Dermoscopy of mycosis fungoides: could it be a confirmatory aid to the clinical diagnosis?

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma that is difficult to be differentiated from other dermatological diseases. Dermoscopy is an easy and non-invasive office procedure that is widely used nowadays in the diagnosis of a wide variety of skin diseases. This prospective study aimed to describe and to differentiate the dermoscopic pattern of different stages and to compare the dermoscopic features observed in different clinical types of mycosis fungoides. Dermoscopic examination of different skin lesions was performed by two independent examiners and dermoscopic images of lesions were taken to detect the different morphologic criteria. The diagnosis was confirmed histopathologically and immunohistochemically in all cases. A total of 53 mycosis fungoides patients with different clinical types were evaluated. Mycosis fungoides lesions exhibited a characteristic dermoscopic pattern with the predominance of the linear configuration of blood vessels in the form of fine short linear vessels, spermatozoa-like vessels and thick linear blood vessels rather than dotted vessels. In addition, the geometric white scales were more evident than the lamellar scales with a high prevalence of white structureless patches (67.9%). The linear blood vessels and brownish pigmentary changes in this study could be suggestive of early stage mycosis fungoides. On the other hand, the dotted blood vessels, purpuric dots, white and whitish pink structureless patches, and ulcerations could be suggestive of advanced MF skin lesions. Other findings like geometric white scales and orange-yellowish structureless areas were not specific to differentiate between different MF stages. The study observations indicate that early MF lesions exhibit a characteristic dermoscopic pattern which is different from late MF lesions. Dermoscopy is an easy and rapid tool that could aid in the early diagnosis of mycosis fungoides to improve the outcome in these patients.