Early stage mycosis fungoides represents the most common clinical presentation of cutaneous lymphoma, with skin-directed therapies long established in its treatment. These therapies continue to change as new treatment regimens emerge. Other skin-directed treatments include light and radiation therapy. Therapies with higher levels of evidence and less systemic toxicity are usually preferred as first-line treatment. However, even these established therapies, like topical corticosteroids and carmustine, lack randomized clinical trials to establish their efficacy. Research is also needed to further define the role of combination topical therapies and how skin-directed therapies can be used as adjuvants to systemic medications.
Key points
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Not all patients with early stage cutaneous T-cell lymphoma (CTCL) require treatment.
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Topical therapies are effective in treatment and management of early stage CTCL and as adjuvant treatment with systemic therapy for more aggressive disease.
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Topical therapies have been most extensively studied for use in mycosis fungoides. Further studies are needed to evaluate their efficacy in other forms of CTCL.

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