Authors: Christopher Portelli , Paul Farrugia , Miljan Milic , Stephen Mangion

Abstract

Background: Among extranodal non-Hodgkin lymphomas, primary cutaneous lymphomas rank as the second most prevalent.
These lymphomas can originate from T cells, B cells, or natural killer cells. Cutaneous T cell lymphomas (CTCLs) form a diverse
group of lymphomas that display clinical distinctions from systemic lymphomas, despite potential similarities in histology Mycosis fungoides (MF) stands out as the most prevalent subtype of CTCL. Pierre-Antoine-Ernest Bazin outlined the transformation from patches - defined as non-infiltrated lesions exhibiting erythema, scaling, and atrophy - to infiltrated plaques and tumors. Histologically, this progression is marked by the increase of small to medium-sized epidermotropic CD4+ T lymphocytes that have folded nuclei.
Case Presentation: We present a case of an 85-year-old man with a known history of vascular dementia who presented with a
lesion on his left posterior thigh. After no improvement with a potent steroid cream, a punch biopsy of the lesion was done and confirmed the diagnosis of MF, tumor stage. However, due to the patient’s poor clinical frailty and ECOG performance score, the intent of treatment was palliation.
Conclusion: This case report aims to discuss the challenges in the diagnosis and management of cancer in elderly patients with significant comorbidities. We will also highlight the management pathway of MF. 

Keywords: Mycosis Fungoides, geriatric-oncology, palliative, case report.