Mycosis Fungoides and Melanoma: The Latest Research

Amrita Goyal-O’Leary, MD, is a board-certified dermatologist and recent graduate of the dermatopathology fellowship at Massachusetts General Hospital. She is also board-eligible in Internal Medicine. Her expertise involves the intersection between dermatology and hematology/oncology, particularly cutaneous lymphoma and dermato-oncology. Her primary research interests include the clinical management and dermatopathic diagnosis of rare cutaneous T-cell lymphomas and the varied cutaneous manifestations of systemic cancers. She is the lead author of a series of research papers published in the prestigious Journal of the American Academy of Dermatology and the European Journal of Dermatology and Venereology documenting that patients with mycosis fungoides (MF), a rare T-cell lymphoma of the skin, have an increased risk of developing second cancers. MF patients have a significantly increased risk of  non-Hodgkin lymphoma, Hodgkin lymphoma,  lung cancer, bladder cancer, and melanoma. In conjunction with a group of dermatologists and oncologists from across the country, she is in the process of creating cancer screening guidelines for MF patients.

In this video Dr Goyal discusses her latest research which focuses on second malignancies in mycosis fungoides including non-hodgkin lymphoma, Hodgkin lymphoma, lung cancer, bladder cancer, and melanoma.

You can also check out her unique tips and insights regarding mycosis fungoides and melanoma here.

Transcript:

Dr Goyal-O’Leary: Several actual really important takeaways from our study. What I want clinicians to come away from this knowing is that patients with mycosis fungoides are at increased risk of five specific malignancies, Hodgkin's lymphoma, non‑Hodgkin's lymphoma, lung cancer, bladder cancer, and melanoma.

Regarding the risk of Hodgkin's and non‑Hodgkin's lymphoma, we should be doing lymph node exams on every one of these patients basically at every visit, and we should be asking a full review of systems. That is probably the best way to detect Hodgkin's and non‑Hodgkin's lymphoma.

For lung cancer and bladder cancer, the thing I want people to take away is that those are both smoking‑related illnesses. We actually found that a number of patients who develop lung cancer subsequently died of other smoking‑related cancers.

Really, smoking cessation is not a topic we usually discuss a lot in dermatology visits, but I think, given this connection, we are really obligated to at least address the concept of smoking cessation at every visit with patients, give them the resources, and at least connect them with other physicians that can help them with smoking cessation.

Finally, for melanoma, I just want people to take away that we need to be paying specific attention to these patients. I believe that we can hopefully make a big difference in the stage of diagnosis, and ultimately, prognosis for these patients diagnosed with melanoma.

Since about 1980, there's been increasing evidence that patients with mycosis fungoides ‑‑ which is an indolent, non‑Hodgkin's T‑cell lymphoma of the skin ‑‑ that these patients have increased risk of developing second cancers.

It was mostly clearly established that they're at increased risk of Hodgkin's and non‑Hodgkin's lymphomas, but in the last couple of years, work from our group and with other groups has found that patients are also at increased risk of lung cancer, bladder cancer, and melanoma. Today, I think we're particularly interested in talking about the melanoma risk.

What was really interesting in our study is that patients who had MF and were diagnosed with lung cancer and bladder cancer had better survival than their counterparts who only had lung cancer or bladder cancer, and not MF.

However, for melanoma, we didn't see that improvement. Whereas the patients with lung cancer and bladder cancer who had MF were diagnosed at earlier stages of their second malignancy, patients with melanoma didn't really see that effect, which suggests a couple of possible things.

Either we're not identifying these melanomas as early as we possibly could, or that there's something different about the underlying fundamental biology of melanoma in the setting of mycosis fungoides, which we would suggest is possible, because mycosis fungoides is a state of basically immunosuppression.

Patients have a decreased T‑cell repertoire. They have defects in NK cell and dendritic cells. We suppose that it may be a combination of that it's difficult, in some cases with extensive MF, for us to find these pigmented lesions beneath their patches and plaques of their MF. Also, that there may be something different fundamentally about disease progression.

Basically, the question we need to ask when we're looking at the relationship is are these patients at increased risk, and why might they be at increased risk? Are there common genetic underpinnings that we need to establish?

Is it related to immunosuppression in the setting of mycosis fungoides? Or even more intriguingly, is there something about the mycosis fungoides and the immune suppression that those patients have that alters the fundamental biology of the melanomas that they are experiencing?

That's the next place that we need to go. I've been talking to a couple of basic scientists at Harvard about pursuing additional experiments.