Mycosis fungoides natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2], Sogand Goudarzi, MD [3]

Overview

If left untreated, cutaneous T cell lymphoma may progress to develop cutaneous patches, plaque, and tumors. Depending on the extent of the lymphoma at the time of diagnosis, the prognosis may vary.

Natural History

  • Mycosis fungoides is initially an indolent lymphoma that may later develop peripheral lymphadenopathy and can finally progress to widespread visceral involvement.[1]
  • Cutaneous T cell lymphoma is usually initially seen by dermatologists with patients presenting with skin lesions such as erythematous patches or plaque.
  • Patients often have a history of several years of eczematous or dermatitic skin lesions before the diagnosis is finally established.
  • The skin lesions then progress from the patch stage to the plaque stage to cutaneous tumors.

Complications

  • Common complications of Cutaneous T cell lymphoma include:
    • Mycosis Fungoides increased risk of secondary malignancies such as primary malignancy, especially Hodgkin lymphoma, chronic leukemia, and lung cancer.
    • [Complication 2]
    • [Complication 3]

Prognosis

  • Cutaneous T cell lymphoma is usually a slow-growing (indolent) lymphoma.[2]
  • The prognosis for people with cutaneous T cell lymphoma is based on the extent of disease and how the person responds to treatment.
  • Although more advanced stages of cutaneous T cell lymphoma may not be cured, the lymphoma can still be controlled with treatment.

Favorable prognosis

  • Early stage disease
  • Lymphoma is confined to the skin

Unfavorable prognosis

  • More advanced disease
  • Lymphoma has spread to lymph nodes
  • Lymphoma has spread to other organs


Staging

The staging of cutaneous T cell lymphoma is based on skin and lymph node involvement.[2] Staging for cutaneous T cell lymphoma is provided in the following table:

Staging of cutaneous T cell lymphoma [2]
Stage Involvement
stage I
I A
  • Less than 10% of the skin is covered with patches or plaques
I B
  • 10% or more of the skin is covered with patches or plaques
stage II
II A
  • Any amount of the skin is covered in patches or plaques
  • Lymph nodes are enlarged, but do not contain cancer
II B
  • There is one or more raised tumors on the skin
  • Lymph nodes may or may not be enlarged and do not contain cancer
stage III
III
  • Almost all of the skin is reddened
  • There may or may not be patches, plaques or skin tumors
  • Lymph nodes may or may not be enlarged and do not contain cancer
stage IV
IV A
  • Cancer has spread to the lymph nodes, but not to other organs in the body
IV B
  • Cancer has spread to other organs in the body, including the blood and bone marrow
  • Lymph nodes may be enlarged and may contain cancer

References

  1. Mycosis fungoides. Radiopaedia.http://radiopaedia.org/articles/mycosis-fungoides Accessed on January 20, 2016
  2. 2.0 2.1 2.2 Cutaneous T cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/cutaneous-t-cell-lymphoma/?region=on Accessed on January 19, 2016


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