Loading
4 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Mycosis fungoides is staged by the ISCL/EORTC TNMB system, which classifies skin (patches or plaques covering under or over 10 per cent of the body surface, tumours, erythroderma), nodes, viscera and blood. The staging revision of 2007 remains the basis of treatment choice and trial eligibility, and a validation study in a large cohort confirmed that the resulting stages separate survival. Why it matters more here than in most cancers: early-stage mycosis fungoides (stage IA to IIA, patches and plaques without tumours or blood involvement) has a life expectancy close to that of the general population and is treated with creams and light, while advanced disease (tumour stage, erythroderma, nodal or blood involvement) needs systemic treatment. Treating early disease with chemotherapy shortens neither the disease nor anything else and causes harm, which is the single most important thing to get right. The diagnosis itself is often slow, because early mycosis fungoides looks like eczema or psoriasis for years and the biopsy is frequently non-diagnostic until the disease is established. Repeated biopsies over time, read by a dermatopathologist, are normal and are not a failure.
This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
Add these to your appointment list, or take the full question set for this cancer.
The aim is control of the skin with the least treatment that achieves it, over decades. Topical corticosteroids, potent or very potent, are first line for patches and plaques and clear a large proportion. Topical mechlorethamine (chlormethine) gel, approved in the United States on 23 August 2013 for stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma after prior skin-directed therapy, cleared index lesions in its pivotal randomised trial in 58.5 per cent of patients against 47.7 per cent with the traditional compounded ointment, meeting the non-inferiority bar; contact dermatitis is the main problem and is managed by reducing frequency rather than stopping. Topical bexarotene gel and topical carmustine are alternatives. Imiquimod is used for a small number of resistant plaques. Phototherapy is the mainstay for widespread patch and plaque disease: narrowband UVB for patches and thin plaques, PUVA (psoralen with UVA) for thicker plaques and follicular disease, given two or three times a week at a dermatology unit and then tapered to a maintenance schedule. Cumulative UV dose carries its own long-term skin cancer risk, which is the reason for tapering. Localised radiotherapy at low dose, often 8 Gy in two fractions, clears an individual tumour or a resistant plaque quickly and can be repeated. Total skin electron beam therapy treats the whole skin surface and is reserved for extensive disease; low-dose schedules of 10 to 12 Gy are now preferred to the historic 30 to 36 Gy because they can be repeated.
Mechlorethamine, or nitrogen mustard, was the first chemotherapy ever used, in 1940s Hodgkin lymphoma. Today its main use is as a skin gel (Valchlor in the US, Ledaga in Europe) for early cutaneous T-cell lymphoma.
Bexarotene (Targretin) is a vitamin A-like capsule and gel for the skin disease of cutaneous T-cell lymphoma when other treatments have stopped working.
Carmustine is a chemotherapy that reaches the brain. It is given by infusion for brain tumours, lymphoma and myeloma, and as a slow-release wafer left in the cavity after a brain tumour is removed.
Imiquimod (Aldara) is a cream that provokes the skin's own immune system to clear superficial basal cell carcinomas and the sun-damage patches (actinic keratoses) that can turn into skin cancer.
A low-energy electron beam treats the entire skin surface, for lymphomas that live in the skin, without penetrating to the organs beneath.
