Unilesional plantar mycosis fungoides treated with topical photodynamic therapy - case report and review of the literature.

Background: Unilesional mycosis fungoides (UMF) and pagetoid reticulosis (PR) are variants of mycosis fungoides. Conventional therapy comprises surgical excision or radiotherapy, which may be associated with long-term side effects, especially when the lesion is located at a special site like the palms and soles. Therefore, alternative treatment options are needed to treat solitary lesions in the case of UMF or PR. Recently, topical photodynamic therapy (PDT) has been described to be an efficient and non-invasive therapeutical option with excellent clinical outcome.

Objective: The objective of this study was to report a 43-year-old woman with plantar UMF treated successfully with PDT, and to compare our findings with the data on PDT in UMF and PR reported in the literature.

Methods: The literature was analysed for articles on UMF and PR, respectively, treated with topical PDT. Various parameters including form of PDT and response to treatment were analysed and compared with our case.

Results: A total of 24 patients were documented with 24 lesions treated with PDT, either using aminolevulinic acid (ALA) or methylaminolevulinate (MAL). In average, a single lesion was treated 4 times with PDT. In 21 cases (88%), complete response could be achieved, whereas three cases (13%) showed partial remission. None of the cases showed stable or progressive disease.

Conclusions: PDT is a safe, efficient and non-invasive therapeutical approach for the treatment of UMF and PR. It has no long-standing adverse events and therefore is of high therapeutic value especially in cases of UMF and PR located at special sites like the palms and soles. We propose to include topical PDT as therapeutic option for the treatment of UMF and PR in future guidelines on the management MF.