Our patient with Stage IIB Mycosis Fungoides was discussed at the relevant MDT and his care remained primarily under the dermatology and clinical oncology service. They instigated topical treatment alongside localized radiotherapy to his tumour site on the right arm. He also required systemic treatment with oral methotrexate. He responded well and achieved a good partial response (PR) with resolution of his severe itch.
2 years later he is referred urgently to haematology clinic. Several new lesions have appeared, at the original site of disease (right arm) but also on his chest wall and left ankle. These lesions initially responded to radiotherapy but recurred within a few weeks. His skin disease is less responsive to topical treatment.
He feels generally fatigued and describes unintentional weight loss over the last few months. On examination, he has nodular, ulcerating lesions in the distribution above, as well as bilateral axillary and inguinal lymphadenopathy.
Re-staging investigations demonstrate Stage IVA disease.
What treatment options would you consider?
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