Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC).

The ISCL/EORTC recommends revisions to the Mycosis Fungoides Cooperative Group classification and staging system for cutaneous T-cell lymphoma (CTCL). These revisions are made to incorporate advances related to tumor cell biology and diagnostic techniques as pertains to mycosis fungoides (MF) and Sézary syndrome (SS) since the 1979 publication of the original guidelines, to clarify certain variables that currently impede effective interinstitution and interinvestigator communication and/or the development of standardized clinical trials in MF and SS, and to provide a platform for tracking other variables of potential prognostic significance. Moreover, given the difference in prognosis and clinical characteristics of the non-MF/non-SS subtypes of cutaneous lymphoma, this revision pertains specifically to MF and SS.

Should coal tar products carry cancer warnings?

This article addresses the controversy whether over-the-counter products that contain coal tar concentrations greater than 0.5% must carry cancer warnings. Evidence that topical coal tar is carcinogenic in laboratory animals and humans is reviewed.

Prognosis, clinical outcomes and quality of life issues in cutaneous T-cell lymphoma.

Although the need for a specific QOL index for MF/SS has been recognized, little work has been done in this area. QOL instruments should address general health concepts, as well as specific issues that are relevant to patients who have MF/SS; a combination of two instruments may be appropriate. Confirming the validity, reliability, and responsiveness to change of a combination of QOL instruments, such as SKINDEX-29 and FACT-G, in patients who have MF/SS will be relevant.

Topical carmustine (BCNU) in the treatment of mycosis fungoides.

The University of California, San Francisco (UCSF), experience with topical carmustine (BCNU) in the treatment of approximately 200 patients with mycosis fungoides (MF) is summarized. Topical BCNU is an effective treatment for patch- and early plaque-stage MF. Side-effects are usually not a major deterrent to continuation of therapy.

Treatment of patch-stage mycosis fungoides with topical corticosteroids.

Experience at the University of California, San Francisco (UCSF), in the management of patch-stage mycosis fungoides (MF) with topical, predominantly high-potency, corticosteroids is reviewed. The technique of applications is discussed in detail. Approximately 200 patients have been treated.

Low-dose methotrexate to treat mycosis fungoides: a retrospective study in 69 patients.

Background: Although low-dose methotrexate has been used to treat mycosis fungoides for many years, documentation is very limited.

Objective: Our purpose was to review our experience with methotrexate in the treatment of 69 patients with patch/plaque and tumor stage mycosis fungoides observed for up to 201 months.

Methods: This was a retrospective study.

Lymphomatoid papulosis associated with mycosis fungoides: a study of 21 patients including analyses for clonality.

Background: Although an association of lymphomatoid papulosis (LyP) with mycosis fungoides (MF) is recognized, our understanding of this relation is limited.

Objective: We sought to document the clinical experience at the University of California, San Francisco, in 21 patients who had both LyP and MF and to do clonality studies in 7 of those patients in whom this was possible.

Methods: We conducted chart review of the 21 patients and analysis for T-cell receptor-gamma gene rearrangements by the polymerase chain reaction.

The FDA guidelines for the treatment of psoriasis using cyclosporine A: are they adequate?

I present a review of the current US Food and Drug Administration (FDA) guidelines for using cyclosporine A (CSA) to treat psoriasis, with particular emphasis on the period for which CSA may be administered. My concern is that, without violating the guidelines, CSA could be given for a prolonged period with only very brief time-outs. I also review the risks for renal toxicity, malignancy, and other side effects from prolonged administration.

Mycosis fungoides: the great imitator.

A considerable number of reports have documented mycosis fungoides (MF) mimicking other dermatoses, but a comprehensive review has not been published. Our aim was to comprehensively review reports of various dermatoses simulated by MF. Additionally, 2 cases in which MF simulated diseases not previously documented (psoriasis and erythema annulare centrifugum) are presented.

A modified staging classification for cutaneous T-cell lymphoma.

Background: Despite refinements in the diagnosis of cutaneous T-cell lymphoma (CTCL), since 1979 there have been no changes to the staging of CTCL used to classify mycosis fungoides and Sézary syndrome.

Objective: We reviewed the current staging of CTCL and examined the usefulness of a new staging scheme for mycosis fungoides and Sézary syndrome.

Methods: We determined overall survival of 450 patients with mycosis fungoides and Sézary syndrome using the current and modified staging classifications.

Relative frequency of various forms of primary cutaneous lymphomas.

Background: Data on the relative frequency of the various forms of primary cutaneous lymphomas (PCLs) are largely limited to European institutions.

Objective: Our purpose was to document the relative frequencies of various PCLs seen at 3 US institutions with active cutaneous lymphoma programs and to compare those with the European data.

Methods: Included in this study are newly registered patients seen at MCP Hahnemann University, New York University, and the University of California, San Francisco from July 1, 1995 to June 30, 1998.

Cutaneous T cell lymphoma: update of treatment.

The state-of-the art therapy of cutaneous T cell lymphoma (CTCL) is reviewed. Commonly used treatments for early-stage (patch/plaque) mycosis fungoides (MF) include topical corticosteroids, mechlorethamine, carmustine, ultraviolet light B and PUVA. Total skin electron beam (TSEB) therapy is indicated for widespread infiltrated plaque and tumor stage disease.

Mycosis fungoides masquerading as an ischemic foot.

This case is of a man with bilateral lower-extremity ischemia and a solitary nonhealing ulcerated lesion of the right great toe. After revascularization with an aortobifemoral bypass, his right ABI increased from 0.5 to approximately 0.

Prognosis in cutaneous T-cell lymphoma by skin stage: long-term survival in 489 patients.

Background: Although a number of studies have documented the long-term survival of patients with cutaneous T-cell lymphoma (CTCL), none have provided data as to the relative survival of all 4 skin stages.

Objective: We document survival of CTCL patients by T stage relative to that of an age-, sex-, and race-matched population.

Methods: The survival of 489 patients with CTCL registered since 1957 was compared with that of a California control population.

Topical corticosteroids for mycosis fungoides. Experience in 79 patients.

Objective: To determine the effectiveness of topical corticosteroids in the management of mycosis fungoides.

Design: Prospective study.

Setting: Academic referral center, Veterans Affairs Medical Center, and private practice.