RESUMO
Introduction: Teledermatology adoption continues to increase, in part, spurred by the COVID-19 pandemic. This study analyzes the utility and cost savings of a store-and-forward teledermatology consultative system within the Veterans Health Administration (VA). Methods: Retrospective cohort of 4,493 patients across 14 remote sites in Tennessee and Kentucky from May 2017 through August 2019. The study measured the agreement between the teledermatology diagnoses and follow-up face-to-face clinic evaluations as well as the cost effectiveness of the teledermatology program over the study period. Results: Fifty-four percent of patients were recommended for face-to-face appointment for biopsy or further evaluation. Most patients, 80.5% received their face-to-face care by a VA dermatologist. There was a high level of concordance between teledermatologist and clinic dermatologist for pre-malignant and malignant cutaneous conditions. Veterans were seen faster at a VA clinic compared with a community dermatology site. Image quality improved as photographers incorporated teledermatologist feedback. From a cost perspective, teledermatology saved the VA system $1,076,000 in community care costs. Discussion: Teledermatology is a useful diagnostic tool within the VA system providing Veteran care at a cost savings.
Assuntos
COVID-19 , Redução de Custos , Dermatologia , Dermatopatias , Telemedicina , United States Department of Veterans Affairs , Humanos , Dermatologia/economia , Dermatologia/normas , Dermatologia/organização & administração , Estudos Retrospectivos , Dermatopatias/diagnóstico , Dermatopatias/economia , Estados Unidos , Telemedicina/economia , United States Department of Veterans Affairs/organização & administração , Feminino , Kentucky , Masculino , Controle de Qualidade , Pessoa de Meia-Idade , Tennessee , SARS-CoV-2 , Consulta Remota/economia , Idoso , Análise Custo-BenefícioRESUMO
The number of patients with primary cutaneous lymphoma (PCL) relative to other non-Hodgkin lymphomas (NHLs) is small and the number of subtypes large. Although clinical trial guidelines have been published for mycosis fungoides/Sézary syndrome, the most common type of PCL, none exist for the other PCLs. In addition, staging of the PCLs has been evolving based on new data on potential prognostic factors, diagnosis, and assessment methods of both skin and extracutaneous disease and a desire to align the latter with the Lugano guidelines for all NHLs. The International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous LymphomaConsortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organization for the Research and Treatment of Cancer (EORTC) now propose updated staging and guidelines for the study design, assessment, endpoints, and response criteria in clinical trials for all the PCLs in alignment with that of the Lugano guidelines. These recommendations provide standardized methodology that should facilitate planning and regulatory approval of new treatments for these lymphomas worldwide, encourage cooperative investigator-initiated trials, and help to assess the comparative efficacy of therapeutic agents tested across sites and studies.
Assuntos
Linfoma Cutâneo de Células T , Micose Fungoide , Síndrome de Sézary , Neoplasias Cutâneas , Ensaios Clínicos como Assunto , Humanos , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/patologia , Linfoma Cutâneo de Células T/terapia , Micose Fungoide/diagnóstico , Micose Fungoide/patologia , Micose Fungoide/terapia , Estadiamento de Neoplasias , Síndrome de Sézary/diagnóstico , Síndrome de Sézary/patologia , Síndrome de Sézary/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Estados UnidosRESUMO
The cutaneous lymphomas are malignancies of T-cell and B-cell lymphocytes in which the skin is the primary organ of involvement. The cutaneous T-cell lymphomas include variants that can mimic the presentation of common skin diseases or arthropod bites. Mycosis fungoides, the most common cutaneous T-cell lymphoma, usually presents as fixed asymptomatic patches or plaques in sun-protected areas. The cutaneous B-cell lymphomas have fewer variants that often present as papules or nodules that can mimic nonmelanoma skin cancers. Some therapies for cutaneous lymphoma have unique side effects such as central hypothyroidism, hyperlipidemia, and peripheral neuropathy.
