This handout is for cutaneous t-cell lymphoma — mycosis fungoides & sézary syndrome (dermatology lens). Your care team identified this based on: adult with a fixed, persistent "eczema" or "psoriasis" that never truly clears despite adequate therapy — the canonical ctcl misdiagnosis, routed in from derm.atopic-dermatitis / derm.psoriasis (iscl/eortc pmid 17540844; eortc 2023 pmid 37890355).
Other reasons your team may use this plan: fixed, non-sun-exposed "bathing-trunk"-distributed scaly patches/plaques with poikiloderma (atrophy, telangiectasia, dyspigmentation) — classic patch/plaque-stage mycosis fungoides (iscl/eortc pmid 17540844); new cutaneous tumour(s) / ulcerated nodule arising in long-standing patch–plaque disease — tumour-stage (t3) or large-cell transformation (agar pmid 20855822); erythroderma (>80% bsa) with intractable pruritus, ectropion, alopecia, keratoderma, lymphadenopathy — erythrodermic mf / sézary syndrome screen (iscl/eortc pmid 17540844).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| triamcinolone acetonide | 0.1% cream/ointment | topical | BID to lesions | EORTC 2023 (PMID 37890355) — topical corticosteroids are a first-line skin-directed option for early-stage MF; potency matched to lesion thickness/site. NOTE: hold ≥2 wk before any diagnostic/repeat biopsy (steroids blunt the epidermotropic infiltrate). |
| clobetasol propionate | 0.05% ointment | topical | BID short course | EORTC 2023 (PMID 37890355) — superpotent topical corticosteroid for thick/indurated plaques as skin-directed control; same pre-biopsy washout caveat. |
| mechlorethamine | 0.016% gel (chlormethine) | topical | once daily to affected skin | EORTC 2023 (PMID 37890355) — topical chlormethine (nitrogen-mustard) gel is a first-line skin-directed therapy for early-stage MF; main adverse effect is cutaneous (allergic/irritant) contact dermatitis. |
| bexarotene (topical) | 1% gel | topical | applied to localised lesions, titrated | EORTC 2023 (PMID 37890355) — topical bexarotene gel is a skin-directed option for localised early-stage MF lesions; local irritation common. |
| narrowband_uvb_or_puva_phototherapy | — | — | — | EORTC 2023 (PMID 37890355) — phototherapy is a first-line skin-directed therapy: nbUVB for patch/thin-plaque disease, PUVA for thicker plaques / deeper involvement; durable responses in early-stage MF. |
| localized_radiotherapy | — | — | — | EORTC 2023 (PMID 37890355) — MF is exquisitely radiosensitive; localized (spot) radiotherapy is highly effective for unilesional / localized refractory disease and palliation of individual tumours. |
Plan: Cutaneous T-cell lymphoma (MF/SS) — stage-directed ladder (ISCL/EORTC + EORTC 2023; advanced/systemic routed to hematology-oncology)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifelong dermatology continuity (incurable but often chronic-indolent in early stages): stage-stratified skin exams, mSWAT + blood-Sézary surveillance, intensive skin-barrier + antipruritic + emollient care and S. aureus decolonisation/surveillance (leading cause of death in advanced), patient education on the indolent-but-monitored course and QoL-weighted goals (avoid overtreatment of early disease — most have a normal life expectancy), bexarotene metabolic-monitoring continuity, and re-biopsy + re-stage + heme-onc re-route on transformation/progression/erythroderma/Sézary conversion. Reconcile any systemic-therapy cutaneous toxicity and resume skin-directed control after routed systemic therapy.
Guideline: ISCL/EORTC revised staging and classification of mycosis fungoides & Sézary syndrome (Olsen et al, Blood 2007; PMID 17540844, DOI 10.1182/blood-2007-03-055749) + EORTC consensus treatment recommendations Update 2023 (Latzka et al, Eur J Cancer; PMID 37890355, DOI 10.1016/j.ejca.2023.113343 — newest authority, incorporates chlormethine/brentuximab/mogamulizumab/pegylated-IFN; supersedes EORTC 2017 update Trautinger et al PMID 28365528, DOI 10.1016/j.ejca.2017.02.027) + ALCANZA brentuximab vedotin (Prince et al, Lancet 2017; PMID 28600132) + MAVORIC mogamulizumab (Kim et al, Lancet Oncol 2018; PMID 30100375) + bexarotene pivotal (Duvic et al, JCO 2001; PMID 11331325) + romidepsin pivotal (Whittaker et al, JCO 2010; PMID 20697094) + MF/SS prognosis-by-stage validation cohort n=1,502 (Agar et al, JCO 2010; PMID 20855822)