A rare indication for surgical treatment in mycosis fungoides

We present an unusual, surgical method of treatment of a locally advanced mycosis in an adult man treated at the Department of General and Oncological Surgery of the University Hospital in Zielona Gora. Mycosis fungoides is a chronic malignant skin cancer from T cells of the lymphatic system. The essence of the disease is the uncontrolled proliferation of T cells localized in the skin (cutaneous T-cell lymphoma – CTCL). The incidence of the disease is estimated at 0.29 cases per 100 thousand. population. It affects men about twice as often [1, 2]. The etiology of the disease is not known exactly [3, 4]. On March 26, 2020, we admitted a 79-year-old man referred from the Department of Hematology of the University of Life Sciences in Zielona Gora due to a huge inflammatory infiltrate with ulceration of the left thigh. The patient was admitted years ago with a diagnosis of mycosis fungoides of the left thigh. Apart from the extensive, disintegrating ulceration of the posterior part of the right thigh, no nodal or organ changes were found.
The first erythematous lesions on the skin appeared in August 2011. The patient was treated in the Dermatological Outpatient Department with methotrexate 20 mg/week and methylprednisolone 12 mg/day. In April 2012, there was a significant deterioration of the local skin condition in the form of numerous erythematous, erythematous infiltrative and single nodular eruptions scattered over the surface of entire body. Diagnostic procedures were performed in the Department of Dermatology, Venereology and Allergology, Clinical Hospital No. 1 in Wroclaw. The diagnosis was established and the treatment of skin lesions was introduced. For several days of hospitalization, the patient was observed to have a large inflammatory infiltrate with left thigh edema accompanied by fever up to 38.5°C. Histopathological examination confirmed the diagnosis: “Mycosis fungoides with large cell transformation”. In additional tests, significant leukocytosis up to 22,000/µl, increased inflammatory parameters (CRP – 77.4 mg/l) and increased levels of tumor markers Ca 125 II (280.4 U/ml), and Ca 15-3 (91.6 U/ml) were observed. Imaging excluded changes in lymph nodes and organs beyond the skin. The outpatient chemotherapy cycle was proposed according to the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) regimen. During subsequent exacerbations of the disease, interferon was also included (peginterferon alfa-2a 90 µg, once a...


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