The clinical and prognostic implications of head and neck involvement of mycosis fungoides (MF) was outlined in study data published in the Journal of the American Academy of Dermatology. In a study cohort of patients with MF, head and neck involvement was associated with more rapid disease progression and worse prognosis overall compared with MF without head and neck involvement.
Using a Korean medical center database, investigators identified patients diagnosed with MF by skin biopsy from January 1997 to September 2020. Demographic and clinical data were extracted from medical records, including age at diagnosis, sex, disease duration, morphology and location of lesion, MF variation, and the presence of head and neck involvement. Patients with and without head and neck involvement were designated as Group A and Group B, respectively. Overall survival was defined as the time between initial diagnosis and death from any cause or last follow-up examination. Progression-free survival was calculated from the date of initial diagnosis to the date of disease progression or last follow-up. Overall and progression-free survival were compared in Groups A and B. The Kaplan-Meier method was used for survival analyses; Cox proportional hazard models were used to identify correlates of survival.
The study cohort comprised 124 patients with MF, of whom 39 had head and neck involvement (Group A) and 85 did not (Group B). Mean age at diagnosis was significantly greater in Group A compared with Group B (48.9 vs 38.8 years; P =.004). Compared with Group B, Group A more often presented with the folliculotropic variant of MF (28.2% vs 10.6%; P =.027), lymph node involvement (30.8% vs 2.4%; P <.001), serum lactate dehydrogenase elevation (60.9% vs 9.4%; P <.001), and advanced-stage disease (43.6% vs 5.9%; P <.001). Group A also more often presented with stages T2, T3, or T4 MF compared with Group B (all P <.05). Ten-year overall survival in Group A was 53.4% (95% confidence interval [CI], 36.8-77.6%) compared with 94.6% (95% CI, 88.4-100.0%) in Group B (P <.001). Progression-free survival was also substantially worse in Group A (P <.001).
In fully adjusted regression models, head and neck involvement at diagnosis was significantly associated with worse progression-free survival (hazard ratio [HR], 24.44; 95% CI, 2.23-267.59; P =.009). Head and neck involvement also predicted worse overall survival in patients with early-stage MF (P =.004). Stage IV MF was independently associated with worse overall survival (HR, 23.36; 95% CI, 3.61-150.93; P <.001) and progression-free survival (HR, 14.37; 95% CI, 2.29-90.34; P =.005) compared with stage I. No other correlates were significant in the multivariable model.
The data suggest to the investigators that head and neck involvement is associated with worse clinical outcomes in MF.
As study limitations, investigators cited the retrospective design and use of a single study center; further population-based studies are necessary to better examine MF outcomes.
“Considering the poor survival outcomes of patients with head and neck MF, active staging work-up with a multidisciplinary approach to assess lymph node and viscera involvement and closer follow-up should be considered for these patients,” investigators wrote.
Jung JM, Yoo H, Lim DJ, et al. Clinicoprognostic implications of head and neck involvement by mycosis fungoides: a retrospective cohort study. J Am Acad Dermatol. Published online March 23, 2021. doi: 10.1016/j.jaad.2021.03.056