Mycosis Fungoides (leonine facies)

Diagnosis: Mycosis Fungoides (leonine facies)

Leonine facies in an eldely woman with mycosis fungoides

Clinical Presentation

Leonine facies in an eldely woman with mycosis fungoides

Clinical History

Submitted by Alaa Saad. Originally posted October 12, 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, leonine, facies, alaa saad