At the other end of the spectrum is the Sézary syndrome. This is an erythrodermic variant of mycosis fungoides with peripheral blood involvement. Circulating Sézary cells are the hallmark of this syndrome. The Sézary cells are enlarged lymphocytes with cerebriform nuclei. The cerebriform nuclei can best be appreciated under electron microscopy. It is considered to be a leukemic phase of mycosis fungoides. Sézary syndrome has a poor prognosis.
There are many varying stages of disease between these two extremes. The morphology of cutaneous lymphoma changes from patches to plaques to nodules or tumors. Varying amounts of ulceration may be present. The natural history of progression of mycosis fungoides is variable and difficult to predict clinically. The most accurate way to predict the course is based on the type of involvement and the BSA involved. The smaller the BSA of involvement, the better the prognosis. A worse prognosis is seen with the nodular form as opposed to the plaque type or the patch form of mycosis fungoides.
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