial CLL treatments vary depending on the exact diagnosis and the progression of the disease, and even with the preference and experience of the health care practitioner. Any of dozens of agents may be used for CLL therapy. Decision to treat
While it is generally considered incurable, CLL progresses slowly in most cases. Many people with CLL lead normal and active lives for many years—in some cases for decades. Because of its slow onset, asymptomatic early-stage CLL (Rai 0, Binet A) is, in general, not treated since it is believed that early-stage CLL intervention does not improve survival time or quality of life. Instead, the condition is monitored over time to detect any change in the disease pattern.The decision to start CLL treatment is taken when there is evidence for progressive symptomatic disease (summarized as "active disease").Clinical "staging systems" such as the Rai four-stage system and the Binet classification can help to determine when and how to treat the patient.Determining when to start treatment and by what means is often difficult; no survival advantage is seen in treating people with asymptomatic early-stage CLL. The International Workshop on CLL (iwCLL) has issued guidelines with specific markers that should be met to initiate treatment. Chemotherapy
Combination chemotherapy regimens are effective in both newly diagnosed and relapsed CLL.
Areas consistent with proliferation can be found in some cysts. In rare cases, this leads to formation of a tumor, known as a proliferating trichilemmal cyst. The tumor is clinically benign, although it may display nuclear atypia, dyskeratotic cells, and mitotic figures. These features can be misleading, and a diagnosis of squamous cell carcinoma may be mistakenly rendered. Treatment
Surgical excision is required to treat a trichilemmal cyst. The method of treatment varies depending on the physicians training. Most physicians perform the procedure under local anesthetic. Others prefer a more conservative approach. This involves the use of a small punch biopsy about one-fourth the diameter of the cyst. The punch biopsy is used to enter the cyst cavity. The contents of the cyst are emptied, leaving an empty sac. As the pilar cyst wall is the thickest and most durable of the many varieties of cysts, it can be grabbed with forceps and pulled out of the small incision. This method is best performed on cysts larger than a pea that have formed a thick enough wall to be easily identified after the sac is emptied. Small cysts have thin walls, so are easily fragmented on traction. This increases the likelihood of cyst recurrence. This method often results in only a small scar, and very little if any bleeding. See also
Proliferating epidermoid cyst
List of cutaneous conditions

References


== External links ==