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| Fig. 46.1 Mycosis fungoides. A, A 12-year-old boy with extensive patch-stage mycosis fungoides. B, A patient with extensive patch-, plaque-, and tumor-stage mycosis fungoides. C, Tumor-stage mycosis fungoides. This patient had skin lesions for 18 years before tumors developed and a diagnosis was made. |
Typically, mycosis fungoides begins with persistent scaly patches (Fig. 46-1A) that respond poorly to topical therapy with emollients and topical steroids. In the early stages, skin biopsy is frequently not diagnostic. The average time from onset of skin lesions to diagnosis is 7 years. In this early phase of the disease, a diagnosis of parapsoriasis en plaque is often made. In time, the patches thicken and become plaques. Eventually, skin tumors develop (Fig. 46-1B,C) and the lymph nodes can become involved. Visceral disease is a late occurrence in this low-grade lymphoma. Median survival for persons with patchand plaque-stage disease is 12 years; for tumor-stage disease, it is 5 years; and for nodal or visceral disease, it is 3 years.
Epstein E, Levin D, Croft J, et al: Mycosis fungoides: survival, prognostic features, response to therapy, and
autopsy findings, Medicine 51:61–72, 1972.
