E) Mycosis fungoides (MF)
MF is a form of CTCL. As mentioned earlier, there is controversy over whether PPD is associated with MF, but many authors believe that PPD merely shares overlapping clinical features with certain rare subtypes of MF. MF can manifest with a wide variety of clinical lesions, including thin scaly patches, nodules, frank ulcerated tumors, poikilodermatous-like lesions, hypopigmented patches, and, occasionally, lymph node involvement. PPD-like MF lesions have been described.8 The diagnosis of MF is established by histopathology, but early changes can be subtle, and often more than one biopsy is required to make the diagnosis. Histopathologic examination of MF demonstrates atypical lymphocytes, which characteristically display trophism for the epidermis. In the superficial dermis, a variable perivascular lymphocytic infiltrate can be seen.
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Explore This IssueSeptember 2013
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Dr. Femia completed a fellowship in dermatology–rheumatology at Brigham and Women’s Hospital in Boston, MA, and is now an assistant professor in the department of dermatology at New York University. She is a diplomat of the American Board of Dermatology.
Dr. Merola is an instructor in the department of dermatology at Harvard Medical School and an instructor in the department of medicine, division of rheumatology at Brigham and Women’s Hospital, both in Boston. He is the assistant program director for the combined medicine–dermatology training program and a diplomat of the American Board of Dermatology and the American Board of Internal Medicine.