Histopathologic Staging at Initial Diagnosis of Mycosis Fungoides and the Sézary Syndrome

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Abstract
The optimal staging evaluation at the time of initial diagnosis of mycosis fungoides or the Sezary syndrome was studied. Consecutive patients [152] who had mycosis fungoides with or without the Sezary syndrome within 6 months of the initial definitive diagnosis were studied. A detailed staging evaluation including physical examination, routine laboratory studies, chest roentgenogram, lymphangiogram, peripheral blood smear, lymph node biopsy, bone marrow aspirate or biopsy, and liver biopsy in selected 152 patients was made. Univariate adverse prognostic features at initial diagnosis in patients with mycosis fungoides included (P < 0.01) one or more cutaneous tumors or generalized erythroderma, adenopathy, blood smear involvement with Sezary cells, lymph node effacement, eosinophilia, and visceral involvement. Important, independent prognostic factors in a multivariate analysis are the presence of visceral disease and type of skin involvement. A staging system based on histopathologic evaluation of skin, lymph nodes, blood, and visceral sites provides more comprehensive prognostic information than clinical evaluation of skin disease and adenopathy.