Ann Dermatol.  2011 Sep;23(Suppl 1):S57-S60. 10.5021/ad.2011.23.S1.S57.

The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

• Lee SY
• Kwon HC
• Cho YS
• Nam KH
• Ihm CW
• Kim JS

• KMID: 2156752
• DOI: http://doi.org/10.5021/ad.2011.23.S1.S57

Abstract

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

Keyword

Hyperkeratotic plantar lesions; Mycosis fungoides; Three-dimensional conformal radiotherapy (3D-CRT)

MeSH Terms

Adolescent
Female
Follow-Up Studies
Humans
Mechlorethamine
Methotrexate
Mycosis Fungoides
Phototherapy
Radiotherapy, Conformal
Recurrence
Steroids
Mechlorethamine
Methotrexate
Steroids

Figure

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  Fig. 1 Thick keratotic scales and furrows with mild erythema involves the entire plantar surface bilaterally, including its lateral borders and interdigital spaces.

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  Fig. 2 (A) A low magnification view shows compact hyperkaratois, acanthosis, and exocytosis with intraepidermal collection of mononuclear cells. The hyperkeratotic horny layer also shows many nuclear remnants (H&E, ×100). (B) The higher magnification of intraepidermal collections of mononuclear cells showed atypical hyperchromatic nuclei of cells compatible with Pautrier's microabscesses (H&E, ×400). (C) Papillary dermal and intraepidermal exocytic cells were CD4 positive (immunoperoxidase, ×100).

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  Fig. 3 The image is a three-dimensional conformal radiation treatment field. With the patient in a frog leg position, a 1 cm-thick silicon bolus was placed on the sole, as a tissue compensator. The photon beam could reach the entire lesions.

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  Fig. 4 (A) The plantar skin on the day of completion of treatment shows disappearance of thick keratotic scales. (B) A follow-up picture taken one-year after treatment shows complete resolution of plantar skin lesions.

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