Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma and typically presents with erythematous or scaly patches in older adults with a CD4 + immunophenotype. In Sri Lanka, however, a hypopigmented variant with CD8 + predominance and an apparently indolent clinical course is frequently encountered. A retrospective descriptive study was conducted on 243 patients with histologically confirmed MF diagnosed at the National Hospital, Kandy, between 2018 and 2024. Clinical, histopathologic, and immunophenotypic features were reviewed in all cases. A subset of 27 patients with a minimum follow-up of 2 years was analyzed for treatment modalities and clinical outcomes. Diagnoses were established according to WHO-EORTC 2018 criteria. Patients predominantly presented with hypopigmented patch-stage disease involving sun-protected sites. Histology showed subtle epidermotropism with small Pautrier microabscesses and a characteristic "eyeliner" pattern. Immunohistochemistry demonstrated a CD8 + -predominant infiltrate in 95.9% of cases, with absent or reduced CD4 expression. Most patients achieved complete or partial remission with topical therapy or phototherapy, and no progression to plaque or tumor stage was observed. Hypopigmented CD8 + MF in Sri Lanka represents an indolent clinicopathologic variant within the MF spectrum, recognition of which is essential to avoid misdiagnosis and overtreatment.

Cutaneous T-cell lymphoma (CTCL) is an infrequent non-Hodgkin lymphoma of the skin, with mycosis fungoides (MF) as the most common subtype. MF in palms and soles is an exceptionally rare presentation, particularly in pediatric patients. We report a case of a 17-year-old boy presenting with progressive enlargement of his hands and feet with thickening of palms and soles, initially suspected to have acromegaly. Laboratory and imaging workup ruled out endocrine and genetic causes of acromegaly. A skin biopsy confirmed a diagnosis of MF. This case illustrates the diagnostic challenges of pediatric MF, due to both its extreme rarity and potential for overlapping clinical presentation with other systemic conditions. The patient's socioeconomic background and immigration status limited initial access to specialized care, further complicating the evaluation and underscoring the health care barriers for immigrant populations. Community health centers play a crucial role in early diagnosis and care coordination, yet limited access to dermatology services in rural areas remains a significant challenge. Beyond expanding our current understanding of pediatric MF and broadening the differential diagnosis of acral enlargement in adolescents, this case emphasizes the importance of equitable health care access for immigrant patients. The findings highlight the need for increased dermatologic services in community health settings and among underserved populations.

Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma (CTCL), characterized by heterogeneous clinical behavior and variable prognosis. Accurate prognostication is essential for risk-adapted management. This review synthesizes emerging evidence on prognostic factors in MF and SS, with a focus on recent genomic advances. Traditional prognostic frameworks are outlined, highlighting the prognostic impact of demographics, stage, clinical features, and histologic findings. More advanced prognostics are then outlined, including genomic alterations and impact of the tumor microenvironment. We highlight realms in which integration of traditional and more biological prognostic frameworks can support more individualized treatment strategies.

Mycosis fungoides (MF) is a rare extranodal T-cell lymphoma with primary cutaneous involvement. While it is the most common primary skin lymphoma, large-scale real-world data defining survival benchmarks and the prognostic significance of specific nodal sites remain limited. To address this, we conducted a retrospective cohort study using the TriNetX global health research network and identified 25 467 patients with MF. The 5- and 10-year OS for the overall cohort was 83.4% and 74.7%, respectively. Patients with disease limited to the skin had 5- and 10-year OS rates of 86.1% and 78.0%, respectively. Nodal involvement at diagnosis was associated with significantly inferior survival [adjusted HR (aHR) = 1.60; 95% CI: 1.50-1.71; p < 0.001], exhibiting 5- and 10-year OS rates of 74.5% and 63.6%, respectively. Among patients with single-site lymphadenopathy, survival outcomes varied substantially by anatomical site, revealing a potential prognostic hierarchy: patients with inguinal/lower limb involvement exhibited the most favorable outcomes (5-year OS 80.2%), while those with visceral lymphadenopathy had the poorest prognosis (5-year OS 62.9%). In multivariable analysis, elevated LDH (aHR 3.06), lymphocytosis (aHR 1.37), and eosinophilia (aHR 1.29) were strong independent predictors of mortality, among others. To summarize, this study of over 25 000 MF patients represents the largest real-world analysis to date. Data suggest a potential prognostic divergence based on the anatomical site of nodal involvement. Additionally, our findings reinforce the prognostic value of LDH, eosinophils, lymphocytes and the hypopigmented and poikilodermatous variants as independent predictors of mortality, supporting their integration into routine risk stratification.

