Staging laparotomy in cutaneous T-cell disease.

Staging laparotomy performed in 13 patients with various forms of cutaneous T-cell disease (mycosis fungoides, Sézary syndrome, cutaneous lymphoma, atrophic parapsoriasis, and alopecia mucinosa) showed evidence of visceral or lymph node involvement in three (23%) patients; in two of these patients, noninvasive investigations and staging procedures did not disclose any abnormalities. All three patients were alive after a mean follow-up period of 3 1/2 years. In the ten patients with normal findings at laparotomy, the presence of intra-abdominal lymphoma was suggested in six by noninvasive staging procedures (lymphangiogram, spleen or liver-spleen scan, and computerized tomographic scan of the abdomen). Five of these ten patients died; four of the five patients died after relentless progression of the disease and visceral involvement. Staging laparotomy may have a role in the management of cutaneous T-cell disease because noninvasive investigations may be poor indicators of the presence or absence of intra-abdominal disease. The course of these patients, even those in whom laparotomies did not show any abnormalities, emphasizes the progressive potential of cutaneous T-cell disease.