Ece GÖKYAYLA, Neslihan DEMİREL ÖĞÜT
Turkish Journal of Dermatology - 2026;20(1):1-9
Aim: Mycosis fungoides [(MF) the most common primary cutaneous T-cell lymphoma] is difficult to diagnose early, and treatment access is uneven in middle-income countries; therefore, we aimed to describe current practice, identify barriers, and propose guideline-aligned, resource-adapted solutions. Materials and Methods: Cross-sectional anonymous online survey of dermatologists (May-June 2025) on diagnostic workflows/access, treatments, and barriers. Analyses were performed using SPSS v23, with descriptive statistics and Spearman's rho correlations. Two-tailed P < 0.05 was considered significant. Results: Among 239 respondents, 61.1% managed MF; 49.3% reported diagnostic uncertainty, and T-cell receptor testing was rarely available. The use of diagnostic algorithms and structured training was inconsistent. Basic topical agents and retinoids were widely available, whereas advanced systemic and device-based options were scarce. Barriers clustered around registration and market availability, workforce constraints, and equipment and maintenance issues. Reported workarounds included evidence-based substitutions, interim symptom-directed therapy, repeat biopsies, and referrals; multidisciplinary tumor boards were underused. Conclusion: MF care is heterogeneous and resource constrained. A four-component plan - a national diagnostic algorithm with a minimum package and a re-biopsy-consultation-multidisciplinary team loop; targeted capacity building; tiered treatment pathways prioritizing narrow-band ultraviolet B +/- retinoids with clear referral thresholds; and system integration via centers of excellence, a national registry, and device uptime programs - may standardize care and improve outcomes.
