Internal dissemination of mycosis fungoides despite successful local therapy

Abstract

Prediction of the course of mycosis fungoides is still impossible, despite thorough examination and staging of the disease before treatment. Since several forms of potent local treatment are available for this disease, such as topical nitrogen mustard, total skin electron irradiation and psoralen combined with long wave UV light, signs of internal dissemination of the disease must be noted even when the skin is free from mycosis fungoides lesions. This is illustrated by the case histories of 3 patients initially considered to be free from lymph node or internal dissemination after successful local treatment but who subsequently developed disseminated lymphoma without any skin lesions. Mycosis fungoides usually has a slowly progressing course. Internal dissemination occurs mainly in the advanced stages. The presented case histories underline the importance of the question whether mycosis fungoides starts in the skin, which might justify the treatment of the skin only, or whether it is a generalized lymphoma from the very outset, for which both topical treatment and internal cytostatic therapy are needed.