Short courses of radiation, often a single treatment, to relieve pain from bone metastases, stop bleeding, open blocked airways or protect the spinal cord. Among the most cost-effective treatments in cancer.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Systemic treatment is indicated for tumour-stage disease, erythroderma, nodal or visceral involvement, blood involvement, or skin disease that has failed skin-directed therapy. Single agents are preferred to combination chemotherapy, which produces fast responses that do not last and damages the immune system in a patient already prone to skin infection and sepsis. Retinoids and interferon. Oral bexarotene and interferon alfa are long-standing options, often combined with phototherapy; both are slow-acting and require monitoring of lipids and thyroid function in the case of bexarotene. Methotrexate at low weekly oral dose, which is inexpensive, familiar and effective in a proportion. Mogamulizumab, an anti-CCR4 antibody approved in the United States on 8 August 2018. MAVORIC randomised 372 patients with previously treated mycosis fungoides or Sezary syndrome to mogamulizumab or vorinostat: median progression-free survival 7.7 against 3.1 months (hazard ratio 0.53) and overall response 28 against 5 per cent, with a response in the blood compartment of 68 per cent. It is therefore the drug of choice where the blood is involved. Brentuximab vedotin for CD30-expressing disease. ALCANZA randomised patients with CD30-positive mycosis fungoides or primary cutaneous anaplastic large cell lymphoma to brentuximab vedotin or to physician's choice of methotrexate or bexarotene: objective response lasting four months or more was 56.3 against 12.5 per cent and median progression-free survival 16.7 against 3.5 months. Peripheral neuropathy is the limiting toxicity. Other options: romidepsin, denileukin diftitox, which returned in 2024 as Lymphir for relapsed or refractory stage I to III disease after at least one systemic therapy, gemcitabine, pegylated liposomal doxorubicin, and allogeneic transplant with reduced-intensity conditioning, which is the only treatment that produces long remissions in advanced disease and is offered to younger fit patients.
Mogamulizumab is an antibody that clears cancerous T cells from the blood in mycosis fungoides and Sézary syndrome, the leukaemic form of skin lymphoma.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Bexarotene (Targretin) is a vitamin A-like capsule and gel for the skin disease of cutaneous T-cell lymphoma when other treatments have stopped working.
Interferon alfa was the first biologic cancer drug (1986). It treated hairy cell leukaemia, CML, melanoma, kidney cancer and Kaposi sarcoma, and has been replaced almost everywhere by better-tolerated agents.
The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.
Romidepsin is an epigenetic drug for T-cell lymphomas of the skin and lymph nodes; its US lymph-node indication was withdrawn when a confirmatory trial failed.
Vorinostat (Zolinza) was the first drug of its kind, a capsule that loosens the chemical packaging of DNA. It treats the skin disease of cutaneous T-cell lymphoma after two other treatments have failed.
Denileukin diftitox (Lymphir) is an infusion that uses the interleukin-2 signal as a homing device to deliver a bacterial toxin into cutaneous T-cell lymphoma cells. It was withdrawn in 2014 and returned in an improved form in 2024.
A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.
Doxorubicin wrapped in a fatty bubble so it reaches tumours with less heart damage; a workhorse of relapsed ovarian cancer.
Allogeneic stem cell transplantation replaces a patient's blood system with a donor's after conditioning chemotherapy, so donor immune cells hunt down leukaemia left behind. It remains the only cure for adverse-risk acute myeloid leukaemia, high-risk acute lymphoblastic leukaemia and Richter transformation, at the price of graft-versus-host disease.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Itch is the symptom patients rank as the worst and it is undertreated. Emollients applied several times a day, potent topical steroids, sedating antihistamines at night, gabapentin or pregabalin for neuropathic itch, and aprepitant or mirtazapine in resistant cases. Controlling the disease is the most effective anti-itch treatment, which is an argument for treating skin disease that is not otherwise dangerous. Infection. Staphylococcus aureus colonises broken skin and is a common cause of both flares and sepsis; swabs, topical antiseptics, bleach baths and prompt antibiotics for cellulitis are part of routine care, and a patient with advanced disease and a fever is treated as an emergency. Skin care. Soap substitutes, lukewarm baths, cotton clothing, and avoidance of overheating. Photoprotection after phototherapy or radiotherapy. The long view. Early-stage mycosis fungoides is a chronic skin disease to be managed rather than an emergency, and most people with it die of something else. That is worth saying out loud at diagnosis, because the word lymphoma does not sound like that.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
Mechlorethamine, or nitrogen mustard, was the first chemotherapy ever used, in 1940s Hodgkin lymphoma. Today its main use is as a skin gel (Valchlor in the US, Ledaga in Europe) for early cutaneous T-cell lymphoma.
Bexarotene (Targretin) is a vitamin A-like capsule and gel for the skin disease of cutaneous T-cell lymphoma when other treatments have stopped working.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.