Loading
Early mycosis fungoides is treated on the skin, not through the bloodstream. Steroid creams, a chemotherapy gel, ultraviolet light cabinets and very small doses of radiotherapy control it for years, and chemotherapy at this stage does harm without benefit.
Topical corticosteroids, potent or very potent, are the first treatment for patches and plaques and produce clearance in a large proportion. They are used in courses rather than continuously, to limit skin thinning.
Topical chemotherapy. Mechlorethamine (chlormethine) 0.016 per cent gel, licensed for mycosis fungoides, is applied once daily to affected skin. In the pivotal randomised non-inferiority trial it produced a response by the composite assessment of index lesion severity in 58.5 per cent of patients against 47.7 per cent for the traditional compounded ointment, with a ratio of 1.23 and non-inferiority met. Contact dermatitis is the common problem and is managed by reducing the frequency of application rather than by stopping. Topical bexarotene gel and topical carmustine are alternatives; imiquimod is used on a small number of resistant plaques.
Phototherapy. Narrowband UVB, given two or three times a week in a light cabinet, is used for patch and thin plaque disease. PUVA, oral or bath psoralen with UVA, penetrates further and is used for thicker plaques and folliculotropic disease. Both are tapered to a maintenance schedule once the skin clears, and both add to a lifetime ultraviolet dose that itself carries a skin cancer risk, which is the reason maintenance is limited.
Radiotherapy. Mycosis fungoides is exquisitely radiosensitive. A single tumour or resistant plaque responds to about 8 Gy in two fractions, which takes two visits and can be repeated at the same site. Total skin electron beam therapy treats the entire skin surface; low-dose schedules of 10 to 12 Gy have largely replaced the historic 30 to 36 Gy because they cause less toxicity and can be given more than once.
What not to do. Systemic chemotherapy in early-stage disease produces fast responses that do not last, damages an immune system already prone to skin infection, and has never been shown to lengthen life in a stage whose life expectancy is close to that of the general population.
Showing the molecule this term concerns: Mechlorethamine (chlormethine).
This trial gave mechlorethamine, the first chemotherapy drug ever used, a modern licensed form: the FDA approved Valchlor gel in 2013 for early mycosis fungoides-type cutaneous T-cell lymphoma after skin-directed therapy, replacing pharmacy-compounded preparations of uncertain stability.
The stages quoted on the cutaneous T-cell lymphoma page and the skin-directed versus systemic treatment split by stage follow this classification.
Shares Topical chemotherapy in cutaneous T-cell lymphoma: positive results of a randomized, controlled, multicenter trial testing the efficacy and safety of a novel mechlorethamine, 0.02%, gel in mycosis fungoides, Mechlorethamine (chlormethine), Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
Shares Methoxsalen (extracorporeal photopheresis), Sezary syndrome, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
Shares Bexarotene, Sezary syndrome, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
Shares Methoxsalen (extracorporeal photopheresis), Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
Shares Bexarotene, Imiquimod.
Shares Electron beam therapy systems (linac electrons, total skin electron units, mobile electron IORT), Photodynamic therapy lasers and light sources, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).
Shares Topical chemotherapy in cutaneous T-cell lymphoma: positive results of a randomized, controlled, multicenter trial testing the efficacy and safety of a novel mechlorethamine, 0.02%, gel in mycosis fungoides, Mechlorethamine (chlormethine).
Shares Bexarotene, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome).