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Dermatology and Therapy
Erschienen in: Dermatology and Therapy 1/2023

Open Access 30.11.2022 | Letter

Letter to the Editor Regarding a Comprehensive Update of the Atypical, Rare, and Mimicking Presentations of Mycosis Fungoides

verfasst von: Christy Nwankwo, Yazmeen Tembunde, Pauline Flaum-Dunoyer, Jarad Levin

Erschienen in: Dermatology and Therapy | Ausgabe 1/2023

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This comment refers to the article available online at https://​doi.​org/​10.​1007/​s13555-021-00625-6.
Dear Editor,
We read Lebas et al.’s systematic review with great interest [1]. Their study provided a necessary update on dermatoses that can present similarly to mycosis fungoides (MF). We appreciate their findings and would like to highlight the importance of inclusion of diverse patient images. Despite a low incidence in the general population, MF has a higher incidence in Black patients [2]. Moreover, Black patients with MF present with earlier onset and more advanced disease compared with white patients in the USA [3]. More research is needed to establish definite causes of these racial disparities in patients with MF, but delays in diagnosis may contribute to this finding. MF can present with numerous variants that may mimic other dermatoses, such as atopic dermatitis, psoriasis, or vitiligo, which can cause delays in the initial diagnosis and thus treatment for this condition [4]. To further our understanding of racial disparities in MF outcomes and appropriately train medical providers on the wide array of clinical presentations of MF, inclusion of diverse patient images is paramount. In this study, we reviewed the primary articles identified in this systematic review to assess the inclusion of skin of color (SOC) patients.
We collected the following information from the articles: dermatosis initially diagnosed or phenotypic features described and skin tone diversity and how this was assessed or denoted.
From the original article, 74 studies were reviewed. Of the 74 studies, 10 did not explicitly specify the race/ethnicity or skin type of patients and this information was incapable of being ascertained from included images [514]. The number of studies explicitly noting race/ethnicity or skin type included skin of color patients at a rate of 23.0% (n = 17, Table 1) [1531]. The inclusion of studies with Black patients and those with Fitzpatrick Type 4 or greater was 12.2% (n = 9, Table 1) [2331]. Lastly, the studies that included Black patients focused on misdiagnoses that were initially diagnosed as hypopigmentation (n = 4, Table 1), porokeratosis (n = 2, Table 1), dissecting cellulitis of the scalp (n = 1, Table 1), leprosy (n = 1, Table 1), or showing an atypical feature of necrobiosis (n = 1, Table 1).
Table 1
Studies with skin of color patients
Title
Other diagnosis/variant phenotype
Country
Proportion of skin of color patients to total patients
Skin tone diversity
Hypopigmented mycosis fungoides mimicking vitiligo [15]
Vitiligo
Korea
1/1
Race, Korean
Mycosis fungoides bullosa associated with bullous pemphigoid [16]
Bullous
Japan
1/1
Race, Japanese
Mycosis fungoides palmaris et plantaris successfully treated with radiotherapy: case report and mini-review of the published work [17]
Hyperkeratosis
Japan
1/1
Race-Japanese
Ichthyosiform mycosis fungoides: report of a case associated with IgA nephropathy [18]
Ichthyosis
Japan
1/1
Race, Japanese
Serpiginous mycosis fungoides in a 21-year-old man [19]
Pigmented purpuralike
Canada
1/1
Race, Asian
Poikilodermatous mycosis fungoides with a CD8 + CD56 + immunophenotype: a case report and literature review [20]
Poilkiloderma
Japan
1/1
Race, Japanese
Pediatric mycosis fungoides in Singapore: a series of 46 children [21]
Pityriasis lichenoides chronica; Postinflammatoru hypopigmentation
Singapore
42
Race, Chinese (33); Malay (7); Indian (2); others (4)
Solitary plaque on the leg of a child: a report of two cases and a brief review of acral pseudolymphomatous angiokeratoma of children and unilesional mycosis fungoides [22]
Acral pseudolymphomatous angiokeratoma of children
USA
1/2
Race/ethnicity, Hispanic
Mycosis fungoides presenting as areas of hypopigmentation [23]
Hypopigmentation
USA
3/3
Race, Black (2); Nicaraguan (1)
Cutaneous T-cell lymphoma mimicking porokeratosis of Mibelli [24]
Porokeratosis
USA
1/1
Race, Black
Cutaneous T-cell lymphoma with porokeratosis-like lesions [25]
Porokeratosis
USA
2/2
Race, Black
Hypopigmented macules [26]
Hypopigmentation
USA
1/1
Race, Black
Hypopigmented variant of mycosis fungoides: demography, histopathology, and treatment of seven cases [27]
Hypopigmentation
USA
7/7
Race, African American; Puerto Rican; Trinidadian (number unspecified)
Folliculotropic mycosis fungoides with large-cell transformation presenting as dissecting cellulitis of the scalp [28]
Dissecting cellulitis of the scalp
USA
1/1
Race, Black
Hypopigmented mycosis fungoides [29]
Hypopigmentation
USA
3/3
Race, Black/African American
Perineural and intraneural cutaneous granulomas in granulomatous mycosis fungoides mimicking tuberculoid leprosy [30]
Leprosy
Colombia
1/4
Image 1-FST III, Image 2-FST IV, Image 3 FST II
Necrobiotic cutaneous T-cell lymphoma [31]
Necrobiotic features
UK
1/3
Ethnicity, Afro-Caribbean
There is a paucity of inclusion of case reports reporting conditions that are initially misdiagnosed before the correct diagnosis of MF in SOC patients. In the study analyzed, there are over 50 diagnoses mentioned that can mimic MF, yet only 5 of these diagnoses have referenced studies that included Black patients [1]. Interestingly, hypopigmented MF is a variant more commonly seen in Black patients and may indicate a greater chance of improved outcomes [32]. Folliculotropic MF is a variant in which malignant cells infiltrate hair follicles, and has been reported to present similar to dissecting cellulitis of the scalp [4]. Granulomatous MF is another variant and has been reported to show features of necrobiosis and similarities to leprosy. Further review of MF mimickers and variants more common in Black patients may help elucidate reasons for racial differences in outcomes. Given the difference in outcomes of Black patients with MF and reports of increased prevalence of the condition in Black patients, studies about MF should include images of SOC patients or reference skin tone differences in their patient cohorts. Likewise, the lack of included articles with SOC patients also impacts trainee education on the presentation of MF [33]. Trainees and providers should be aware of the ways MF can present in darker-skinned patients, since Black patients with MF are more likely to have a worse prognosis. Lastly, providers in any specialty should be compelled to contribute to the literature on this topic by publishing articles or submitting images of challenging MF diagnoses in SOC patients. Future studies should assess the inclusion of SOC patients with MF in more resources.

Acknowledgements

Compliance to Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Author Contributions

Design: Nwankwo. Acquisition, analysis, or interpretation of data: Nwankwo, Tembunde, Flaum-Dunoyer. Drafting of the manuscript: Nwankwo, Tembunde. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Nwankwo. Supervision: Levin.

Funding

No funding received for this study.

Disclosures

No disclosures to report.
Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by-nc/​4.​0/​.
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Metadaten
Titel
Letter to the Editor Regarding a Comprehensive Update of the Atypical, Rare, and Mimicking Presentations of Mycosis Fungoides
verfasst von
Christy Nwankwo
Yazmeen Tembunde
Pauline Flaum-Dunoyer
Jarad Levin
Publikationsdatum
30.11.2022
Verlag
Springer Healthcare
Erschienen in
Dermatology and Therapy / Ausgabe 1/2023
Print ISSN: 2193-8210
Elektronische ISSN: 2190-9172
DOI
https://doi.org/10.1007/s13555-022-00856-1

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