HPI: This 65 yo man has had a dermatitis around his hips since childhood. In 1999, a biopsy was done that was reported as "very suggestive of MF." He was treated with PUVA in 1999 and since then with topical corticosteroids (initially clobetasol and more recently fluocinonide). His disease is either quiescent or has not progressed since diagnosis.
O/E: There are patches and plaques on the left and to a lesser extent right hips. Some atrophy and "cigarette paper changes" are present on the left hip. There is no to minimal involvement elsewhere. He has no lymphadenopathy.
Diagnosis: CTCL, MF type. Patient has had a rash in the area since childhood. Since the pathological diagnosis was first made in 1999 his disease has not progressed much and is still probably Stage IA.
Pimpinelli N, Wood GS; et. al. International Society for Cutaneous Lymphoma.
J Am Acad Dermatol. 2005 Dec;53(6):1053-63. Review.
Abstract: This editorial review summarizes the results of 5 meetings sponsored by the International Society for Cutaneous Lymphoma at which the clinicopathologic and ancillary features of early mycosis fungoides were critically examined. Based on this analysis, an algorithm was developed for the diagnosis of early mycosis fungoides involving a holistic integration of clinical, histopathologic, immunopathologic, and molecular biological characteristics. A novel aspect of this algorithm is that it relies on multiple types of criteria rather than just one, for example, histopathology. Before its finalization, the proposed diagnostic algorithm will require validation and possibly further refinement at multiple centers during the next several years. It is anticipated that a more standardized approach to the diagnosis of early mycosis fungoides will have a beneficial impact on the epidemiology, prognostication, treatment, and analysis of clinical trials pertaining to this most common type of cutaneous lymphoma.
3. Imiquimod in mycosis fungoides. Free Open Access