Assuntos
Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/terapia , Dermatopatias/diagnóstico , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Artrópodes , Bexaroteno/efeitos adversos , Mordeduras e Picadas/diagnóstico , Brentuximab Vedotin/efeitos adversos , Diagnóstico Diferencial , Humanos , Hiperlipidemias/induzido quimicamente , Hipotireoidismo/induzido quimicamente , Linfoma Anaplásico Cutâneo Primário de Células Grandes/diagnóstico , Linfoma Cutâneo de Células T/classificação , Papulose Linfomatoide/diagnóstico , Micose Fungoide/diagnóstico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Prognóstico , Síndrome de Sézary/diagnóstico , Dermatopatias/patologiaRESUMO
INTRODUCTION: Low-dose total skin electron beam therapy provides a durable treatment response for skin lesions caused by cutaneous T-cell lymphoma. We prospectively assessed the durability of response and quality of life for patients receiving low-dose total skin electron beam therapy using a novel rotational technique and dosing regimen. METHODS: Patients completed baseline Skindex-29 quality-of-life surveys and had baseline Modified Severity-Weighted Assessment Tool score recorded. Patients received 12 Gy in 12 fractions with a dual-field rotational technique. The primary outcome was overall response rate, with the secondary outcomes being time to treatment response, duration of clinical benefit, and quality-of-life change. RESULTS: We enrolled 20 patients and recorded an overall response rate of 90%. The median time to treatment response was 6.5 weeks. The baseline Modified Severity-Weighted Assessment Tool score was 55.6 and it declined to a median of 2.2 at last follow-up (P < .001). The median duration of clinical benefit was 21 months. There was a decline in the Skindex-29 total score and every subdomain when each follow-up visit was compared (P = .004). CONCLUSIONS: This prospective study demonstrated a very high overall response rate and improvement in skin-related quality of life. Low-dose rotational total skin electron beam therapy can be implemented routinely in clinical practice.
Assuntos
Micose Fungoide/radioterapia , Qualidade de Vida , Neoplasias Cutâneas/radioterapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radioterapia/métodos , Dosagem Radioterapêutica , Índice de Gravidade de Doença , Inquéritos e Questionários , Tempo para o Tratamento , Resultado do TratamentoAssuntos
Infecções por Coronavirus/imunologia , Linfoma Cutâneo de Células T/terapia , Micose Fungoide/terapia , Pneumonia Viral/imunologia , Síndrome de Sézary/terapia , Neoplasias Cutâneas/terapia , Antibióticos Antineoplásicos/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , COVID-19 , Quimiorradioterapia/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Serviços Hospitalares de Assistência Domiciliar , Humanos , Linfoma Cutâneo de Células T/complicações , Linfoma Cutâneo de Células T/imunologia , Micose Fungoide/complicações , Micose Fungoide/imunologia , Pandemias , Seleção de Pacientes , Fotoferese , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Medição de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Síndrome de Sézary/complicações , Síndrome de Sézary/imunologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/imunologia , Telemedicina/métodos , Terapia Ultravioleta , Estados UnidosRESUMO
Little is known about the anatomic distribution of cutaneous chronic graft-versus-host disease (cGVHD). Using data from the cGVHD Consortium Improving Outcomes Assessment Study, we describe the frequency and extent of erythema and superficial and deep sclerosis in 8 anatomic sites in patients with incident disease (ie, new cGVHD diagnosis within 3 months of study entry) receiving systemic therapy. Of 339 patients with incident disease, 182 (54%) had skin involvement. When an extremity was involved, the same type of disease was present contralaterally in 92% of cases, revealing a high level of symmetry. As anticipated, erythema was the most common incident feature; however, sclerotic skin involvement at the time of cGVHD diagnosis was more common than has been suggested by previous studies. Erythema occurred in 155 (85%) and sclerosis in 53 (29%) of the patients with skin involvement (46% and 16%, respectively, of the entire cohort of 339 incident cGVHD cases). Erythema was least common on the lower extremities (nâ¯=â¯71; 39% of patients with skin involvement). Moveable sclerosis was rare on the head, neck, and scalp (nâ¯=â¯4; 2%). Deep sclerosis did not occur in this region, and instead was most likely to occur on the upper extremities (nâ¯=â¯14; 8%) and lower extremities (nâ¯=â¯14; 8%). More than one-half of patients with erythema (nâ¯=â¯107; 58.7%) had diffuse involvement (4 or more of 8 sites involved), compared with less than one-third of those with sclerosis (nâ¯=â¯16; 30.2%).
