The predominant therapy for cutaneous T cell lymphoma is PUVA. Adjunctive chemotherapy, radiotherapy, biological therapy, retinoid therapy, and photophoresis may be required.

• Patients with Mycosis fungoides are treated based on the stage and the previous treatment history.^{[1][2][3][4][5][6]}

• Stage IA
  • Patients with mycosis fungoides in stage IA ( patches, plaques, may be papules involve <10 % of total skin surface) treat by skin directed therapy [topical corticosteroids, nitrogen mustard (meclorethamin, NH2)].
  • Skin direct therapy is recommended more than systemic therapy (chemotherapy+ skin direct therapy) in this stage.
  • Systemic therapies +/- topical therapy are recommended for patients who intolerant of topical treatments

• Stage IB-IIA
  • Generalized skin directed therapy with or without combination other skin direct therapy
    • In majority of patients in this stages, skin directed therapy (topical corticosteroid, HN2, ultraviolet B (UVB) therapy) recommended use more than systemic therapy.
• The predominant therapy for cutaneous T cell lymphoma is PUVA. Adjunctive chemotherapy, radiotherapy, biological therapy, retinoid therapy, and photophoresis may be required.
• Stage IIB-IV
  • BV is used for the treatment of advanced stage
  • PCLBCL-LT
  • The efficacy of BTK inhibitors

• Skin-directed therapies such as steroids, PUVA, nb-UVB, or mechlorethamine should be used as treatments for early-stage MF patients (stage IA-IIA)
• PUVA is the preferred method for patients with thicker plaques [III, A], while patients with patches or very thin plaques can be treated with nb-UVB
• Adding low-dose local RT [III, A] is sufficient for patients with one or few infiltrated tumors or plaques (stage IIB).
• In patients with unilesional MF and pagetoid reticulosis [IV, A], local RT eith dose 20–24 Gy [IV, A] is recommended.
• In patients with more extensive infiltrated plaques and tumours or patients refractory to skin-directed therapies, a combination of PUVA and IFNα or PUVA and retinoids (including bexarotene), a combination of IFNα nd retinoids or TSEBT can be considered [III, B].
• Even though total doses of TSEBT have been used in the range of 30 – 36 Gy, lower doses of 10 – 12 Gy are possible. This could benefit from shortertreatment periods, fewer side effects, and retreatment chances [III, A].
• Gemcitabine or liposomal doxorubicin can be applied for patients with advanced and refractory disease. However, responses are short-lived in general [II, B].
• Mycosis fungoides patients with distorted lymph nodes or visceral involvement (stage IV), or patients with widespread tumor stage MF, show signs of multi-stage ChT. Controlling a multi-stage ChT with therapies that are skin-targeted and immunomodulating or single-agent ChT is not feasible.
• Local RT to doses 8 Gy [III, A] can be employed for local palliation of cutaneous and extracutaneous lesions.
• Young patients with refractory and progressive MF may be treated with alloSCT.  Though timing and optimal conditioning regimen are yet to be determined for an allogenic transplant.
• Mogamulizumab, a new drug, is currently being examined in clinical trials.

• During treatment with systemic retinoids, lipid panel and thyroid function tests should be closely monitored
• Gemfibrozil should be avoided because of the known side effects of the combined therapy; fish oil tablets can be used instead
• Some authors have also documented liver toxicities associated with administration of retinodis, and liver function tests (LFTs) should also be monitored in these patients.

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