Cutaneous T-cell lymphoma is a chronic disease with a highly heterogeneous and unpre-dictable clinical course, and the impact on psychological resilience is still unknown. The primary aim was to investigate psychological resilience in cutaneous T-cell lymphoma patients over time and to relate it to dermatology-related quality of life (QoL) metrics. Psychological investigations were evaluated in 45 patients with mycosis fungoides included in the BIO-MUSE study. Psychological resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), and dermatology-associated QoL was assessed with the Dermatology Life Quality Index (DLQI) and numeric rating scales for itch and sleep disorders. The resilience of the mycosis fungoides patients was further compared to a Swedish general population cohort comprising more than 2,500 individuals. This study demonstrates that mycosis fungoides patients in the BIO-MUSE cohort, where 39 of 45 cases had early-stage disease, exhibit a high and stable resilience over 1 year of the disease. The CD-RISC score is higher than in a Swedish general population cohort and in a subgroup of that cohort with psoriasis or eczema. Furthermore, the DLQI was consistently low, indicating a higher QoL in the BIO-MUSE cohort than in published data for similar patient populations.

Leadless pacemakers in patients with active haematological cancer: procedural details and long-term clinical outcomes

Mycosis Fungoides with Concurrent Squamous Cell Carcinoma in a Young Patient: A Rare Case.

Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of non-Hodgkin lymphomas characterized by neoplastic T cells in the skin. Common subtypes of CTCL are mycosis fungoides (MF) and Sézary syndrome (SS). Patients with MF/SS can experience significant symptoms that affect health-related quality of life (HRQoL). Although the Functional Assessment of Cancer Therapy-Cutaneous T-Cell Lymphoma (FACT-CTCL) was developed as a disease-specific patient-reported outcome measure (PROM) for MF/SS, qualitative evaluation of its content validity in the target population has not been assessed. We therefore evaluated the content validity of the FACT-CTCL in patients with MF/SS and clinicians with expertise in MF/SS. Semi-structured cognitive interviews of patients with a diagnosis of MF or SS, as well as healthcare providers with expertise in treating MF/SS were conducted in alignment with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Patients evaluated the relevance, comprehensibility, and comprehensiveness of the FACT-CTCL. Clinicians evaluated relevance and comprehensiveness. Twelve patients (9 MF, 3 SS) and eight clinician experts (3 oncologists, 4 dermatologists, 1 nurse practitioner) participated. The median age of patients was 68 years (range 36-77); six had early-stage (IA - IIA) disease and six had advanced-stage (IIB - IVB) disease. All items were deemed relevant by at least 95% of participants, and 44 of 47 items achieved 100% relevance across patients and clinicians. All items achieved at least 90% comprehensibility among patients, and 39 of 47 scored items were understood by all patients. All patients found the instructions and response options easy to understand, and all participants considered the instrument comprehensive. The FACT-CTCL demonstrated strong content validity in this sample of patients with MF/SS and expert clinicians. These findings support further evaluation and use of the FACT-CTCL as a disease-specific HRQoL instrument in MF/SS, while additional study in larger and more diverse populations remains warranted.

Narrowband UVB Phototherapy in Dermatology: 2026 Update.

Accurate assessment of lymph node (LN) involvement is crucial in cutaneous T-cell lymphoma (CTCL), but biopsy-based evaluation carries risks, limiting its use. This study aims to evaluate ultrasound effectiveness in detecting malignant LN involvement and identify optimal ultrasound parameters for prediction. A retrospective cohort study was conducted with 250 CTCL patients who underwent LN ultrasound evaluations between 2018 and 2024. Ultrasound parameters were compared with histopathological results, and receiver operating characteristic (ROC) analysis was performed to assess diagnostic accuracy. Ultrasound improves the detection rate of LN enlargement, from 21.6% to 57.6%. Lymphadenopathy on ultrasound was associated with higher disease staging and lower progression-free survival rates in mycosis fungoides. Key parameters, including increased short-axis diameter (p=0.004) and loss of the echogenic hilum (p=0.04), were significant indicators of malignant LN involvement. The combination of these two parameters in predicting malignant lymphadenopathy achieved an accuracy of 76.2%, with a sensitivity of 68.4% and a specificity of 82.6%, demonstrating superior diagnostic performance and providing valuable prognostic insights. Ultrasound is a reliable method for detecting malignant lymphadenopathy in CTCL, aiding clinicians in deciding whether an invasive biopsy is necessary.

