Skin-Directed Therapies in Mycosis Fungoides: An Update

Mycosis fungoides (MF) is the most common subtype of cutaneous T cell lymphoma (CTCL), characterized by monoclonal proliferation of malignant T cells primarily involving the skin. The management of MF, especially in the early stages, involves skin-directed therapies (SDTs) to achieve disease control, alleviate symptoms, and enhance the quality of life (QoL). This review provides an updated overview of SDTs in MF treatment, including topical agents such as corticosteroids, retinoids, mechlorethamine, carmustine, imiquimod, as well as photodynamic therapy (PDT); phototherapy modalities including narrowband UVB (nb-UVB) and psoralen-UVA (PUVA); local radiotherapy; total skin electron beam radiotherapy (TSEBT) and total skin helical tomotherapy (TSHT). We review the indications, mechanisms of action, efficacy data, and adverse effect profiles associated with both established and emerging SDTs. Additionally, we present ongoing clinical trials evaluating emerging SDTs in the treatment of MF.