Conflicting clinical presentations and pathologic features create diagnostic challenges2
For early and accurate diagnosis of MF-CTCL, consider history, location, morphology, and pathology3
The persistent nature of MF-CTCL may be an important aspect of the patient’s medical history3
Predominant locations of MF-CTCL versus other inflammatory skin conditions4-6
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
- Scaly, erythematous, atrophic patch
- Individual lesions may vary in size, shape, and pigment, but are typically >5 cm
- Scaly, infiltrative, coalescing plaques, with some associated erythema
- More generalized distribution
- Loss of skin pigment
- Nonatrophic macules and patches
- Rare variant of early stage MF-CTCL
Pathologic features of early stage MF-CTCL3,7
- Mild band-like infiltrate in superficial dermis with papillary dermis fibrosis and atypical haloed lymphocytes scattered along dermoepidermal junction
- Dense, thick, band-like infiltrate in middle and upper dermis
- Marked atypical lymphocytes are present with irregular nuclear contours and perinuclear halos
- Prominent epidermotropism and patchy periadnexal lymphocytic infiltrates
- 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.
- 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.
- Pimpinelli N, Olsen EA, Santucci M, et al. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53:1053-1063.
- Weidinger S, Novak N. Atopic dermatitis. Lancet. 2016;387(10023):1109-1122.
- Psoriasis: more than skin deep. Harv Men's Health Watch. 2010;14(12):4-5.
- 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.
- Ahn CS, ALSayyah A, Sangüeza OP. Mycosis fungoides: an updated review of clinicopathologic variants. Am J Dermatopathol. 2014;36(12):933-951.
- 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.
- 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.
- Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol. 2016;91(1):151-165.