ImportanceHypopigmented mycosis fungoides (HMF) is uncommon in adults, and data on clinicopathologic features and long-term outcomes remain sparse.ObjectiveTo investigate the clinicopathologic features and outcomes of adults with HMF in a large multicenter cohort.Design, Setting, and ParticipantsThis retrospective multicenter cohort study conducted from January 2011 to October 2023 at 6 US tertiary referral centers and included adults (18 years or older at diagnosis) with biopsy-confirmed HMF and hypopigmentation documented at diagnosis, with a median (range) follow-up of 39 (1-347) months. Data were analyzed from February to December 2025.ExposuresClinical variant, immunophenotype predominance, and polymerase chain reaction–based T-cell receptor (TCR) gene rearrangement in peripheral blood and/or skin.Main Outcomes and MeasuresBest overall response, defined as complete response, partial response, stable disease, or progressive disease, and progression to a higher stage.ResultsThe cohort included 224 adults with HMF (median [range] age, 44 [18-74] years), of whom 164 (73%) were women (60 men [27%]), 5 (2%) were Asian individuals, 1 (0.4%) was a Hispanic/Latino individual, 1 (0.4%) was a Middle Eastern individual, 19 (8%) were White individuals, and 186 (83%) were Black individuals; 219 (98%) presented with early-stage disease. Most had hypopigmented lesions only (159 [71%]), whereas 65 (29%) exhibited mixed-variant mycosis fungoides; outcomes were similar between groups. Among 141 patients with available immunophenotyping, 88 (63%) had CD8-positive predominance. Among 207 treated patients, most (179 [90%]) received skin-directed therapy alone. Among 198 evaluable patients, the best overall response was complete response for 52 (26%), partial response for 101 (51%), stable disease for 34 (17%), and progressive disease for 11 (6%). Over a median (range) follow-up of 39 (1-347) months, 14 of 224 patients (6%) experienced progression to a higher stage, including 5 of 219 patients (2%) with early-stage disease at baseline who experienced progression to advanced-stage disease. Peripheral blood TCR monoclonality was detected in 23 of 85 tested patients (27%) and was associated with poorer treatment response but not with disease progression.Conclusions and RelevanceThe finding of this cohort study suggest that adult HMF demonstrated a generally indolent course, with favorable response to skin-directed therapy, irrespective of immunophenotype or mixed-variant presentation. Peripheral blood TCR monoclonality was associated with lower treatment response but not disease progression.

JAAD Game Changers: "Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: a Danish nationwide population-based cohort study".

Brentuximab vedotin in cutaneous T-Cell lymphoma: emerging evidence and therapeutic insights for CD30-negative and CD30-low disease.

Studies on the state of medical care for patients with cutaneous T-cell lymphoma (CTCL) are limited. To date, only secondary data analyses are available for Germany. Cross-sectional study conducted over a one-year recruitment period (01 March 2024 to 28 February 2025) in the dermatological department of a German university hospital. The physician questionnaire recorded the skin-related burden of disease using the mSWAT and data on disease course, while the patient questionnaire recorded socio-demographic and clinical parameters, patient satisfaction, and health-related quality of life using the Skindex-29. 121 patients (median age 63 years, 66.9% male) with mycosis fungoides (95.0%) and Sézary syndrome (5.0%) were included. 30.0% of the working patients reported sick leave due to CTCL and 51.7% had already been hospitalized at least once for this indication. The Skindex-29 revealed an impairment in quality of life in 52.9% of patients. Patients with higher disease stages (IIB-IVB according to EORTC/ISCL), lack of response to therapy, and an mSWAT ≥30 showed a significantly higher impairment in quality of life. A median of 4 follow-up appointments were attended annually, with 63.6% of patients being treated exclusively at the university hospital. This study is the first to analyze the state of medical care of patients with mycosis fungoides and Sézary syndrome using primary data from routine care at a German university hospital and reveals a high burden of disease as well as a high need for care.

Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare form of cutaneous lymphoma characterized by neoplastic T-cell infiltration of subcutaneous tissue, clinically mimicking panniculitis. This study aimed to evaluate the applicability and prognostic value of the T component of the Tumor-Node-Metastasis (TNM) classification system, as well as the prognostic significance of skin lesion characteristics in patients with SPTL. Clinical characteristics and survival outcomes of patients with SPTL treated at a Korean academic medical center were retrospectively reviewed to assess the prognostic significance of TNM T staging and skin lesion features. Among 43 patients with SPTL, nine had concurrent hemophagocytic lymphohistiocytosis (HLH). Higher T categories were associated with an increased likelihood of HLH. Although overall survival (OS) did not differ significantly across T categories, higher T stage and presence of lipoatrophy correlated with poorer relapse-free survival (RFS). Of all clinical variables, only HLH was significantly associated with reduced OS. Decreased RFS was associated with lipoatrophy, HLH, and visceral or nodal involvement. Multivariable analysis identified T3 stage and HLH as independent prognostic factors of RFS. Patients with SPTL presenting with extensive skin involvement (T3) have a higher risk of disease relapses and are more likely to develop HLH.

