Reflectance Confocal Microscopy as New Diagnostic Tool in Folliculotropic Mycosis Fungoides

Abstract

We present a case of folliculotropic mycosis fungoides (FMF), a variant of cutaneous T-cell lymphoma which particularly affects hair follicles. FMF can imitate a wide variety of otherwise benign dermatoses, so it poses major diagnostic obstacles both for the dermatologist as well as the dermatopathologist. In our case, in vivo reflectance confocal microscopy (RCM) was very important for guiding the skin biopsy site selection. For this reason, RCM can reduce the number of unsuccessful histopathological examinations and increase the diagnostic accuracy for different skin dermatoses.

Confocal microscopy features of patch‐stage mycosis fungoides and their correlation with horizontal histopathological sections. A case series

“…As shown by previous studies, RCM is a useful tool to enhance the clinical diagnosis of MF by showing the peculiar features that we have observed in our case series . In our study, we compared horizontal RCM with horizontal histopathology, achieving a remarkable correlation further confirming the diagnostic reliability of RCM.…”

“…MF has been investigated with RCM resulting in the identification of some diagnostic features . The interpretation of such results, however has been always based on the comparison with vertical conventional histopathological sections that, as known, do not reflect the same plane of RCM images.…”

Systematic review and proposal of an in vivo reflectance confocal microscopy assessment tool for cutaneous lymphoma

“…Identifying follicular and adnexal involvement can be useful in evaluating patients with MF and LyP but has only been reported in a limited number of patients.…”

Reflectance confocal microscopy may be included as part of the diagnostic algorithm of early‐stage mycosis fungoides

“…The Cochran analysis showed good concordance between investigators, and occurrence rate was highest for junctional atypical lymphocytes, architectural disarray, and spongiosis. There are also some case reports about specially classified MF using RCM in the diagnostic process, Yeager et al applied RCM to the diagnosis of a case of tumor‐stage MF, and Fabbrocini et al also used this technology to help obtain a definitive diagnosis of folliculotropic mycosis fungoides. Both of them have one common feature that disorganized honeycomb epidermis with small, weakly refractile, round to oval cells scattered within the epidermis.…”