Dermoscopy of Early-Stage Mycosis Fungoides: Comparative Study with Inflammatory Dermatoses

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Introduction: The diagnosis of early-stage mycosis fungoides (MF) is challenging often requiring multiple biopsies and may be confused with plaque psoriasis (PP) and chronic dermatitis (CD). Objecytive: Our study aimed to describe the dermoscopic features of early-stage MF and compare them with PP and CD. Methods: This was a multicenter cross-sectional study conducted in three Tertiary Referral Dermatology Departments in Tunisia between January 2021 to December 2021, including 89 patients with phototype III-V. For all included patients, up to 3 representative cutaneous lesions were selected and examined using dermoscopy. Both clinical and dermoscopic photos were recorded for each selected lesion. Dermoscopic photos were interpreted by two independent evaluators. Results: Vascular structures significantly associated with the diagnosis of early-stage MF included polymorphic, coiled, serpentine, and linear vessels, in an unspecific distribution. Branched vessels were only seen in granulomatous MF. Conversely, monomorphous vessels in uniform distribution were associated with PP, whereas CD was associated with monomorphous vessels with unspecific distribution. Non-vascular structures associated with the diagnosis of MF included reticular lines, orange background color, and structureless areas. Pink background was more prevalent in PP and CD. Additionally, in patients with CD, yellow clods were more frequently observed. Conclusion: This study highlights characteristic dermoscopic features of early-stage MF compared with PP and CD. Dermoscopic aspects of folliculotropic MF were particularly distinguishing. These aspects would help clinicians in correctly guiding skin biopsy sites in difficult cases.