Assuntos
Transplante de Células-Tronco Hematopoéticas , Neoplasias , Dermatopatias , Adulto , Aloenxertos , Doença Crônica , Feminino , Doença Enxerto-Hospedeiro/epidemiologia , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Estudos Prospectivos , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Dermatopatias/patologiaAssuntos
Aprepitanto/uso terapêutico , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Prurido/tratamento farmacológico , Síndrome de Sézary/complicações , Neoplasias Cutâneas/complicações , Idoso , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/etiologia , Falha de TratamentoRESUMO
This selection from the NCCN Guidelines for Merkel Cell Carcinoma (MCC) focuses on areas impacted by recently emerging data, including sections describing MCC risk factors, diagnosis, workup, follow-up, and management of advanced disease with radiation and systemic therapy. Included in these sections are discussion of the new recommendations for use of Merkel cell polyomavirus as a biomarker and new recommendations for use of checkpoint immunotherapies to treat metastatic or unresectable disease. The next update of the complete version of the NCCN Guidelines for MCC will include more detailed information about elements of pathology and addresses additional aspects of management of MCC, including surgical management of the primary tumor and draining nodal basin, radiation therapy as primary treatment, and management of recurrence.
Assuntos
Carcinoma de Célula de Merkel/terapia , Oncologia/normas , Poliomavírus das Células de Merkel/isolamento & purificação , Neoplasias Cutâneas/terapia , Assistência ao Convalescente/normas , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/virologia , Quimiorradioterapia/métodos , Quimiorradioterapia/normas , Humanos , Incidência , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/virologia , Sociedades Médicas/normas , Estados Unidos/epidemiologiaRESUMO
Linear IgA bullous dermatosis (LABD) is an autoimmune blistering rash caused by IgA autoantibodies against the epidermal basement membrane zone. It commonly is drug induced, often in association with systemic vancomycin. We report a case of a previously healthy 77-year-old man who developed a diffuse macular rash and hemorrhagic bullae on the left leg 10 days after placement of a vancomycin-impregnated cement spacer (VICS) during a revision knee arthroplasty and initiation of postoperative treatment with intravenous (IV) vancomycin. The lesions initially were limited to the leg in which the hardware was placed, but the patient later developed painful palmoplantar and oropharyngeal blisters as well as edematous, erythematous plaques on the back and buttocks. A punch biopsy from a lesion on the left thigh revealed neutrophil-rich subepidermal bullae, and immunofluorescence revealed linear IgA and C3 deposition along the dermoepidermal junction, confirming a diagnosis of LABD. This report illustrates the importance of considering antibiotic-impregnated cement spacers, which frequently are used to manage prosthetic joint infections, as potential culprits in patients with cutaneous eruptions.
Assuntos
Antibacterianos/efeitos adversos , Dermatose Linear Bolhosa por IgA/induzido quimicamente , Vancomicina/efeitos adversos , Idoso , Antibacterianos/administração & dosagem , Cimentos Ósseos , Humanos , Prótese do Joelho/efeitos adversos , Masculino , Vancomicina/administração & dosagemAssuntos
Antígenos CD4/metabolismo , Antígenos CD8/metabolismo , Oftalmopatias/imunologia , Micose Fungoide/imunologia , Neoplasias Cutâneas/imunologia , Idoso , Antígenos CD4/imunologia , Antígenos CD8/imunologia , Oftalmopatias/complicações , Oftalmopatias/metabolismo , Oftalmopatias/patologia , Feminino , Humanos , Imunofenotipagem , Pessoa de Meia-Idade , Micose Fungoide/complicações , Micose Fungoide/metabolismo , Micose Fungoide/patologia , Prognóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: Tumor stage mycosis fungoides (MF) is a subtype of cutaneous T-cell lymphoma (CTCL). Tumor stage MF is rarely curable. Treatment is aimed towards controlling the disease and minimizing side effects from therapy. OBJECTIVE: To characterize clinicopathologic features of tumor stage MF and the impact of clinical characteristics and treatment modalities on patient outcome. METHODS: A retrospective chart review was conducted on 39 patients with tumor stage MF followed at Vanderbilt University between July 1995 and July 2010. RESULTS: The median age of diagnosis was 61 years (IQR: 54-70). Sixty-nine percent of the patients were male (27/39). The median follow-up time was 13.6 months (IQR: 5.5-35.9). Among the patients younger than 60 years at the time of initial diagnosis (n = 19), median overall survival (OS) was 7.0 years (95% CI: 2.1-17.9), compared with 3.3 years (95% CI: 2.4-9.3) in patients who were 60 years or older at initial diagnosis. Ten patients with T1/T2 stage at diagnosis had median OS of 5.0 years (95% CI 3.2-7.0). Twenty-eight patients with T3 stage at diagnosis had median OS of 5.8 years (95% CI 2.4-14.2). Median OS for patients with large cell transformation (LCT) and without LCT was 3.3 and 7.7 years, respectively. LIMITATIONS: This is a retrospective study with the bias of a tertiary-care referral center. CONCLUSION: Although LCT and older age at diagnosis were not statistically significant negative prognostic indicators of OS, there was a trend towards statistical significance for LCT. Clinical stage at diagnosis may not affect OS in patients who develop tumor stage MF.
