Abstract
Poikilodermatous mycosis fungoides is a rare variant of cutaneous T-cell lymphoma that is often misdiagnosed given its diverse clinical presentation. Often diagnosed as vitiligo or morphea, poikilodermatous mycosis fungoides can be asymptomatic or present as pruritic lesions. Discrepant signs and symptoms can lead to diagnostic delays. No consensus on its treatment currently exists, but treatment options include corticosteroids, phototherapy, and radiation. Here, we present a case of poikilodermatous mycosis fungoides in an otherwise healthy young man who showed limited improvement after years of treatment with topical antifungals, topical steroids, and phototherapy. Improvement was seen following a single session of radiation therapy, highlighting radiation's potential in cases resistant to traditional first-line treatments. We propose that radiation may be efficacious for the treatment of poikilodermatous mycosis fungoides in cases of delayed diagnosis or resistance, and further research is needed to investigate radiation monotherapy as a treatment option for poikilodermatous mycosis fungoides.