eMedicine Specialties > Hematology > Stem Cells and Disorders

Mycosis Fungoides: Follow-up

Author: Lauren C Pinter-Brown, MD, Director, Lymphoma Program, Clinical Professor of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, UCLA Medical Center
Contributor Information and Disclosures

Updated: Oct 4, 2009

Follow-up

Complications

  • Infection, particularly from indwelling intravenous catheters or from lymph node biopsy sites
  • High-output cardiac failure
  • Anemia of chronic disorders
  • Edema
  • Secondary malignancies
    • Skin cancer
    • Melanoma
    • Colon cancer
    • Hodgkin lymphoma
    • Non-Hodgkin lymphomas

Prognosis

  • Mycosis fungoides and Sézary syndrome are incurable conditions in most patients, with the exception of those with stage IA disease.
  • Mortality and prognosis are related to the stage at diagnosis
    • Patients diagnosed with stage IA disease (patch or plaque skin disease limited to <10% of the skin surface area) who undergo treatment, have an overall life expectancy similar to the age-, sex-, and race-matched controls.
    • Patients who have stage IIB disease with cutaneous tumors have a median survival rate of 3.2 years, and those who have stage III disease (generalized erythroderma) have a median survival rate of 4-6 years.
    • Patients with extracutaneous disease stage IVA (lymph nodes) or stage IVB (viscera) have a survival rate of less than 1.5 years.

Patient Education

  • Encourage the use of supportive treatments in patients with mycosis fungoides to decrease pruritus and to lubricate the skin. Avoid sun exposure and remain in a cool environment.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis and perform a skin biopsy.
  • Failure to repeat a skin biopsy with special tests if the patient is not responding to treatment or the condition persists.
  • Failure to examine extracutaneous tissues (eg, blood, nodes) to obtain the diagnosis if the skin biopsy result is nondiagnostic, particularly in a patient with generalized erythroderma.
 


More on Mycosis Fungoides

Overview: Mycosis Fungoides
Differential Diagnoses & Workup: Mycosis Fungoides
Treatment & Medication: Mycosis Fungoides
Follow-up: Mycosis Fungoides
Multimedia: Mycosis Fungoides
References
Further Reading
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References

  1. Diamandidou E, Cohen PR, Kurzrock R. Mycosis fungoides and Sezary syndrome. Blood. Oct 1 1996;88(7):2385-409. [Medline]. [Full Text].

  2. Olsen E, Vonderheid E, Pimpinelli N, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. Sep 15 2007;110(6):1713-22. [Medline]. [Full Text].

  3. Hoff NP, Groffik A, Mota R, et al. [Successful use of allogeneic stem cell transplantation for treatment-refractory mycosis fungoides] [German]. Hautarzt. Oct 2008;59(10):779-82. [Medline].

  4. Rook AH, Yoo EK, Grossman DJ, et al. Use of biological response modifiers in the treatment of cutaneous T-cell lymphoma. Curr Opin Oncol. Mar 1998;10(2):170-4. [Medline].

  5. Koh HK, Charif M, Weinstock MA. Epidemiology and clinical manifestations of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. Oct 1995;9(5):943-60. [Medline].

  6. Girardi M, Heald PW, Wilson LD. The pathogenesis of mycosis fungoides. N Engl J Med. May 6 2004;350(19):1978-88. [Medline].

  7. Weinstock MA, Gardstein B. Twenty-year trends in the reported incidence of mycosis fungoides and associated mortality. Am J Public Health. Aug 1999;89(8):1240-4. [Medline]. [Full Text].

  8. Kim YH, Hoppe RT. Mycosis fungoides and the Sézary syndrome. Semin Oncol. Jun 1999;26(3):276-89. [Medline].

  9. Fink-Puches R, Wolf P, Kerl H, Cerroni L. Lichen aureus: clinicopathologic features, natural history, and relationship to mycosis fungoides. Arch Dermatol. Sep 2008;144(9):1169-73. [Medline].

  10. Kim ST, Sim HJ, Jeon YS, Lee JW, Roh HJ, Choi SY, et al. Clinicopathological features and T-cell receptor gene rearrangement findings of mycosis fungoides in patients younger than age 20 years. J Dermatol. Jul 2009;36(7):392-402. [Medline].

  11. Pai RK, Mullins FM, Kim YH, Kong CS. Cytologic evaluation of lymphadenopathy associated with mycosis fungoides and Sezary syndrome: role of immunophenotypic and molecular ancillary studies. Cancer. Sep 17 2008;epub ahead of print. [Medline].

  12. Furmanczyk PS, Wolgamot GM, Kussick SJ, Sabath DE, Olerud JE, Argenyi ZB. Diagnosis of mycosis fungoides with different algorithmic approaches. J Cutan Pathol. Jul 7 2009;[Medline].

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  14. Duvic M, Cather JC. Emerging new therapies for cutaneous T-cell lymphoma. Dermatol Clin. Jan 2000;18(1):147-56. [Medline].

  15. Foss FM, Kuzel TM. Novel treatment approaches for cutaneous T-cell lymphoma. Cancer Treat Res. 1999;99:227-40. [Medline].

  16. Herrmann JJ, Roenigk HH Jr, Hönigsmann H. Ultraviolet radiation for treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. Oct 1995;9(5):1077-88. [Medline].

  17. Zackheim HS. Cutaneous T cell lymphoma: update of treatment. Dermatology. 1999;199(2):102-5. [Medline].

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  19. Ramsay DL, Meller JA, Zackheim HS. Topical treatment of early cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. Oct 1995;9(5):1031-56. [Medline].

  20. Prince HM, Whittaker S, Hoppe RT. How we treat mycosis fungoides and Sezary syndrome. Blood. Aug 20 2009;[Medline].

  21. Gardner JM, Evans KG, Musiek A, Rook AH, Kim EJ. Update on treatment of cutaneous T-cell lymphoma. Curr Opin Oncol. Mar 2009;21(2):131-7. [Medline].

  22. Wu PA, Kim YH, Lavori PW, Hoppe RT, Stockerl-Goldstein KE. A meta-analysis of patients receiving allogeneic or autologous hematopoietic stem cell transplant in mycosis fungoides and Sézary syndrome. Biol Blood Marrow Transplant. Aug 2009;15(8):982-90. [Medline].

  23. D'Acunto C, Gurioli C, Neri I. Plaque stage mycosis fungoides treated with bexarotene at low dosage and UVB-NB. J Dermatolog Treat. Jan 1 2009;1-4. [Medline].

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Further Reading

Related eMedicine Topics


Clinical Trials
 Clinical Guideline



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Keywords

mycosis fungoides, MF, cutaneous T-cell lymphoma, CTCL, malignant T-cell lymphoma of the skin, Sézary syndrome, SS, pagetoid reticulosis, erythroderma, malignant lymphoma, skin lesions, Staphylococcus aureus, , Pseudomonas aeruginosa, , non-Hodgkin lymphoma, non-Hodgkin's Lymphoma, NHL

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Contributor Information and Disclosures

Author

Lauren C Pinter-Brown, MD, Director, Lymphoma Program, Clinical Professor of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, UCLA Medical Center
Lauren C Pinter-Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hematology, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Medical Editor

Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Marcel E Conrad, MD, (Retired) Distinguished Professor of Medicine, University of South Alabama
Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group
Disclosure: No financial interests None None

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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