A Cross-Sectional Study of Mycosis Fungoides Care: Diagnostic Challenges, Therapeutic Accessibility, and Resource-Adapted Solutions

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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 settings; 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.

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