Mycosis Fungoides in Black Patients: Time for a Better Look

Abstract

ecent advances in the immunopathogenesis and therapy of cutaneous T-cell lymphoma (CTCL) have shown great promise for the care of patients with mycosis fungoides (MF) and Sézary syndrome (SS). [1][2][3] Research into the tumor microenvironment, microbiome, and molecular genetics may yield further information as we strive to develop MF/SS therapy from the bench to the bedside. 3 Although progress has been made on multiple fronts in MF, some important-particularly epidemiologic and clinical-questions remain unanswered.Racial disparities are well known to exist in CTCLs, particularly MF and SS. [4][5][6][7] The incidence of MF and SS in the United States is higher in African American/Black patients than in White patients 4 ; in addition, MF has an earlier age at onset in Black patients compared with White patients. 4,5 Gender disparities also exist, with relatively more Black females than males affected with MF [4][5][6] ; in particular, early-onset MF (ie, <40 years of age) is more common in Black females than Black males. 6,7 According to Surveillance, Epidemiology, and End Results (SEER) data 4 and the US National Cancer Database, 5 African American/Black patients with MF have worse outcomes compared with other races (shorter overall survival and higher mortality) and also exhibit higher stages of disease at presentation (stage IIb or higher). 5 Black race also was found to be a predictor of poor overall survival after accounting for disease characteristics, socioeconomic factors, and types of treatment. The factors responsible for these racial disparities remain unclear.A fortuitous collision of interests and technology may have helped to shed light on some of the reasons for these racial disparities in MF. Nearly 2 decades ago, high-quality, whole-body digital cutaneous photography was implemented by the Dermatology Service at