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July 2009

“Cutaneous T-Cell Lymphoma”: Cutaneous TNMania in Cutaneous Lymphomas

Arch Dermatol. 2009;145(7):842-843. doi:10.1001/archdermatol.2009.135

In the recent consensus statement on granulomatous mycosis fungoides and granulomatous slack skin (GSS),1 there was a misuse of the TNM staging terminology in Table 1. This misuse will not affect outcomes for patients with either disease, but it reflects the confusion that still abounds in the field of cutaneous lymphoma.

Nomenclature is the foundation of our specialty. Shortcuts are the bane of our specialty. I suspect that the mistake made in this article1 resulted from an attempt at expediency of reporting rather than a lack of the authors' understanding of the science. Indeed, one of the many authors listed is on record as affirming that the TNM system was developed for mycosis fungoides, not for variants like follicular mucinosis or, in the case of the article in question, GSS. In Table 1, under the heading “Granulomatous Slack Skin,” the patients are listed as having their stages assigned by TNM. Granulomatous slack skin is not the disease that defined the TNM system used for mycosis fungoides.

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