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Digital Myxoid Cyst — SCE Dermatology MCQ

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HardNail DisordersDigital Myxoid CystSCE Dermatology

A patient has poikilodermatous bathing-trunk patches unresponsive to eczema treatment. Two biopsies show only chronic spongiotic dermatitis, but clinicopathological concern for early mycosis fungoides persists. What is the best strategy?

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Correct answer: A — Repeat representative biopsies off topical treatment with clinicopathological correlation

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

D is correct. Early mycosis fungoides is patchy and can be histologically subtle; repeated representative biopsies may be needed when the clinical pattern and course remain suspicious. Sampling untreated, morphologically different lesions and correlating serial histology, immunophenotype and clonality with the examination improves yield. Spongiosis does not permanently exclude MF. Empirical systemic immunosuppression can obscure diagnosis and create avoidable risk. Blood studies are useful for suspected erythrodermic or advanced disease but cannot replace lesional tissue in an otherwise patch-stage presentation.

Reference: BAD and UKCLG guideline for cutaneous T-cell lymphoma: https://doi.org/10.1111/bjd.20458