Treatment of mycosis fungoides: results from a large international study

Mycosis fungoides is a type of blood cancer. The early phases of mycosis fungoides are represented by patches (flat lesions) or plaques (solid lesions) on the skin. Treatment usually consists of topical steroid creams, phototherapy (using ultraviolet light) or radiotherapy (using radiation). Together these methods are called skin‐directed treatments. This study enrolled 395 patients with a new diagnosis of mycosis fungoides from 41 centres across 17 countries in Europe, North and South America, and Australia. The results show that the majority of patients (82%) received skin‐directed treatment as the first medication, while 11% first received tablets or injections. Patients who were treated first with tablets or injections showed more severe disease, plaques more frequently than patches, thicker skin lesions, and mycosis fungoides involving hair follicles. The presence of plaques was associated with a worse outcome and lower response to therapy. We also showed that half of these patients had significantly reduced quality of life, which improved after treatment. The proportion of patients who achieved a complete or partial clearance of the skin lesions was 67%. Overall, 73% more people receiving skin‐directed treatments responded to therapy than those receiving tablets or injections. This means that it is generally preferable to start therapy with skin‐directed treatment in most cases. This study suggests that treatment of patients with early‐stage mycosis fungoides should focus on patients with high‐risk skin features and evaluation of quality of life. Linked Article :  Quaglino et al . Br J Dermatol 2021; 184 :722–730.