Dermoscopy of Early-Stage Mycosis Fungoides: Comparative Study with Inflammatory Dermatoses
Keywords:
dermoscopy, mycosis fungoides, dark phototype, Psoriasis, EczemaAbstract
Introduction: The diagnosis of early-stage mycosis fungoides (MF) is challenging often requiring multiple biopsies and may be confused with plaque psoriasis (PP) and chronic dermatitis (CD).
Objecytive: Our study aimed to describe the dermoscopic features of early-stage MF and compare them with PP and CD.
Methods: This was a multicenter cross-sectional study conducted in three Tertiary Referral Dermatology Departments in Tunisia between January 2021 to December 2021, including 89 patients with phototype III-V. For all included patients, up to 3 representative cutaneous lesions were selected and examined using dermoscopy. Both clinical and dermoscopic photos were recorded for each selected lesion. Dermoscopic photos were interpreted by two independent evaluators.
Results: Vascular structures significantly associated with the diagnosis of early-stage MF included polymorphic, coiled, serpentine, and linear vessels, in an unspecific distribution. Branched vessels were only seen in granulomatous MF. Conversely, monomorphous vessels in uniform distribution were associated with PP, whereas CD was associated with monomorphous vessels with unspecific distribution. Non-vascular structures associated with the diagnosis of MF included reticular lines, orange background color, and structureless areas. Pink background was more prevalent in PP and CD. Additionally, in patients with CD, yellow clods were more frequently observed.
Conclusion: This study highlights characteristic dermoscopic features of early-stage MF compared with PP and CD. Dermoscopic aspects of folliculotropic MF were particularly distinguishing. These aspects would help clinicians in correctly guiding skin biopsy sites in difficult cases.
References
Willemze R, Cerroni L, Kempf W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood. 2019;133(16):1703-1714. Blood. 2019 Sep 26;134(13):1112. doi: 10.1182/blood.2019002852. Erratum for: Blood. 2019 Apr 18;133(16):1703-1714. DOI: 10.1182/blood-2018-11-881268. PMID: 31558559; PMCID: PMC6764272.
Bradford PT, Devesa SS, Anderson WF, Toro JR. Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases. Blood. 2009 May 21;113(21):5064-73. DOI: 10.1182/blood-2008-10-184168. Epub 2009 Mar 11. PMID: 19279331; PMCID: PMC2686177..
Wain EM, Orchard GE, Whittaker SJ, Spittle M Sc MF, Russell-Jones R. Outcome in 34 patients with juvenile-onset mycosis fungoides: a clinical, immunophenotypic, and molecular study. Cancer. 2003;98(10):2282-2290. DOI:10.1002/cncr.11780. PMID: 14601100.
Sidiropoulos KG, Martinez-Escala ME, Yelamos O, Guitart J, Sidiropoulos M. Primary cutaneous T-cell lymphomas: a review. J Clin Pathol. 2015;68(12):1003-1010. DOI:10.1136/jclinpath-2015-203133. PMID: 26602417.
Xu C, Liu J, Wang T, Luo Y, Liu Y. Dermoscopic patterns of early-stage mycosis fungoides in a Chinese population. Clin Exp Dermatol. 2019;44(2):169-175. DOI:10.1111/ced.13680. PMID: 29876963.
Kittler H, Marghoob AA, Argenziano G, et al. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. J Am Acad Dermatol. 2016;74(6):1093-1106. DOI:10.1016/j.jaad.2015.12.038. PMID: 26896294; PMCID: PMC5551974.
Errichetti E, Zalaudek I, Kittler H, et al. Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society. Br J Dermatol. 2020;182(2):454-467. DOI:10.1111/bjd.18125. PMID: 31077336.
Dereure O, Guilhou JJ. Invisible mycosis fungoides: a new case. J Am Acad Dermatol. 2001;45(2):318-319. DOI:10.1067/mjd.2001.114561. PMID: 11464203.
Pujol RM, Gallardo F, Llistosella E, et al. Invisible mycosis fungoides: a diagnostic challenge. J Am Acad Dermatol. 2002;47(2 Suppl):S168-S171. DOI:10.1067/mjd.2002.107231. PMID: 12140452.
Hwong H, Nichols T, Duvic M. "Invisible" mycosis fungoides?. J Am Acad Dermatol. 2001;45(2):318. DOI:10.1067/mjd.2001.114568. PMID: 11464202.
