A historical review of mycosis fungoides: from Alibert to mogamulizumab

In 1806, French physician Baron Jean-Louis Alibert saw a man with a desquamating rash and skin tumours. Alibert considered this to be a variant of yaws. In 1829 Alibert named the condition mycosis fungoides (MF), meaning 'mushroom-like fungal disease'. Over 100 years later, French dermatologist Albert Sézary published papers from 1938 to 1949 detailing a mysterious disease containing 'cellules monstrueuses', describing cutaneous 'monster cells'. In 1961, these clinical findings were collated together into 'Sézary syndrome'. In the 1870s English dermatologist William Tilbury Fox published a dermatology atlas detailing cases similar to what we know now as MF, with the name 'fibroma fungoides'. The atlas described MF as a type of fungus, before giving a description of yaws and painting a clinical picture that differed from that of a lymphoma. Over the twentieth century, our understandings of the origins of MF were changing and by 1975 the classification system and term we now recognize as cutaneous T-cell lymphoma (CTCL) was developed. Neoplastic cells have been thought to arise from chronic activation of T cells via antigen-presenting cells due to inappropriate cytokines and C-C chemokine receptors. In 2018, the World Health Organization and European Organisation for Research and Treatment of Cancer officially recognized four variants of MF. These are the classic Alibert-Bazin variant and its three variants: folliculotropic MF, pagetoid reticulosis and granulomatous slack skin. Developments in immunohistochemistry for the T-cell receptor gene in the 1990s improved the diagnosis of CTCL; however, diagnosis is still challenging. Advanced MF therapies have evolved from cytotoxic chemotherapy to novel monoclonal antibodies such as mogamulizumab, targeting proteins on T-cell lymphoma cells.