In conclusion, we regard "alopecia mucinosa" to be mycosis fungoides from the outset, not a paraneoplasia, not a precursor, not an "abortive" lymphoma, and not a "comparatively benign" variant of lymphoma. It is that particular expression of mycosis fungoides morphologically typified clinically at first as patches punctuated by "follicular" papules and histopathologically by involvement prominently of infundibula, of sebaceous lobules, and of follicles by lymphocytes disposed as solitary units, the effects of those neoplastic cells resulting in infundibular, sebaceous, and follicular mucinosis. Subtle, and not so subtle, changes in surface epidermis are typical of the patch stage of mycosis fungoides with epithelial mucinosis, but even in the absence of such changes, a diagnosis of mycosis fungoides with epithelial mucinosis can be made with confidence by virtue of findings detailed repeatedly in this work. Atypical lymphocytes and clonal rearrangement of T-cell receptors may be helpful in substantiating a diagnosis of mycosis fungoides with epithelial mucinosis but, in most instances, a diagnosis of mycosis fungoides of that particular type can be made with confidence without any aid other than hematoxylin and eosin.

The course of a patient with mycosis fungoides with epithelial mucinosis cannot be predicted accurately based on assessment either of features clinically or findings histopathologically, or of both of them together. In this regard, mycosis fungoides with epithelial mucinosis is no different from other manifestations of mycosis fungoides as they express themselves in patches and "early" plaques. Most patients with mycosis fungoides, including those with epithelial mucinosis, have only patches and plaques for a lifetime; they do not develop nodules and tumors and they do not die from the effects of their lymphoma. Nonetheless, mycosis fungoides, from the outset, is a systemic lymphoma and at the beginning of the process, no judgment of worth can be made about prognosis. How macules and patches will evolve is mere supposition and will remain that until much more is learned about the roles of genetics, the neoplastic lymphocytes themselves, and the host who combats them. What is not supposition to us is that understanding of this subject is enhanced by relinquishing the terms "follicular mucinosis" and "alopecia mucinosa" in favor of "epithelial mucinosis" and "mycosis fungoides with epithelial mucinosis," respectively.

In Figs. 38 through 44 that follow, we engage in clinico-pathologic correlation of mycosis fungoides with epithelial mucinosis, seeking to convey in the exercise the essential message of this work, namely, that so-called alopecia mucinosa, clinically and histopathologically, is mycosis fungoides.