An uncommon form of skin cancer, mycosis fungoides affects lymphocytes, a type of white blood cell responsible for fighting infection. As a result of its involvement with T-cells, a subtype of lymphocyte, mycosis fungoides is also known as cutaneous T-cell lymphoma. As well as spreading to other organs, such as lymph nodes, blood, and bone marrow, Mycosis fungoides can cause skin lesions that resemble rashes, plaques, or tumors. In older adults, especially men, and people with weakened immune systems, mycosis fungoides is more common. Genetic mutations or environmental factors may contribute to its development.
Causes
In mycosis fungoides, DNA changes make the T-cells grow and multiply abnormally, which may explain its cause. These abnormal T-cells accumulate in the skin and form lesions that itch, bleed, or become infected. They may also travel through the bloodstream or the lymphatic system and affect other parts of the body as well.
There are several factors that may increase the risk of developing mycosis fungoides, including:
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Over 50-year-olds are more likely to develop mycosis fungoides.
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Men are more likely to contract Mycosis fungoides than women.
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Mycosis fungoides is more common in people with weakened immune systems, such as those with HIV or organ transplants.
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Chemicals, viruses, and radiation may cause Mycosis fungoides.
Symptoms
Mycosis fungoides usually progresses slowly and can take years to develop. The main stages of mycosis fungoides are:
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Patch stage: Mycosis fungoides usually begins with a red or brown patch on the chest, back, or buttocks. The patch may be scaly, dry, or itchy, and may be similar to eczema or psoriasis, but may not cause any other symptoms for months or years.
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During the plaque stage, the patch may thicken and form a raised lesion that may be oval, irregular, or ring-shaped. A plaque may be more itchy, painful, or sensitive than a patch, and may affect other parts of the body, such as the face, scalp, or genitals. It is possible for the plaque stage to last for years while the patch stage coexists.
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Plaque can grow into a large, solid mass, known as a tumor, which may be red, purple, brown, ulcerate, or bleed. It may affect the skin or subcutaneous tissue, causing swelling, deformity, or infection. In the tumor stage, mycosis fungoides spreads to the lymph nodes, the blood, or the bone marrow, making it the most advanced and aggressive stage.
Other symptoms of mycosis fungoides include:
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Fever
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Loss of weight
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Sweating at night
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Tiredness
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Swollen lymph nodes (lymphadenopathy)
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Liver or spleen enlargement (hepatosplenomegaly)
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Low red blood cell count (anemia)
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Low platelet count (thrombocytopenia)
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A high white blood cell count indicates leukemia
Diagnosis
Because symptoms can mimic other skin conditions or infections, mycosis fungoides can be difficult to diagnose.
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The doctor will ask about the symptoms, duration, and progression of the skin lesions as well as any other medical conditions or risk factors.
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A doctor will examine the skin to check for patches, plaques, or tumors, as well as the lymph nodes, liver, spleen, and other organs for signs of involvement.
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The doctor will take a small sample of the lesion and send it to a laboratory for microscopic analysis. The biopsy can confirm the presence of abnormal T-cells and rule out other causes of skin lesions.
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Doctors may order blood tests to check blood cell counts, liver and kidney function, and immune system status. Blood tests can also detect abnormal T-cells in the blood, which may indicate a more advanced stage of the disease.
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For signs of tumor growth or spread to other organs, the doctor may order imaging tests, such as X-rays, CT scans, MRI scans, or PET scans.
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An abnormal T-cell count in the bone marrow can be detected by a bone marrow biopsy, which may indicate a more advanced stage of the disease.
Treatment
There are several treatments available for mycosis fungoides, depending on the stage and severity of the disease, the patient's age, health, and preferences, as well as the availability and effectiveness of the therapies.
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It involves applying creams, ointments, or gels containing medications, such as steroids, chemotherapy, or immunotherapy, to the skin lesions. It is possible to use topical therapy for early or mild cases of mycosis fungoides to reduce inflammation, itching, and size of the lesions.
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Mycosis fungoides may be treated with phototherapy, which involves exposing the skin to ultraviolet (UV) light in order to kill abnormal T-cells.
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X-rays and gamma rays are used to destroy the abnormal T-cells in mycosis fungoides. Radiation therapy can shrink tumors and relieve pain, and it may be used in advanced or localized cases.
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A drug, either intravenous or oral, can be used to kill the abnormal T cells. Chemotherapy can slow the progression and spread of mycosis fungoides, and may be used for advanced cases.
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By using drugs, either orally, intravenous, or subcutaneously, immunotherapy stimulates the immune system to fight abnormal T-cells. A patient with advanced or refractory mycosis fungoides may benefit from immunotherapy, which can improve survival and quality of life.
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When the abnormal T-cells are destroyed with high dose chemotherapy or radiation therapy, stem cells are transplanted into the bone marrow. In some cases, stem cell transplants offer a chance of cure, but they are risky and complex procedures that require a compatible donor and a specialized facility.
Prevention
A few possible measures to reduce the risk or delay the onset of mycosis fungoides include:
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T-cell DNA should not be damaged by chemicals, viruses, or radiation
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Using sunscreen, clothing, or hats to protect the skin from sun damage
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Eating a balanced diet, exercising regularly, and managing stress are all important aspects of maintaining a healthy lifestyle
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If you notice any signs or symptoms of mycosis fungoides, especially persistent or unexplained skin lesions, seek medical attention right away.