Pathogenesis of cutaneous T-cell lymphoma: Malignant inflammation, immune reprogramming, and microenvironmental drivers.

Serum proteomic and single-cell transcriptomic profiling reveals immunoproteomic features distinguishing early-stage mycosis fungoides from atopic dermatitis.

Hypopigmented mycosis fungoides (MF) is a rare clinical variant of MF that often presents in childhood or young adulthood and is typically associated with an indolent course. In contrast to classic MF, hypopigmented MF frequently shows a CD8+ T-cell-predominant phenotype, and cytotoxic immune responses have been implicated in melanocyte injury; however, the cutaneous immune microenvironment across different ages of onset remains incompletely characterized. We reported two cases of hypopigmented MF with distinct ages of disease onset and evaluated lesional immune profiles by immunohistochemistry, focusing on CD8, FOXP3, CXCL10, and CCL19. In both cases, the epidermotropic infiltrate was CD8-positive T-cell dominant, accompanied by scarce FOXP3-positive cells and increased expression of CXCL10 together with CCL19. These shared features support the concept that a Tc1-associated cytotoxic immune milieu, accompanied by scarce FOXP3-positive cells, may be associated with hypopigmentation in hypopigmented MF, irrespective of the age at clinical presentation.

This retrospective cohort study evaluated adults with mycosis fungoides (MF) or Sezary syndrome (SS) treated with mogamulizumab at community or academic centers (2018–2023). Among 104 patients (MF/SS: 50/54), median (Q1, Q3) time from diagnosis to mogamulizumab was 38.0 (3.0, 12.2) months and median (Q1, Q3) number of prior systemic therapies was 2 (1, 4). Of 99 patients assessed, 68.7% responded, with a median response duration of 11.2 (95% confidence interval [CI]: 7.5, 20.5) months. Median time to next treatment and progression-free survival were 12.3 (95% CI: 7.2, 22.3) and 8.4 (95 CI%: 4.9, 11.9) months, respectively. Selected adverse events (AE) occurred in 94 patients (85.5%) (infection: 44 [40.0%]; infusion reaction: 28 [25.5%]; skin AEs: 79 [71.8%]). Treatment-emergent rash was reported in 18/45 patients (40%). The findings of similar AE rates and treatment outcomes suggest comparable safety and effectiveness in patients treated with mogamulizumab in the community and academic settings.

Mycosis fungoides (MF) is the most common type of primary cutaneous T-cell lymphoma (CTCL), a malignant and chronic skin disease. Early-stage MF has a generally favorable prognosis, but effective and well-tolerated skin-directed therapies are crucial for management. HyBryte™ is a photodynamic therapy of topical hypericin that was recently shown to be well tolerated and efficacious in early-stage CTCL. Valchlor® (mechlorethamine) is an approved second-line therapy for use in early-stage CTCL after other topical therapies. This study compared Valchlor® to HyBryte™ following 12weeks of treatment. The objectives in this study were (i) to obtain preliminary comparative assessment of safety and efficacy of Valchlor® versus HyBryte™ through 12weeks of treatment, and (ii) to better understand the impact of HyBryte™ application on the measurement of modified Composite Assessment of Index Lesion Severity (mCAILS). This was an open-label trial enrolling 10 patients with CTCL (stageIA, IB, or IIA) randomized 1:1 to receive topical HyBryte™ or topical Valchlor® for 12weeks. The overall response rate (ORR, i.e., complete responders + partial responders) was 60% (3/5) in the HyBryte™ treatment group and 20% (1/5; not significant) in the Valchlor® treatment group over 12weeks. HyBryte™ demonstrated no local adverse events at application sites, while 60% (3/5) of patients treated with Valchlor® had skin reactions, including one case which led to study withdrawal. This is a single-center, open-label study. It is a pilot study requiring additional research to confirm its results. This study demonstrated the favorable safety and efficacy profile of HyBryte™ compared to Valchlor® in patients with CTCL. HyBryte™ showed higher treatment success rates and was better tolerated. ClinicalTrials.gov, NCT06149247; registered November 20, 2023.