Mycosis fungoides patch stage C84.0

Clinically diverse and variable picture (mean time interval from first symptoms to diagnosis: 4.2 years!). Skin symptoms are initially in the foreground, systemic involvement is only detectable after a longer clinical course.

• Initial stage (premycosid stage) ("patch-stage"):
  • Mostly few (> 10), rarely solitary, constant location spots occurring in non-exposed areas (chest, flexion side of the upper arms and thighs, other parts of the trunk, e.g. flanks). Sharply defined, large-area (length > 5.0 cm; width < 3.0 cm), either homogeneously red or reddish-brown spots with a wrinkled surface (like cigarette paper), aligned in the cleft lines of the skin.
  • Clinically less characteristic, eczema-like picture, moderate or absent itching. Minor to absent, mostly small spotted scaling. Significant improvement under sunlight and local glucocorticoid therapy, but no healing.
  • Rare is also a colourful surface pattern (poikilodermatic) with intralesional, alternating brown, brown-red and white spots and telangiectasia.

Preferably on the trunk, also on the buttocks. Rarely extensor sides of the lower or upper extremities.

Initial stage (premycosid stage) ("patch-stage"):

• Mostly few (&gt; 10), rarely solitary, stationary patches occurring in places not exposed to sunlight (chest, flexion side of upper arms and thighs, other parts of the trunk, e.g. flanks). The face is rarely affected in the early stages!
• Sharply defined, large-area (length &gt; 5.0 cm; width &lt; 3.0 cm), in the cleft lines of the skin aligned, either homogeneously salmon-red or red-brown spots with a wrinkled surface (like cigarette paper). This surface texture is typical for this disease. It is best tested by pushing the skin together between 2 fingers with good lateral light incidence.
• A colourful surface pattern (poikilodermatic) with intralesional, alternating brown, brown-red and white patches and telangiectasia (rare occurrence; cf. parapsoriasis en plaques large-heart poikilodermatic form) is also possible.
• Overall, clinically little characteristic eczema-like picture with moderate or absent itching. Minor to absent, if present mostly small spotted scaling.

• Parapsoriasis en grandes plaques; in fact, this form of pasapsoriasis turns into a manifest form of mycosis fungoides in 1/3 of the cases, and is therefore to be regarded as its early form (see below Parapsoriasis en plaques large-hearth inflammatory form).
• tinea corporis
• Microbial (nummular) eczema

Recurrent course for years with improvement in summer or under UV (PUVA) therapy. Significant improvement under sunlight and local glucocorticoid therapy, but no healing.

Clinical data and further pictures of Mycosis fungoides s.there.

1. Alibert JLM (1806) Description des maladies de la peau observees a l'Hospital Saint-Louis et exposition des meilleures methodes suivies pour leur traitement. Paris, Barrois l' aine et fils: 157
2. Auspitz H (1885) A case of Granuloma fungoides (Mycosis fungoides Alibert). Quarterly journal for dermatology and syphilis (Vienna) 12: 123-143
3. Diederen PV et al (2003) Narrowband UVB and psoralen-UVA in the treatment of early-stage mycosis fungoides: a retrospective study. J Am Acad Dermatol 48: 215-219
4. Kempf W et al (2003) Cutaneous T-cell lymphomas. In: Histopathology of the skin. Kerl H et al (Ed.) Springer Publishing House Berlin, Heidelberg, New York S 872-876
5. Pimpinelli N (2005) Defining early mycosis fungoides. J Am Acad Dermatol 53: 1053-1063
6. Willemze R et al (1997) EORTC classification for primary cutaneous lymphomas: a proposal from cutaneous lymphoma study group of the European Organization for Research and Treatment of Cancer. Blood 90: 354-371