Assuntos
Micose Fungoide/mortalidade , Neoplasias Cutâneas/mortalidade , Fatores Etários , Idoso , Anticarcinógenos/uso terapêutico , Antineoplásicos/uso terapêutico , Bexaroteno , Transformação Celular Neoplásica , Progressão da Doença , Feminino , Furocumarinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Micose Fungoide/terapia , Estadiamento de Neoplasias , Prognóstico , Radioterapia/métodos , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Centros de Atenção Terciária , Tetra-Hidronaftalenos/uso terapêutico , Terapia Ultravioleta/métodosRESUMO
Basal cell carcinoma (BCC) of the skin is the most common cancer, with a higher incidence than all other malignancies combined. Although it is rare to metastasize, patients with multiple or frequently recurring BCC can suffer substantial comorbidity and be difficult to manage. Assessment of risk is a key element of management needed to inform treatment selection. The overall management of BCC primarily consists of surgical approaches, with radiation therapy as an alternate or adjuvant option. Many superficial therapies for BCC have been explored and continue to be developed, including topicals, cryosurgery, and photodynamic therapy. Two hedgehog pathway inhibitors were recently approved by the FDA for systemic treatment of advanced and metastatic BCC, and others are in development. The NCCN Guidelines for Basal Cell Skin Cancer, published in full herein, include recommendations for selecting among the various surgical approaches based on patient-, lesion-, and disease-specific factors, as well as guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Estados UnidosRESUMO
Many malignant hematologic neoplasms can directly and indirectly involve the skin with lesions that are disfiguring, painful, and compromise integumentary function. The majority of lymphomas that directly infiltrate the skin are of T-cell origin but B-cell lymphomas, and other hematologic neoplasms, including acute myeloid and lymphoblastic leukemias, can also have cutaneous involvement, whereas some have an indolent course, eg, mycosis fungoides and marginal zone lymphoma, and easily respond to localized therapy with overall survival (OS) measured in years to decades. Others have a more clinically aggressive course, eg, natural killer (NK)/T-cell lymphoma and diffuse large B-cell lymphoma, leg type, that require high-dose multimodality therapy, and have an OS measured in months to a few years. Lymphoma can also lead to secondary cutaneous alterations, including a variety of paraneoplastic phenomena. We present an overview of direct and indirect skin involvement by malignant lymphocytes and other hematologic neoplasms. We also describe molecular and immunophenotypic aspects of these diseases and how they are treated.
Assuntos
Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/classificação , Neoplasias Hematológicas/imunologia , Humanos , Linfoma de Células B/etiologia , Linfoma de Células B/patologia , Linfoma de Células T/patologia , Micose Fungoide/patologia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/secundárioRESUMO
Extracorporeal photopheresis (ECP) is an immunomodulating procedure that leads to an expansion of peripheral blood dendritic cell populations and an enhanced TH1 immune response in cutaneous T-cell lymphoma (CTCL). Because of its excellent side effect profile and moderate efficacy, ECP is considered first-line therapy for erythrodermic mycosis fungoides (MF) and Sézary syndrome. Patients with a measurable but low blood tumor burden are most likely to respond to ECP, and the addition of adjunctive immunostimulatory agents may also increase response rates. There may be a role for ECP in the treatment of refractory early stage MF, but data are limited.
Assuntos
Micose Fungoide/tratamento farmacológico , Fotoferese/métodos , Síndrome de Sézary/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante/métodos , Humanos , Imunomodulação , Metoxaleno/farmacocinética , Metoxaleno/uso terapêutico , Micose Fungoide/mortalidade , Fotoferese/efeitos adversos , Fármacos Fotossensibilizantes/farmacocinética , Fármacos Fotossensibilizantes/uso terapêutico , Síndrome de Sézary/mortalidade , Neoplasias Cutâneas/mortalidade , Resultado do TratamentoRESUMO
The pathogenesis of mycosis fungoides (MF), the most common cutaneous T-cell lymphoma (CTCL), is unknown. Although genetic alterations have been identified, none are considered consistently causative in MF. To identify potential drivers of MF, we performed whole-genome sequencing of MF tumors and matched normal skin. Targeted ultra-deep sequencing of MF samples and exome sequencing of CTCL cell lines were also performed. Multiple mutations were identified that affected the same pathways, including epigenetic, cell-fate regulation, and cytokine signaling, in MF tumors and CTCL cell lines. Specifically, interleukin-2 signaling pathway mutations, including activating Janus kinase 3 (JAK3) mutations, were detected. Treatment with a JAK3 inhibitor significantly reduced CTCL cell survival. Additionally, the mutation data identified 2 other potential contributing factors to MF, ultraviolet light, and a polymorphism in the tumor suppressor p53 (TP53). Therefore, genetic alterations in specific pathways in MF were identified that may be viable, effective new targets for treatment.
