Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion
Open accessAbstract
Mycosis fungoides (MF) is a rare, primary cutaneous T-cell lymphoma that is challenging to diagnose due to its heterogeneous clinical presentation and complex histology. The subtlety of the initial clinical appearance of MF can result in diagnostic delays and hesitancy to refer suspected cases to specialist clinics. An unmet need remains for greater awareness and education. Therefore, an international expert panel of dermatologists, oncologists, hematologists, and dermatopathologists convened to discuss and identify barriers to early and accurate MF diagnosis that could guide clinicians toward making a correct diagnosis. Confirmation of MF requires accurate assessment of symptoms and clinical signs, and subsequent correlation with dermatopathological findings. This review summarizes the expert panel's guidance, based on the literature and real-life experience, for dermatologists to help include MF in their list of differential diagnoses, along with simple clinical and histopathologic checklists that may help clinicians to suspect and identify potential MF lesions and reduce diagnostic delays.
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Cutaneous TCR clonality is confirmed in only 64% of early-stage patients.
“Cutaneous TCR clonality is confirmed in only 64% of earlystage patients”
From Histological triage of early-stage mycosis fungoides using a weakly supervised deep learning-based model: a multicentre, external validation, and clinical utility study (2026) · cites this paper as [4]
In “Steps to Arrive at a Correct Diagnosis” (page unavailable), the paper says early-stage mycosis fungoides can show little clonality, making PCR testing unreliable in a significant fraction of early cases. This supports the general point that cutaneous TCR clonality is not always detected, but the paper does not give the claimed 64% figure (searched: “64%” and early-stage clonality detection). (LLM, conf=0.82)
Experimental — accuracy not yet measuredDetection of aberrant pan-T-cell marker loss carries a sensitivity as low as 10%.
“the detection of aberrant pan-T-cell marker loss carries a sensitivity as low as 10%”
From Histological triage of early-stage mycosis fungoides using a weakly supervised deep learning-based model: a multicentre, external validation, and clinical utility study (2026) · cites this paper as [4]
The Overview section, “Steps to Arrive at a Correct Diagnosis” (page unavailable), says that a panel including CD3, CD5, and CD7 can aid diagnosis. It does not report the sensitivity of detecting pan-T-cell marker loss. Searches for marker loss and 10% sensitivity found no passage establishing the claimed figure. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Hodak, E., Geskin, L., Guenova, E., Ortiz-Romero, P. L., Willemze, R., Zheng, J., Cowan, R., Foss, F., Mangas, C., & Querfeld, C.
- Affiliations
- Tel Aviv University (IL)
- Columbia University Irving Medical Center (US)
- Centre Hospitalier Universitaire Vaudois (CH)
- Universidad Complutense de Madrid (ES)
- Leiden University Medical Center (NL)
- Shanghai Jiao Tong University (CN)
- The Christie Hospital (GB)
- Yale Cancer Center (US)
- Ente Ospedaliero Cantonale (CH)
- City Of Hope National Medical Center (US)
- Corresponding author
- Hodak, Emmilia
- ORCID
- Venue
- American Journal of Clinical Dermatology
- Published
- 2022-11-18
- Volume
- 24
- Issue
- 1
- Pages
- 5-14
- ISSN
- 1175-0561 (ISSN-L)
- 1179-1888
- PMC
- PMC9673193
- OpenAlex
- W4309287222
- Cited by
- 47
- References
- 64
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 11 · 2023: 5
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Update notices
- correction (2023-03-14)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Clinical Dermatology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, cc-by-nc)
- IRIS (submittedVersion, cc-by-nc)
- Funders
- Helsinn (Helsinn Healthcare SA)
- Topics
- Health Sciences › Medicine › Dermatology › Cutaneous lymphoproliferative disorders research
- Health Sciences › Medicine › Dermatology › Cancer and Skin Lesions
- Health Sciences › Medicine › Dermatology › Medicine and Dermatology Studies History
- Keywords
- mycosis fungoides, cutaneous T-cell lymphoma, delayed diagnosis, barriers to diagnosis, differential diagnosis, histopathology, clinical features, diagnostic checklist, expert panel consensus
- MeSH terms
- Diagnosis, Differential, Humans, Mycosis Fungoides, Skin Neoplasms
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