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(38) Localized mycosis fungoides with central clearing

Case reports the eruption persisted. A biopsy showed some hyperkeratosis and areas of epidennal atrophy with damage to the basal layer. There was a patchy monocytic dermal infiltrate near skin appendages. A diagnosis of discoid lupus erythematosus was considered and treatment with topical steroids continued with the addition ofa sunscreen. The eruption waxed and waned and a second biopsy was taken, which showed similar changes to the first. In March 1985, in addition to topical steroids, oral mepacrine 100 mg daily was started and given for 7 months with considerable improvement of the eruption. The patient was then lost to follow up, but presented again in September 1988 with clinical mycosis fungoides showing tumorous involvement of the right temple and periorbital region also involving both eyelids (Fig. i), and widespread indurated plaques over the trunk and arms. Investigation. Histology shows infiltrates of large masses of Iymphoid cells with hyperchromatic nuclei occupying the dermis and penetrating into subcutaneous tissue. Many of these are shown to be T cells with cell-marker studies. Treatment. The tumorous infiltration round the right eye was treated with ^°Co, 2500 cGy given in five fractions in October 1988 with good result. He was then treated with whole-body beta-rays from ^°Sr receiving a total of 3000 cGy given in 10 fractions. A thick plaque on the left ear was treated with 250 kV X-rays, 1500 cGy given in five fractions. There was good initial response to radiotherapy. The patient has been warned about the likely development of a postirradiation cataract.