Mycosis Fungoides

Diagnosis: Mycosis Fungoides

Rust-colored plaque, a stage in the evolution of granulomatous slack skin.

Clinical Presentation

Rust-colored plaque, a stage in the evolution of granulomatous slack skin.

Clinical History

Submitted by Alaa Saad. Originally posted October 3, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Eczema/dermatitis • Psoriasis • Tinea corporis • Pityriasis rosea • Drug eruption • Vitiligo (hypopigmented MF) • Parapsoriasis • Contact dermatitis

Key Learnings

• Most common form of cutaneous T-cell lymphoma (CTCL) • Classic progression: patch → plaque → tumor stage (may take years/decades) • Hypopigmented MF: important variant in children and patients with darker skin • Pautrier microabscesses (collections of atypical T-cells in epidermis) are pathognomonic but not always present • "Bathing trunk" distribution in early stages — non-sun-exposed areas • Sézary syndrome: leukemic form with erythroderma, lymphadenopathy, Sézary cells in blood • Early-stage has excellent prognosis (normal life expectancy) — skin-directed therapy is first-line • Multiple biopsies often needed for diagnosis — clinical-pathological correlation is essential

Tags: mycosis, fungoides, alaa saad