In the management of patients with cutaneous T-cell lymphoma CTCL, there are numerous distinct therapy options. Each of these therapies is discussed in terms of when to use it, what factors limit the success of the treatment, and what to expect. A menu is defined as a list of items from which to choose. The best recognized clinical scenarios of CTCL are those recognized by the staging system: limited patch plaque T1, disseminated patch plaque T2, erythroderma T4, and tumor T3. Each phase of the disease will have the menu of therapy options presented for a given goal of management. The complex nature of the immunology of the skin is represented in the malignancy of one of the key participants—cutaneous T-cells—in cutaneous immune responses. The identification of malignant T-cells bearing an identifiable skin-homing receptor led to the realization that the varied diseases incorporated in the term cutaneous T-cell lymphoma CTCL are clonal expansions of cutaneous T-cells. The presentations of the management menus are to reflect the approach to the patient with CTCL. The first step is to identify the subset of CTCL, the extent of disease, the measurable parameters, the goal of therapy, and then the choice of therapy from a menu.
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