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Identifying early stage MF-CTCL can be critical for determining effective treatment

Time from first symptoms to diagnosis1

Evaluating MF-CTCL

Conflicting clinical presentations and pathologic features create diagnostic challenges2

For early and accurate diagnosis of MF-CTCL, consider history, location, morphology, and pathology3

History

The persistent nature of MF-CTCL may be an important aspect of the patient’s medical history3

Location

Predominant locations of MF-CTCL versus other inflammatory skin conditions4-6

Atopic dermatitis

Atopic dermatitis4

Psoriasis

Psoriasis5

MF-CTCL MF-CTCL

MF-CTCL6

MF-CTCL tends to be seen on sun-protected areas of the body (other areas of the skin may also be affected)6

Morphologic features of early stage MF-CTCL3,7,8

Patch

Patch

  • Scaly, erythematous, atrophic patch
  • Individual lesions may vary in size, shape, and pigment, but are typically >5 cm
Plaque

Plaque

  • Scaly, infiltrative, coalescing plaques, with some associated erythema
  • More generalized distribution
Hypopigmentation

Hypopigmentation

  • Loss of skin pigment
  • Nonatrophic macules and patches
  • Rare variant of early stage MF-CTCL

Pathologic features of early stage MF-CTCL3,7

Patch

Patch

  • Mild band-like infiltrate in superficial dermis with papillary dermis fibrosis and atypical haloed lymphocytes scattered along dermoepidermal junction
Plaque

Plaque

  • Dense, thick, band-like infiltrate in middle and upper dermis
  • Marked atypical lymphocytes are present with irregular nuclear contours and perinuclear halos
Hypopigmentation

Hypopigmentation

  • Prominent epidermotropism and patchy periadnexal lymphocytic infiltrates

Prior to accurate diagnosis, patients may not receive medications that are FDA-approved, or have been studied as MF-CTCL therapy9,10

Understanding MF-CTCL

Understanding
MF-CTCL
Evaluating MF-CTCL

Evaluating
MF-CTCL
Importance of multiple biopsies

Importance of
multiple biopsies

References:

  1. Kim YH, Liu HL, Mraz-Gernhard S, Varghese A, Hoppe RT. Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome. Clinical prognostic factors and risk for disease progression. Arch Dermatol. 2003;139:857-866.
  2. Song SX, Willemze R, Swerdlow SH, Kinney MC, Said JW. Mycosis fungoides: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop. Am J Clin Pathol. 2013;139(4):466-490.
  3. Pimpinelli N, Olsen EA, Santucci M, et al. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53:1053-1063.
  4. Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109-1122.
  5. Psoriasis: more than skin deep. Harv Men's Health Watch. 2010;14(12):4-5.
  6. Mark LA. Mycosis fungoides: diagnosis and work-up of early stage disease. Practical Dermatology website. http://practicaldermatology.com/2010/03/mycosis-fungoides-diagnosis-and-work-up-of-early-stage-disease. Published March 2010. Accessed February 19, 2019.
  7. Ahn CS, ALSayyah A, Sangüeza OP. Mycosis fungoides: an updated review of clinicopathologic variants. Am J Dermatopathol. 2014;36(12):933-951.
  8. Hoppe RT, Kim YH. Clinical manifestations, pathologic features, and diagnosis of mycosis fungoides. UpToDate website. https://www.uptodate.com/contents/clinical-manifestations-pathologic-features-and-diagnosis-of-mycosis-fungoides. Accessed February 19, 2019.
  9. Lymphoma Research Foundation. Getting the facts: cutaneous T-cell lymphoma. Lymphoma Research Foundation website. https://www.lymphoma.org/wp-content/uploads/2017/06/LRF_FACTSHEET_Cutaneous_TCell_Lymphoma_CTCL.pdf. Updated August 2017. Accessed February 19, 2019.
  10. Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016;91(1):151-165.