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.