Mycosis Fungoides

Starting as a non-specific symptom or lesions, Mycosis Fungoides takes a very chronic course, extending over years, to terminate fatally. Its clinical evolution passes through three phases, viz., premycotic or non-specific stage, infiltrative stage and the tumor stage. Organs connected with the reticular system i.e. liver, spleen and lymph glands may also be affected.

Mycosis Fungoides Pre-mycotic stage:

• Clinical Features - Pruritus; erythematous urticarial, eszematous, psoriasiformi, erythema multiforme-like lesions, pityriasis rubra pilaris etc. Distribution generalized Characteristic multiforme and vivid colors.
• Histology - Non-specific inflammation especially in deeper dermis.

Mycosis Fungoides Infiltrative stage:

• Clinical Features - Pre-existing lesions getting infiltrated. Mucous membranes also affected. Erythroderma more often seen in this stage. Lesions may ulcerate.
• Histology - Pleomorphism, Mycosis cells, Mitotic figures, Pautrier's abscesses and Abundant infiltrate.

Mycosis Fungoides Tumor Stage:

• Clinical Features - Infiltrated lesions gaining in size to form tumors. Sometimes de novo origin. The ulcer formed is deep, base covered with grey crust; margins may be rolled.
• Histology - All the features of the infiltrative stage are much more pronounced.

Diagnosis of Mycosis Fungoides

It may not be easy especially in the early stages since clinical and histological features are non-specific but in elderly persons, mycosis fungoides should always be considered--in differential diagnosis.

Treatment of Mycosis Fungoides

Treatment of choice in mycosis fungoides is radiotherapy and steroids. These modalities bring subjective and symptomatic remissions without affecting the ultimate course. Methotrexate has been tried successfully by many. Infusions of monoclonal antibodies may help.