Engin B, Keçici AS, Uzun AÖ, Yalçın M. Psychiatric comorbidity, depression, and anxiety levels and quality of life of the patients with mycosis fungoides. Dermatol Ther. 2020;33(6):e13922. DOI:10.1111/dth.13922. PMID: 32594601.
Ozturk MK, Zindancı I, Zemheri E. Dermoscopy of stage llA mycosis fungoides. North Clin Istanb. 2019;7(2):174-179. Published 2019 Oct 8. DOI:10.14744/nci.2019.02439. PMID:32259040.
Lallas A, Apalla Z, Lefaki I, et al. Dermoscopy of early stage mycosis fungoides. J Eur Acad Dermatol Venereol. 2013;27(5):617-621. DOI:10.1111/j.1468-3083.2012.04499.x. PMID: 22404051.
Suh KS, Park JB, Yang MH, Choi SY, Hwangbo H, Jang MS. Diagnostic usefulness of dermoscopy in differentiating lichen aureus from nummular eczema. J Dermatol. 2017;44(5):533‑7. PMID: 27914108.
Soliman SH, Ramadan WM, Elashmawy AA, Sarsik S, Lallas A. Dermoscopy in the Diagnosis of Mycosis Fungoides: Can it Help? Dermatol Pract Concept. 2023 Oct 1;13(4):e2023284. DOI: 10.5826/dpc.1304a284. PMID: 37992354; PMCID: PMC10656187.
Bosseila M, Sayed Sayed K, El-Din Sayed SS, Abd El Monaem NA. Evaluation of Angiogenesis in Early Mycosis Fungoides Patients: Dermoscopic and Immunohistochemical Study. Dermatol Basel Switz. 2015;231(1):82‑6. PMID: 26044542.
Errichetti E, Apalla Z, Geller S, Sławińska M, Kyrgidis A, Kaminska-Winciorek G, et al. Dermoscopic spectrum of mycosis fungoides: a retrospective observational study by the International Dermoscopy Society. J Eur Acad Dermatol Venereol JEADV. 2022;36(7):1045‑53. PMID: 35285088; PMCID: PMC10239555.
Toncic RJ, Drvar DL, Bradamante M, Rados J, Jerkovic-Gulin S, Caccavale S, et al. Early dermoscopic sign of folliculotropism in patients with mycosis fungoides. Dermatol Pract Concept. 2018;8(4):328‑9. PMID: 30479867; PMCID: PMC6246061.
Tomasini C, Kempf W, Novelli M, Fava P, Annessi G, Rongioletti F, et al. Spiky follicular mycosis fungoides: a clinicopathologic study of 8 cases. J Cutan Pathol. 2015;42(3):164‑72. PMID: 25355400.
Souissi A, Ben Lagha I, Jendoubi F, Drissi H, Chelly I, Mokni M. Spiky follicular mycosis fungoides: a trichoscopic feature. J Eur Acad Dermatol Venereol. 2019 Jul;33(7):e252-e253. DOI: 10.1111/jdv.15365. Epub 2019 Apr 22. PMID: 30472744.
Gerami P, Rosen S, Kuzel T, Boone SL, Guitart J. Folliculotropic mycosis fungoides: an aggressive variant of cutaneous T-cell lymphoma. Arch Dermatol. 2008;144(6):738‑46. PMID: 18559762.
Wieser I, Wang C, Alberti-Violetti S, Lyons G, Tran C, Talpur R, et al. Clinical characteristics, risk factors and long-term outcome of 114 patients with folliculotropic mycosis fungoides. Arch Dermatol Res. 2017;309(6):453‑9. PMID: 28516243.
Hodak E, Amitay-Laish I, Atzmony L, Prag-Naveh H, Yanichkin N, Barzilai A, et al. New insights into folliculotropic mycosis fungoides (FMF): A single-center experience. J Am Acad Dermatol. 2016;75(2):347‑55. PMID: 27245278.
Bilgic SA, Cicek D, Demir B. Dermoscopy in differential diagnosis of inflammatory dermatoses and mycosis fungoides. Int J Dermatol. 2020;59(7):843-850. DOI:10.1111/ijd.14925. PMID: 32406102.
Vázquez-López F, Zaballos P, Fueyo-Casado A, Sánchez-Martín J. A dermoscopy subpattern of plaque-type psoriasis: red globular rings. Arch Dermatol. 2007;143(12):1612. DOI:10.1001/archderm.143.12.1612. PMID: 18087028.
Navarini AA, Feldmeyer L, Töndury B, Fritsche P, Kamarashev J, French LE, et al. The yellow clod sign. Arch Dermatol. 2011;147(11):1350. PMID: 22106141.
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