Mycosis fungoides palmaris et plantaris successfully treated with radiotherapy: Case report and mini‐review of the published work

Abstract

Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of cutaneous T-cell lymphoma limited to the palms and soles that is not widely recognized because of its uncommon occurrence. We report a 73-year-old Japanese man who presented with an erosion on the left dorsal hand, a reddish tumor on the right palm, and hyperkeratotic erythematous plaques on the right sole. Skin biopsy showed histological features of mycosis fungoides (MF) with invasion into the deeper layers of skin. There was no visceral or lymph node invasion. We diagnosed this case as MFPP. External beam radiotherapy (EBRT) was performed to treat the hand lesions. Combination treatment with topical steroids and topical psoralen plus ultraviolet light therapy was performed to treat the right sole lesion, but was ineffective. Therefore, sequential EBRT was performed. Complete remission of all lesions was obtained. This is the first report of MFPP with a locally advanced tumor for which the efficacy of radiotherapy is described in detail. MFPP lesions occur on the dorsal aspect of hand or foot, and here we propose a classification of MFPP as hand and foot MF. The pathogenesis of MFPP is still unclear and further accumulation of data is required.

Palmoplantar eczema as initial sign of mycosis fungoides

“…Since then approximately 30 cases of MFPP have been published in the common literature. [4][5][6] MFPP affected twice more men than females at an average age of 52 years. MFPP can easily be overlooked and mistaken for hand and foot eczema, acral psoriasis, clavi syphilitici or tinea among other differential diagnoses.…”

“…4 Major therapeutic options include topical glucocorticosteroids, psoralen-UVA phototherapy and systemic alitretinoin, among others. 6 The course of MFPP is generally not aggressive with some local recurrences and no lethal case that has been documented until now. 6 Our case supports the value of considering MF as a cause, even rare, of eczematous hand and foot lesions.…”

“…6 The course of MFPP is generally not aggressive with some local recurrences and no lethal case that has been documented until now. 6 Our case supports the value of considering MF as a cause, even rare, of eczematous hand and foot lesions. More generalized itch may be a hint towards MFPP as well as resistance to standard therapies.…”

New aspects of the clinicopathological features and treatment of mycosis fungoides and Sézary syndrome

“…Up to 20% of cases of early MF demonstrate a CD8 + phenotype . Many clinical and immunophenotypic variants are present in MF, including folliculotropic (follicular mucinosis), bullous, hypopigmented, psoriasiform and palmoplantar MF. Although the prognostic significance of these variants is still not fully understood, certain variants, such as folliculotropic and bullous MF, have demonstrated less indolent clinical courses compared with classic MF and necessitate more aggressive therapeutic measures .…”

Mycosis Fungoides

“…22A, B). 56,57 Clinically, patients may present with annular and hyperpigmented patches and plaques, tumors, pustules, verrucous changes, ulceration, and nail dystrophy. The histopathologic differential diagnosis includes other diseases with lymphoid infiltrates surrounding eccrine glands, such as perniosis and neutrophilic eccrine hidradenitis, and conditions with syringometaplasia, such as skin reactions to chemotherapy, cutaneous, ischemia, and radiation dermatitis.…”