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Overlapping Hyperpigmented and Poikilodermatous Mycosis Fungoides
1Department of Dermatopathology, CHU of Sart Tilman, University of Liège, Liège, B-4000, Belgium, ulg.ac.be.
Case Reports in Dermatological Medicine
|June 29, 2026
Summary
This case report details an unusual presentation of overlapping hyperpigmented and poikilodermatous mycosis fungoides (MF), a rare T-cell lymphoma. The findings emphasize the need for careful clinicopathologic correlation in diagnosing atypical pigmentary skin conditions.
Area of Science:
- Dermatology
- Oncology
- Pathology
Background:
- Primary cutaneous T-cell lymphomas (pCTCLs) are rare T-cell disorders, with mycosis fungoides (MF) being the most common subtype.
- MF presents with various clinicopathologic variants, including poikilodermatous and hyperpigmented forms, which can sometimes overlap.
Purpose of the Study:
- To report a unique case of overlapping hyperpigmented and poikilodermatous MF.
- To highlight the diagnostic challenges posed by atypical pigmentary presentations in MF.
Main Methods:
- Case report of a 68-year-old male with a 25-year history of asymptomatic dark plaques.
- Clinicopathologic correlation including histopathology, immunophenotypic studies, and 18F-FDG PET/CT imaging.
- Disease staging according to the TNM system.
Main Results:
- The patient presented with extensive, sharply demarcated confluent hyperpigmentation on the lower extremities and intergluteal fold, consistent with overlapping MF variants.
- 18F-FDG PET/CT showed no systemic involvement but mild hypermetabolism in cutaneous lesions.
- Histopathology revealed epidermotropic atypical lymphocytes, supporting MF diagnosis (Stage IB).
Conclusions:
- The patient's presentation exceeded typical poikilodermatous MF, suggesting a significant overlap with the hyperpigmented variant.
- A watch-and-wait strategy was adopted due to the indolent course and absence of extracutaneous disease.
- This case underscores the importance of clinicopathologic correlation for diagnosing atypical MF presentations.
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