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August 1974

Diagnosis and Treatment of Mycosis Fungoides-Reply

Arch Dermatol. 1974;110(2):302. doi:10.1001/archderm.1974.01630080090046

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To the Editor.—  It has long been acknowledged that pretumorous lesions of mycosis fungoides, such as parapsoriasis en plaques and poikiloderma vasculare atrophicans, cannot always be diagnosed with certainty as mycosis fungoides, clinically or histologically. Our paper titled "Spongiotic Simulants of Mycosis Fungoides" told of another unsettling phenomenon, namely, of patients who did not have mycosis fungoides, but whose skin biopsy specimens showed spongiotic foci containing atypical mononuclear cells that were indistinguishable from Pautrier microabscesses. A corollary from this finding was that patients who do not have absolutely proven mycosis fungoides should not be treated with potentially harmful modalities. If the electron beam or topical mechlorethamine hydrochloride therapy, advocated by Drs. Constantine and Fuks for "early cases of mycosis fungoides," had been given to our patients with spongiotic simulants of mycosis fungoides, the lesions would have likely gone into complete remission, but at what a price! Our patients, in fact,

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