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Mycosis Fungoides

definition

Mycosis fungoides is the most common type of cutaneous lymphoma. Despite its misleading name, it is not caused by a fungal infection. It is a cancer of T-lymphocytes (a type of white blood cell) that primarily affects individuals aged 40 to 60.

Although it often does not significantly impact life expectancy, it can, in advanced cases, lead to malignant proliferation of T-cells, which may spread to lymph nodes and internal organs.

  • Advanced & Modern Treatment Methods
  • Effective Disease Management
  • Improved Quality of Life

Symptoms & Stages

Premycotic Stage

Red, scaly patches appear on the trunk and limbs. These lesions tend to expand and may cover large areas of the skin. Commonly associated skin changes include hyperpigmentation and atrophy.

Plaque Stage

Lesions become thicker and more infiltrated, often accompanied by itching. Skin thickening and color changes indicate progression to active mycosis fungoides.

Tumor Stage

Red or reddish-brown nodules develop, often ulcerated. This stage is associated with a poorer prognosis and possible involvement of lymph nodes and internal organs.

Etiology

The exact cause of mycosis fungoides is not fully understood. However, research suggests a possible link to the HTLV virus (Human T-Cell Lymphotropic Virus), a retrovirus found in malignant T-cells, indicating a potential role in disease development.

Treatment Options

Once considered incurable, mycosis fungoides is now manageable with a range of therapies tailored to the disease stage.

 

Photodynamic Therapy (PDT)

PDT involves applying a light-sensitive agent to the lesion, followed by exposure to a specific light source. The drug becomes activated once the light is applied to the area and selectively destroys cancerous cells with minimal damage to healthy tissue.

  • PUVA: The patient receives psoralen (a light-sensitizing medication), followed by UVA light exposure.
  • ECP (Extracorporeal Photopheresis): A combination of leukapheresis and phototherapy. It can be used alone or in combination with total skin electron beam therapy (TSEB).

Combining phototherapy with systemic treatments like retinoids or interferon-alpha reduces side effects and enhances effectiveness.

 

Radiation Therapy

Radiation uses high-energy rays to kill cancer cells or stop their growth. External radiation therapy uses a machine outside the body to send radiation to the area of the body with cancer.

  • TSEB (Total Skin Electron Beam Therapy): A form of external radiation that targets the skin with electron beams.
  • UVA and UVB Therapy: Ultraviolet light is used depending on the depth and type of skin involvement.

 

Topical Treatments

Corticosteroids (in creams, lotions, or ointments) reduce inflammation, redness, and swelling.

Retinoids (e.g., bexarotene), derived from vitamin A, slow the growth of cancer cells.

Chlormethine gel (mechlorethamine): A bifunctional cytotoxic alkylating agent that binds DNA, preventing cell replication and inducing apoptosis.

Mechlorethamine (mustine) is also used to prevent cancer cell proliferation.

 

Immunotherapy

Interferon therapy has shown efficacy in treating cutaneous T-cell lymphomas (CTCL). The pegylated form (IFN-α2a) is typically administered at 135–180 μg subcutaneously once a week.

The combination of interferon-alpha with PUVA is highly effective, increasing complete response rates and reducing time to symptom remission.

 

Biologic Agents

Monoclonal antibodies are used to treat mycosis fungoides, targeting specific molecules on cancer cell surfaces, such as CCR4 or CD30, to block their growth and survival.

  • Mogamulizumab is a monoclonal antibody used for advanced stages of mycosis fungoides and Sézary syndrome. It targets the CCR4 receptor on malignant cells and exerts strong cytotoxic effects.

 

At Optimum Dermatology, our team of specialized physicians and innovative therapies ensure the most effective, personalized care for every stage of the disease.

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