MYCOSIS FUNGOIDES (MF) is the most common primary cutaneous T-cell lymphoma (CTCL).1 It is characterized by malignant T cells that infiltrate the skin or extracutaneous sites. Early-stage MF (limited, generalized patch, and plaque, T1 and T2, stages IA-IIA) is typically limited to the skin. Subsequently, the management of early-stage MF frequently involves skin-directed therapies, which include topical glucocorticoids, nitrogen mustard (mechlorethamine hydrochloride), carmustine, UV-B radiation, psoralen–UV-A radiation, and electron-beam radiation therapy. Aggressive therapy with combination chemotherapy does not result in a more favorable outcome compared with conservative management with sequential skin-directed therapies. In fact, patch and plaque lesions have been noted to persist throughout the course of chemotherapy regimens or to quickly relapse after initial clearing. Patients with early-stage CTCL have excellent prognoses when they are treated for their skin disease. The overall long-term life expectancy of patients with limited patch or plaque disease has been shown to be similar to that of an age-, sex-, and race-matched control population.2 Moreover, in a long-term retrospective study of patients with MF with extracutaneous disease, the extent of skin involvement correlated with the risk of developing extracutaneous disease.3 Although long-lasting remissions are possible with the previously mentioned skin-directed therapies, most patients experience disease relapses when not receiving therapy. In addition, patients with partial responses or stable disease may require alternative therapies. The expansion of skin-directed agents will prove useful in managing early-stage CTCL.
Howard L. Liu, Youn H. Kim. Bexarotene GelA Food and Drug Administration–Approved Skin-Directed Therapy for Early-Stage Cutaneous T-Cell Lymphoma. Arch Dermatol. 2002;138(3):398–399. doi:10.1001/archderm.138.3.398