Update on skin directed therapies in mycosis fungoides

Mycosis fungoides (MF) represents the majority of the primary cutaneous T-cell lymphomas (CTCL). Most have early stage MF with localised patches and plaques, which has a favourable survival outcome, but nearly a quarter progress to late stage with tumours, erythroderma, and systemic involvement. Management is based on stage directed treatment with early stage MF (IA–IIA) using skin directed therapies (SDTs), including topical corticosteroids (TCS), chlormethine or retinoids, phototherapy, and radiotherapy (localised or total skin electron beam therapy). Advanced stages (IIB–IVB) or refractory MF often requires systemic treatments which may be used in combination with SDTs. These are primarily employed as a palliative approach, aiming to provide symptomatic relief. For advanced patients achieving a complete or near complete response (CR) with a good performance status may be considered for allogeneic bone marrow transplantation. This paper reviews the different SDT modalities and their efficacy in MF management.