Mycosis Fungoides: What You Need to Know

Share Article

Dermatologist Dr. Joshua Fox of Advanced Dermatology PC Offer Tips on a Type of Lymphoma

Dr. Joshua Fox

Mycosis fungoides generally presents initially as a red, itchy rash that may last months or even years and may be difficult to diagnose.

Mycosis fungoides isn't classic skin cancer but it is cancer and it does affect the skin. It is a type of cutaneous T-cell lymphoma. Lymphomas are cancers of the lymph system. In mycosis fungoides, T-cell lymphocytes, which are white blood cells that normally help the body fight infection, become cancerous and cause lesions in the skin. “Mycosis fungoides generally presents initially as a red, itchy rash that may last months or even years and may be difficult to diagnose,” says Dr. Joshua Fox of Advanced Dermatology, P.C. “It's important for people to realize that mycosis fungoides is quite rare, accounting for fewer than 4 cases per million people in the U.S.*, and the vast majority of rashes are caused by a wide variety of less serious factors. But any persistent skin condition, especially if resistant to treatment, should be thoroughly evaluated by a dermatologist and if necessary be biopsied.”

Mycosis fungoides occurs most often in people over the age of 50 and affects twice as many men as women. It typically progresses slowly through several stages although not all individuals go through all the stages. In the earliest stage lesions known as patches appear, usually on the abdomen, thighs, buttocks and breasts. Patches are flat, scaly, red areas that might be itchy. They are caused not by cancerous skin cells but by cancerous T-cells that move from the blood into the skin. Patches may disappear and reappear or remain stable. Mycosis fungoides is often misdiagnosed at this stage, as the rash resembles benign conditions such as eczema, psoriasis, dermatitis or fungal infection. “A skin biopsy is needed to establish the presence or absence of cancerous T-cells,” says Dr. Fox, “but even biopsies are often inconclusive and may have to be repeated over time before a definitive diagnosis can be confirmed.”

In the next stage of mycosis fungoides patches progress to the plaque phase, in which small raised bumps (papules) or hardened lesions appear, generally on the same parts of the body as the patches and sometimes simultaneously with patches. An individual may have patches and plaques for years and never progress further or may develop tumors on the skin, which is the next stage. Tumors appear as raised nodules that are harder and thicker than plaques; they may develop open sores that can become infected. While the cancerous T-cells can spread to internal organs at any stage, it is in the tumor phase that metastasis to the lymph nodes, spleen, liver and lungs is most likely.

Tips on diagnosis and treatment
When mycosis fungoides has been diagnosed at any stage, additional tests and biopsies are performed to determine if the disease has spread beyond the skin to other organs. Depending on results, treatment may be either topical, applied directly to the skin, or systemic, taken orally or by injection and targeting both the skin and internal organs. In general, topical treatments are used in early stage disease and systemic treatment, or a combination of topical and systemic, are used in later stages or in early stages where the condition has not responded to topical therapies.

Topical treatments include topical forms of chemotherapy, retinoids and corticosteroids as well as light and radiation therapies. Other less popular therapies include: Narrow Band UVB at 311nm wavelength, has been used in few practices with great success. “Patients are frequently sent to our offices for this mild, non-toxic therapy. It has reversed the disease in most cases”, says Dr. Fox. If the disease starts to reoccur, the treatment can be restarted. Alternatively the patient once clear can be put on a maintenance schedule of UVB treatments to help keep the disease away. Patients have stayed clear for decades with this treatment.

PUVA is a light therapy that combines a plant product called psoralen with ultraviolet light (UVA or UVB). Psoralen, which is taken orally, makes the T-cells more sensitive to ultraviolet light, enhancing its effectiveness in clearing the skin. Electron beam radiation exposes the entire body to radiation that doesn't penetrate deeper than the skin. Local radiation might be used on a specific area. Systemic treatments include oral retinoids, single-agent chemotherapy such as methotrexate, and interferon alfa, and other new promising biological agents.

It is not known what causes the normal T-cell to become cancerous and cause mycosis fungoides. There have been instances of the condition occurring in families but no link to any specific genetic factor has been identified and it occurs most often in individuals with no family history. “Mycosis fungoides is hard to cure but we have a wide variety of treatments that relieve symptoms and improve quality of life,” says Dr. Fox. “And research continues to identify new treatments and determine which therapies or combinations of therapies are safest and most effective.”

Joshua L. Fox, M.D., F.A.A.D., Medical Director at Advanced Dermatology PC. He is board certified and specializes in skin cancer, cosmetic surgery and laser procedures.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation with 13 locations in New York and New Jersey, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Melissa Chefec
+1 (203) 968-6625
Email >
Visit website