Journal of Cosmetics, Dermatological Sciences and Applications, 2012, 2, 229-233
http://dx.doi.org/10.4236/jcdsa.2012.23043 Published Online September 2012 (http://www.SciRP.org/journal/jcdsa)
229
Mycosis Fungoides: Epidemiology in Isfahan, Iran
Farahnaz Fatemi Naeini1, Jamshid Najafian2, Mansoor Salehi3, Zahra Azimi4,5*, Parvin Rajabi6
1Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 2Isfahan Cardiovascular
Research Center, Isfahan Cardiovascular Research Institue, Isfahan University of Medical Sciences, Isfahan, Iran; 3Department of
Genetics and Molecular Biology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran; 4Skin and Stem Cell Re-
search Center, Tehran University of Medical Sciences, Tehran, Iran; 5Isfahan University of Medical Sciences, Isfahan, Iran; 6Isfahan
University of Medical Sciences, Isfahan, Iran.
Received January 25th, 2012; revised February 28th, 2012; accepted March 13th, 2012
ABSTRACT
Background: Mycosis Fungoides (MF) is the most common and indolent form of Cutaneuse T-cell Lymphomas (CTCL),
that usually occurs in old adults. Objectives: To determine epidemiologic features and patients characteristics of MF in
Isfahan (Iran). Methods: We performed a retrospective study in MF clinic of alzahra hospital that is the main center for
treatment of MF patients in Isfahan (Iran) and evaluated clinicopathologic features. Results: In 3 years 25 patients were
referred to Alzahra MF clinic. 18 patients diagnosed as MF. Seven (38.9%) patients were male and 11 (61.1%) were
female with male to female ratio of 1:1.57. The mean age of patients was 41.06 years. 88.9% of our patients were in
stages ΙA and ΙB. Conclusion: Most of our patients presented in early stages that were similar to other studies, while
male: female ratio is different from other studies.
Keywords: Mycosis Fungoides; Epidemiology; Clinical Features; Iran
1. Introduction
Mycosis Fungoides (MF) is a disease of lymphatic tis-
sues with primary involvement of the skin and is the most
common and indolent form of Cutaneuse T-cell Lym-
phomas (CTCL), followed by Sezary Syndrome. Initially,
MF presents as a round or ovoid, flat erythematous or
eczematous patch lesion, with or without fine scales [1-
3].
MF usually occurs in old adults, with a median age
between 55 and 60 years and a 2:1 male to female ratio
[4,5].
The diagnosis of MF in its patch or early plaque phase
is often difficult, either because MF mimic other cuta-
neuse disorders such as benign dermatoses or discordance
between clinical and pathologic findings [6,7].
Etiology of MF is unknown, however some studies sug-
gested a causative role of environmental exposure to chro-
nic antigenic stimulation, but they have not been sub-
stantiated by subsequent studies [8-10].
MF is a relatively rare disease and there is no registra-
tion system for this disease in Iran and therefore there is
not enough epidemiologic information about MF in our
country. The aim of this study is to collect epidemiologic
information as well as patient characteristics and clini-
copathologic features of MF in our region, Isfahan, Iran.
2. Patients & Methods
We performed a retrospective study in Alzahra hospital
of Isfahan that is the main center for diagnosis and treat-
ment of patients suspected in MF.
Our study included 25 patients that were suspected in
MF and referred to Alzahra MF clinic in three years from
2007 to 2010.
For establishing the diagnosis each patient reexamined
clinically and the type of skin lesions (including patch,
plaque, tumor, erythroderma, …), percentage of skin in-
volvement as well as location of lesions were determined.
We used WHO classification of tumours of haemopoietic
and lymphatic tissue (2008) to classify our cases [11].
For staging TNMB classification system (2007) was em-
ployed that is the newest classification system for MF
and Sezary Syndrome [12].
Haematoxylin and eosin-stained slides reviewed by
pathologist. Immunohistochemical (IHC) stains for basic
T-cell markers CD4, CD8, CD3, CD5, CD7, CD30, and
CD45RO evaluated where needed. Also fresh or paraf-
fin-embedded tissues checked for T-cell clonality, using
TCR gamma gene rearrangement assay kit (In Vivo
Scribe technologies, USA) [13].
For each patient a profile including all related infor-
mation, was collected. Among this were age, gender, ma-
rital status, address, physical examination, type of skin
*Corresponding author.

Mycosis Fungoides: Epidemiology in Isfahan, Iran 230
lesions, lesion distribution, tumor stage as well as results
of pathology and molecular biology studies.
Cases other than MF were excluded from the study
and patient’s forms were reviewed.
After data collection statistical analysis was performed
by SPSS soft ware version 19.
3. Results
During 3 years 25 patients were referred to Alzahra MF
clinic. After clinical, histological and molecular clonality
reevaluation, 18 patients diagnosed as MF. Seven (38.9%)
patients were male and 11 (61.1%) were female with
male to female ratio of 1:1.57. The mean age of patients
was 41.06 years [median, 34.5 years; range, 25 - 86;
standard deviation (SD), 17.9], and that was 41 for male
and 41.09 for female patients.
Seven (38.9%) patients presented with patch, one of
them had hypopigmented patch, 3 (16.7%) with plaque, 6
(33.3%) had combination of patch and plaque and the
disease in 2 (11.1%) patients were in tumor stage.
We performed T-cell receptor gene rearrangement
studies for all patients. In patients were diagnosed as MF,
11 (61.1%) were positive & 7 (38.9%) were negative.
