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Diagnosis of cutaneous T-cell lymphoma (CTCL) rests for the most part on histopathologic evaluation with adjunctive immunohistochemistry. However, considerable overlap exists between forms of chronic inflammatory dermatitis and early mycosis fungoides. Even molecular tests to measure clonality of T-cell receptor (TCR) loci are limited by relatively low sensitivity and the fact that inflammatory reactions can be clonal.
Each T cell possesses a unique combination of TCR chains formed during development by the regulated stochastic shuffling of gene segments. Therefore, in principle, if a high-frequency dominant clone can be identified with confidence, that would imply a neoplastic process. These authors brought the power of genomics to bear, te…