QWhat are the three stages of Mycosis Fungoides?

A
Jill Cowan, FNP-BC

Jill Cowan, FNP-BC

DOCS Dermatology
Cincinnati, OH

Medically Reviewed by Nick Brownstone, MD

Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL) with a higher incidence in males than females. It is also more commonly found in African Americans than Caucasians. The average age of onset is about 50 – 55 years old and tends to have a more indolent nature. The exact etiology of MF is unknown, however, it is thought that ultraviolet radiation, environmental exposures, and infection can play a role.

The three stages of MF are patch, plaque, and tumor. Beginning first with the patch stage, individuals will present with thin plaques, sometimes erythematous, with an overlying fine scale. It is said to resemble cigarette-paper. Commonly affected areas are those not often exposed to sunlight. Next, the plaque stage. In this stage, patients will develop erythematous to brown plaques that are often pruritic. The shape of these plaques can vary from oval to serpiginous. Lastly is the tumor stage. Tumors can vary in size, being anywhere from 1cm or greater, and present as violaceous to erythematous tumors. These tumors can also develop ulcerations or necrosis. Similar to the other stages, pruritus continues to affect patients.

Important to note is the difference between MF and Sezary syndrome. Sezary syndrome consists of the following: erythroderma, lymphadenopathy, and the presence of Sezary cells within the skin, lymph nodes, and bloodstream. A Sezary cell is a cancerous, abnormally shaped, fast-growing T cell that can be found within the skin, blood, and lymph nodes. Sezary syndrome is often more aggressive and tends to affect adults between 60-65 years of age. Fortunately, Sezary syndrome is less common, accounting for 2% of the population with CTCL versus approximately 39% of individuals with CTCL having MF.

References:

  1. Cutaneous T Cell Lymphoma. VisualDx. (n.d.). https://www.visualdx.com/visualdx/diagnosis/?moduleId=101&diagnosisId=51907&age=4#Look_For 
  2. Jonak, C., Guenova, E., Tittes, J., & Brunner, P. (2021). Mycosis fungoides and Sézary syndrome. Journal Der Deutschen Dermatologischen Gesellschaft. 
  3. Miyashiro, D., & Sanches, J. A. (2023). Mycosis fungoides and Sézary Syndrome: Clinical presentation, diagnosis, staging, and Therapeutic Management. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1141108 
  4. NCI Dictionary of Cancer terms. Comprehensive Cancer Information – NCI. (n.d.). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/sezary-cell 
  5. Premalignant and malignant nonmelanoma skin cancer. CTCL. (n.d.). In Habif’s Clinical Dermatology (p. Chapter 21). essay.