Using TNM classification system, 8 patients (44.4%)
were in stage ІA, 8 patients (44.4%) were in stage ІB and
2 (11.1%) in ПB.
Exposure to radiation or chemicals, lesion distribution,
pathologic and IHC results of patients are shown in Ta-
ble 1. Twelve (66.66%) patients had no remarkable ex-
posure to sunray or chemical agents.
Fourteen (77.8%) of the cases were married. Most of
the patients (83.3%) had educational degree of diploma
or less. 81.8% of women were housekeepers and most of
men were workers (42.9%) and salesmen (28.6%).
Seven patients (38.9%) were from Flavarjan and sub-
urb, a small city close o Isfahan, and 5 (27.8%) from Is-
fahan city.
4. Discussion
The current study represents a retrospective review of
patients referred to Alzahra MF clinic in three years, in-
cluding 18 patients confirmed as MF.
There is a male predominance in almost all of studies
on CTCLs and MF with a male: female ratio of 1.30 to
Table 1. patients’ characteristics.
Patient No./sex/age Exposure to
chemicals or radiation Lesion distribution Stage Pathology IHC TCR
1/M/86 Sun ray chemical agents Trunk & lower limbs ПB Panniculitis like T-cell
lymphoma MF +
2/F/34 no Trunk & lower limbs ІB MF MF −
3/F/54 Sun ray Buttocks, right groin, lower limbs ІA MF MF −
4/F/35 no Buttocks
Lower abdomen ІA MF ND −
5/M/35 no Trunk, lower limbs ПB MF MF −
6/F/51 no Axilla, groin ІA MF MF +
7/M/26 HCL smoke Head & neck, trunk, upper & lower limbsІA MF MF +
8/M/52 Sun ray Trunk, upper & lower limbs ІB Parapsoriasis MF +
9/F/25 no Buttocks, upper & lower limbs ІA MF MF +
10/F/30 no Lower limbs ІA MF MF +
11/M/28 no Trunk, upper & lower limbs ІB MF MF +
12/F/50 no Face, back, lower limbs ІB MF ND −
13/F/80 no Buttocks, upper & lower limbs ІB MF MF +
14/F/29 no Trunk, upper & lower limbs ІA Chronic dermatitis MF +
15/F/29 no Head, trunk, upper & lower limbs ІB MF (folliculotropic) MF −
16/M/30 Oil colors Trunk, upper & lower limbs ІA MF MF +
17/M/30 Chemical colors Trunk, upper & lower limbs ІB MF MF +
18/F/35 no Upper & lower limbs ІB MF (hypopigmented) MF −
I
HC: Immunohistochemistry; TCR: T-cell receptor gamma gene rearrangement assay; ND: Non diagnostic.

Mycosis Fungoides: Epidemiology in Isfahan, Iran 231
4.00:1 [14-20]. Male to Female ratio was about 1.00 -
1.4:1 in studies performed in some cities of Iran (Mash-
had, Tabriz and Tehran) [21-23]. In present study this
ratio is 1:1.57 that is similar to our previous study on
incidence rate of MF in Isfahan with male: Female ratio
of 3:4 (1:1.33) [24]. These ratios are completely in con-
trast to other studies. This difference might be due to
ethnic group diversity, however to identify the causes of
this difference, studies with more patients should be done.
Although MF usually affect older adults with median
age of more than 50 years [1,25,26], it was lower in
study in Singapore (33 years) [27]. The mean age of pa-
tients in a study in Kuwait was 35.2 years [28]. Their
results are similar to our study with median of 34.5 years.
It seems the age of disease presentation in Asian coun-
tries is lower, in contrast to western studies.
Approximately 80% of MF patients present in early
stages (ΙA, ΙB and ΠA) [15,20,29]. In agreement to other
studies, 88.9% of our patients were in stages ΙA and ΙB.
T-cell clonality was present in about 70% (50% - 100%)
of the biopsies diagnosed as MF [30-33]; this was 28.5%
in a study in Hong Kong [20]. In current study 61.1% of
cases showed clonality.
In present study high percentages of patients (38.9%)
were from an agricultural area near to Isfahan (Flavarjan).
A reason for this could be closeness of this city to Isfa-
han, so they can come to Isfahan easily; another might be
environmental pollution due to huge industries near that
area because according to previous studies environmental
exposure to chronic antigenic stimulation (e.g., industrial
chemicals, metals, and herbicides/pesticides) may have a
causative role [8,10,34].
Occupations involving sun exposure increases the risk
of MF [35]; but in this study 66.66% of patients hadn’t
had remarkable exposure to sun, radiations or chemicals,
although we hadn’t detail history of the patients’ expo-
sures.
In a study in the United States, CTCL incidence rate
correlated with high physician density, family income
and higher education that were related to more access to
health care. They also found higher incidence rate of MF
in blacks and concluded that immunogenetics or interac-
tion of genetic susceptibility and the environment in
CTCL, may have a role in MF incidence [18]. In our
study majority of the patients were educated up to the
high school degree and commonly were housekeepers
(women) and workers or salesmen (men).
In conclusion most of our patients presented in early
stages that were similar to other studies, while male: fe-
male ratio is different from other studies.
5. Acknowledgements
We thank Research Department of Isfahan University of
Medical Sciences for their, financial support and Mrs
hassankhani and other Alzahra dermatology clinic staff,
for their contribution in this study.
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