Clinical Features

Men are more often affected than women (male:female ratio, 2:1) (1). Most frequently, MF affects adults, usually in the 5th-6th decades, although any age group may be involved. In some cases, the disease starts with nonspecific scaly lesions resembling chronic dermatitis, parapsoriasis, tinea corporis, or other inflammatory dermatoses. In other instances, patients present with more distinctive irregular, well-circumscribed, scaling patches varying in size from 2-3 to 10-15 cm (Fig. 1). The number of lesions is also variable. In some cases, only a few patches could be observed, whereas in other instances, the lesions can be numerous and widely distributed. Pruritus is common and often severe. In some cases, the patches show a tendency to partial spontaneous remission that, in combination with peripheral growth, leads to the development of lesions with unusual configurations (annular, semicircular, serpinginous). It usually takes several years until the patches progress into plaques and tumors, which may then ulcerate (Figs. 2-4). A subset of patients have persistent patch-stage disease for many years or even decades. Lymph nodes and internal organs may become involved in the later stages of MF. In the advanced

Figure 1 Patch stage: large erythematous and scaling patches on the buttocks, virtually indistinguishable from large plaque parapsoriasis in a patient with proven MF.
Figure 2 Plaque stage: disseminated infiltrated plaques on the back.
Figure 3 Tumor stage: several large tumors on the background of patches and plaques in advanced MF.
Figure 4 Tumor stage: ulcerated tumor in advanced MF.
Figure 5 Patch stage: sparse lymphocytic infiltrate with lymphocytes lined up along the junctional zone and scattered throughout the epidermis.

stages, progression to a high-grade T-cell lymphoma (Fig. 4) is observed in approximately 25% of cases and is usually associated with an aggressive clinical course (2-5).

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