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Chapter 32: Cutaneous T-Cell Lymphoma

INTRODUCTION

KEY POINTS

  • Mycosis fungoides (MF) can present with multiple variants including hypopigmented, folliculotropic, pagetoid reticulosis, granulomatous slack skin, and Sézary syndrome.

  • Hypopigmented MF is a variant seen more commonly in skin of color. It can be mistaken for atopic dermatitis and pityriasis alba when on the face. This can also contribute to delays in diagnosis and increased disease morbidity.

  • MF can also present as hyperpigmented patches and can often resolve with dyspigmentation.

image

FIGURE 32-1.

Numerous scattered, nummular, hypopigmented macules and patches, some of which appear almost depigmented, on the right ventral upper extremity. The depigmented-appearing patches may mimic the appearance of vitiligo. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 180-2. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows similar pale hypopigmented spots in the arm.
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FIGURE 32-2.

Red patches and plaques with areas of overlying scale and peripheral background light-brown patches. (Reproduced with permission from Kane KS, Nambudiri VE, Stratigos AJ. Color Atlas & Synopsis of Pediatric Dermatology, 3rd ed. New York, NY: McGraw Hill; 2017, Figure 19-9.)

A patient with light brown skin exhibits red patches and plaques. The plaques have white overlying scale. Surrounding the patches and plaques are hyperpigmented brown patches.
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FIGURE 32-3.

Ill-defined hypopigmented macules coalescing into patches without overlying scale on the face of a young female. This presentation is similar to what can also be seen in pityriasis alba. (Reproduced with permission from Prose NS, Kristal L. Weinberg’s Color Atlas of Pediatric Dermatology, 5th ed. New York, NY: McGraw Hill; 2017, Figure 12-45.)

A patient with brown skin exhibits hypopigmented light brown macules on the face. Some of the macules combine to form patches.
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FIGURE 32-4.

Numerous scattered, nummular, hypopigmented macules and patches of varying size, with mild background erythema on the bilateral anterior thighs. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 180-1. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows numerous pale hypopigmented patches in both the thighs.
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FIGURE 32-5.

Large red-orange patches and plaques on the lateral trunk and buttock, representing cutaneous T-cell lymphoma stage IB. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 199-5A.)

A photo shows large red patches on the lateral thoracic region of a patient.
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FIGURE 32-6.

Ill-defined large hypopigmented patches on the anterior trunk. Note the lack of visible scale. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 76-16.)

The image shows a photograph depicting hypopigmented patches of mycosis fungoides over the abdomen.
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FIGURE 32-7.

Large hypopigmented patches on the posterior trunk and upper extremities in a seborrheic distribution mimicking the presentation of pityriasis rosea in a Latinx person. (Reproduced ...

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