# A historical review of mycosis fungoides: from Alibert to mogamulizumab

## TL;DR

This paper reviews the history of mycosis fungoides, tracing its discovery and evolving understanding from the 19th century to modern treatments.

## Contribution

The paper provides a historical perspective on the nomenclature, diagnosis, and treatment of mycosis fungoides over two centuries.

## Key findings

- Mycosis fungoides was first described in 1806 by Alibert and misclassified as a fungal disease.
- The term cutaneous T-cell lymphoma was established in 1975, clarifying the disease's origin.
- Modern therapies now include monoclonal antibodies like mogamulizumab.

## Abstract

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.

Since the first description of mycosis fungicides in 1806, there has been widespread confusion regarding the nomenclature, aetiology and origin of the disease. This review reflects on the past two centuries, to offer insight into these challenges.