Rapidly progressing mycosis fungoides: Case report of an uncommon tumor and a brief literature review

It is the most common form of cutaneous T-cell lymphoma, which can be challenging to identify in its early stages due to its clinical and histological similarities to various inflammatory skin diseases and other skin conditions. The diagnostic difficulty may result in significant treatment delays, which may affect the patient. We describe a case of a 52-year-old man who presented with a history of progressive skin lesions for two years. The lesions initially appeared as eczematoid patches, which later developed into extensive, nodular, ulcerated nodules and tumors in the inguinal region, buttocks, axillae, and back, a typical presentation of Stage IIB MF. The skin biopsy, combined with immunohistochemistry, flow cytometry of peripheral blood, and PET-CT imaging, confirmed the diagnosis of CD4+ / CD30+ T-cell malignancy involving the skin, characterized by widespread nodules.

This case highlights the importance of early diagnosis and the benefits of a multidisciplinary approach. The first pitfall is the initial misdiagnosis of a simple dermatosis. The final Diagnosis required a comprehensive clinical assessment, specialized dermatopathology, and laboratory and radiographic analyses. A multidisciplinary tumor board discussion recommended immediate treatment with brentuximab vedotin systemic therapy and radiation due to disease advanced and aggressive stage. The diagnostic process in this case underscores the importance of maintaining a high level of suspicion in cases of persistent or progressive skin lesions that are not responsive to treatment for common, or straightforward conditions. Both early and accurate diagnosis, obtained through collaboration between a multidisciplinary team and promptly initiating proper therapy is crucial to optimize patient prognosis and outcomes in patients with this rare disease