Mechlorethamine is an effective topical therapy for early-stage (patches/thin plaques) mycosis fungoides. However, interpretation of the studies is confounded by the use of other therapeutic modalities for most patients and the retrospective nature of the studies. Duration of response varies, and the efficacy of maintenance therapy (6—18 months) and whole-body application remains unclear, but some patients with stage IA disease may be cured. The survival data reported for topical mechlorethamine are similar to those previously published for patients with early-stage disease (Table 27.1). Any clinical efficacy of topical mechlorethamine therapy after TSEB therapy has to be confirmed. Almost all patients with stage IA mycosis fungoides have a normal life expectancy and so controlled trials are required.
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