Because many cases of mycosis fungoides are initially diagnosed as more benign skin conditions such as psoriasis or fungal infections, the disease may not be treated properly until quite late in its development. Mycosis fungoides treatment typically depends upon the medical services and options available to a patient, as well as the stage of the disease and other individual factors.
Chemotherapy is a first line of defense in treating all forms of cancer, including cutaneous T-cell non-Hodgkins lymphomas; however, because it is a relatively invasive method, most doctors prefer to begin with topical chemotherapy. Topical chemotherapy commonly involves an ointment containing an agent called mechlorethamine, which is applied once or twice daily to the entire body. If this is not effective and other biologic treatments fail as well, doctors may resort to systemic chemotherapy utilizing agents such as cyclophosphamide or adriamycin.
Oral and Topical Retinoids
Bexarotene gel, a derivative of Vitamin A, is a topical medication that has been approved by the FDA for use in the treatment of mycosis fungoides. It works by altering the growth and maturation patterns of cancerous cells, and is often used in combination with other treatments. Oral Bexarotene or Targretin can be taken in capsule form to treat widespread or systemic forms of the cancer. This systemic form of treatment has several potentially serious side effects, and requires close monitoring of thyroid and liver functions as well as lipid levels and blood counts.
Drugs such as interferon alpha can be used to stimulate the body’s natural immune response, and has been shown to be effective in treating non-Hodgkins lymphomas. The treatments are typically given as cutaneous injections three times a week. Side effects can include flu-like symptoms, depression, fatigue, and weight-loss. Immunotherapy methods are sometimes called biologic treatments, as they strengthen the body’s natural impulse to fight disease. However, they still involve powerful systemic medications, and patient blood levels should be monitored over the course of the treatment.
The most commonly applied form of phototherapy is PUVA, a treatment that uses a naturally occurring plant product called psoralen or oxpsoralen in combination with ultraviolet light therapy. The oxpsoralen is usually taken orally about two hours before a patient undergoes the UV light therapy. After ingestion, wraparound sunglasses and sunscreen must be worn to protect eyes and exposed skin for 24 hours, as the risk of cataracts and sun sensitivity increase with long-term exposure to PUVA therapy.
Natural sunlight exposure is often thought to have a beneficial effect on those suffering from mycosis fungoides, as it increases vitamin D and calcium absorption; however, it is obviously not suitable as a main method of treatment. Topical steroids can be used to treat mild cases in which the disease has not spread beyond a controlled cutaneous area, but should not be used on large areas of the skin. Electron beam radiation is a suitable treatment option for patients suffering from more severe cutaneous T-cell lymphoma, as long as the cancer has not yet metastasized to other parts of the body.
It is important to begin mycosis fungoides treatment as early as possible, as the condition is difficult to cure and is fatal to more than half of the people who contract it. However, the disease is slow moving, and many people will survive for years or enter full remission with proper treatment and care.