Assuntos
Exoma/genética , Genoma Humano , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Mutação/genética , Micose Fungoide/genética , Oncogenes/genética , Análise de Sequência de DNA/métodos , Neoplasias Cutâneas/genética , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Micose Fungoide/patologia , Micose Fungoide/terapia , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Raios UltravioletaRESUMO
Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor characterized by a relatively high risk of local recurrence and low risk of metastasis. The NCCN Guidelines for DFSP provide multidisciplinary recommendations on the management of patients with this rare disease. These NCCN Guidelines Insights highlight the addition of the Principles of Pathology section, which provides recommendations on the pathologic assessment of DFSP. Because DFSP can mimic other lesions, immunohistochemical studies are often required to establish diagnosis. Cytogenetic testing for the characteristic translocation t(17;22)(q22;q13) can also be valuable in the differential diagnosis of DFSP with other histologically similar tumors.
Assuntos
Dermatofibrossarcoma/genética , Diagnóstico Diferencial , Recidiva Local de Neoplasia/genética , Neoplasias Cutâneas/genética , Biomarcadores Tumorais , Dermatofibrossarcoma/diagnóstico , Dermatofibrossarcoma/patologia , Humanos , Metástase Neoplásica , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Translocação GenéticaRESUMO
Merkel cell carcinoma is a rare, aggressive cutaneous tumor that combines the local recurrence rates of infiltrative nonmelanoma skin cancer with the regional and distant metastatic rates of thick melanoma. The NCCN Guidelines for Merkel Cell Carcinoma provide recommendations on the diagnosis and management of this aggressive disease based on clinical evidence and expert consensus. This version includes revisions regarding the use of PET/CT imaging and the addition of a new section on the principles of pathology to provide guidance on the analysis, interpretation, and reporting of pathology results.
Assuntos
Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , HumanosAssuntos
Herpes Zoster/etiologia , Fotoferese/efeitos adversos , Síndrome de Sézary/terapia , Tetra-Hidronaftalenos/uso terapêutico , Idoso , Bexaroteno , Terapia Combinada , Seguimentos , Hemaglutinação por Vírus , Herpes Zoster/fisiopatologia , Humanos , Masculino , Fotoferese/métodos , Medição de Risco , Índice de Gravidade de Doença , Síndrome de Sézary/diagnóstico , Resultado do TratamentoRESUMO
The pathogenesis of the cutaneous T-cell lymphoma (CTCL), mycosis fungoides (MF), is unclear. MicroRNA (miRNA) are small noncoding RNAs that target mRNA leading to reduced mRNA translation. Recently, specific miRNA were shown to be altered in CTCL. We detected significantly reduced expression of miR-223 in early-stage MF skin, and further decreased levels of miR-223 in advanced-stage disease. CTCL peripheral blood mononuclear cells and cell lines also had reduced miR-223 as compared with controls. Elevated expression of miR-223 in these cell lines reduced cell growth and clonogenic potential, whereas inhibition of miR-223 increased cell numbers. Investigations into putative miR-223 targets with oncogenic function, including E2F1 and MEF2C, and the predicted miR-223 target, TOX, revealed that all three were targeted by miR-223 in CTCL. E2F1, MEF2C, and TOX proteins were decreased with miR-223 overexpression, whereas miR-223 inhibition led to increased protein levels in CTCL. In addition, we showed that the 3'-UTR of TOX mRNA was a genuine target of miR-223. Therefore, reduced levels of miR-223 in MF/CTCL lead to increased expression of E2F1, MEF2C, and TOX, which likely contributes to the development and/or progression of CTCL. Thus, miR-223 and its targets may be useful for the development of new therapeutics for MF/CTCL.