Modified Goeckerman Technique: A New Therapeutic Modality for Early Stage Mycosis Fungoides: a pilot study

Goeckerman technique (GT) has been used effectively as a therapeutic modality for psoriasis as evidenced by clinical improvement of lesions as well as long remission period. Follow up biopsies of responding cases of psoriasis revealed marked depletion of lymphocytes when compared to pre-treatment biopsies. Accordingly we hypothesized that modified Geockerman technique can deplete epidermotropic as well as upper dermal lymphocytes in early stage mycosis fungoides (MF) lesions. This study aimed to assess and compare the efficacy of modified GT (in which UVA is used instead of UVB) in the management of early stage cutaneous T-cell lymphoma to that of photochemotherapy [psoralen and UVA (PUVA)]. Thirty patients diagnosed with early stage cutaneous T-cell lymphoma (MF, stages: Ia, Ib and IIa) were recruited in the current work. All patients were randomly assigned to treatment by either modified GT (Group A, n=15) or photochemotherapy (psoralen and UVA [PUVA], Group B, n=15). All patients were assessed on clinical and histopathological basis at baseline and after cessation of therapy (after 3 months). The results were analysed using Mann Whitney U, Chi square (c2 ), McNemar and Exact tests. Both therapeutic modalities (modified GT and PUVA) yielded comparable results with insignificant difference either clinically or histopathologically (p-value = 0.833 and 0.958, respectively). Modified Goeckerman technique represents a potentially effective and safe therapeutic alternative to PUVA for early stage MF.