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The Modified Severity-Weighted Assessment Tool: A PASI/EASI System for Mycosis Fungoides
FR-mSWAT: el «PASI/EASI» de la micosis fungoides
Servicio de Dermatología, Hospital Clinic de Barcelona, Barcelona, Spain
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Combalia, T. Estrach" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Combalia" "email" => array:1 [ 0 => "andreacombalia@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Estrach" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Clinic de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-mSWAT: el «PASI/EASI» de la micosis fungoides" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, has a different clinical presentation than most malignant skin tumors. Because of its clinical similarity in the early stages to some inflammatory diseases, such as psoriasis and the eczemas with which it is often confused, it is difficult to include MF in the classic tumor-node-metastasis-blood (TNMB) classification system.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> One of the main problems with applying TNMB staging to MF is the objective assessment of the body surface area (BSA) involved: in the early stages, the classification only considers whether the lesions cover <<span class="elsevierStyleHsp" style=""></span>10% (T1) or<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10% (T2) of the total BSA; consequently, differences between patients with lesions on 20% of the body and those with lesions on 90%-100% of the body are not reflected in the classification. Similarly, it is difficult to assess the impact of a particular treatment on the course of the disease and/or a possible change of stage because the type and number of skin lesions, plaques, and tumors are not reflected in the current TNMB system.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In clinical practice, physicians assess changes not only in the extent of disease but also in the type of individual lesions and the total BSA involved. There is a tool for this purpose that is not well known to those unfamiliar with the field of cutaneous lymphomas. This tool, known as the Severity-Weighted Assessment Tool (SWAT), uses a continuous scale like that of the Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI), facilitating a precise assessment of area of skin involvement by type of lesion.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The SWAT, first proposed by Stevens et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> in 2002, takes into account the percentage of total body surface area (%TBSA) affected by each type of lesion (patch, plaque, tumor, or ulcer), thus providing a defined, objective, and sensitive measurement of possible changes in the course of the disease in patients diagnosed with MF. The SWAT was subsequently modified (mSWAT)<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> to give higher scores for tumors and to differentiate between erythrodermic and nonerythrodermic disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The European Organization for Research and Treatment of Cancer (EORTC) has recommended the mSWAT as the first-line method for calculating cutaneous involvement in patients diagnosed with MF and Sézary syndrome.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The application of this index makes it possible to assign patients a numerical value for the purposes of assessing treatment responses, carrying out comparative studies, and monitoring clinical trials in a quantitative manner, although it is true that the index does not eliminate intraobserver and interobserver variability.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Despite being an excellent tool that makes it possible to quantify cutaneous involvement in patients with MF, it is not included in the staging system and its prognostic implications have not been demonstrated (although a poor prognosis can be inferred from a high mSWAT score).</p><p id="par0025" class="elsevierStylePara elsevierViewall">A free mobile application called Cutaneous Lymphoma Resource Tools allows clinicians to quickly estimate a patient's mSWAT score during a consultation. Along with the patient's TNMB status, the mSWAT score should be added to the clinical record at each visit to improve follow-up.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1033082" "palabras" => array:4 [ 0 => "Mycosis fungoides" 1 => "Sézary syndrome" 2 => "Severity-Weighted Assessment Tool" 3 => "Modified Severity-Weighted Assessment Tool" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Combalia A, Estrach T. FR-mSWAT: el «PASI/EASI» de la micosis fungoides. Actas Dermosifiliogr. 2018;109:745–746.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: mSWAT, Modified Severity-Weighted Assessment Tool; %TBSA, percentage of total body surface area.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source: Scarisbrick and Morris<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and Olsen et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Form \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Formula \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Erythrodermic</td><td class="td" title="table-entry " align="left" valign="top">(patch %TBSA<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(plaque %TBSA<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">×</span><span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(tumor or ulcer %TBSA<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Nonerythrodermic</td><td class="td" title="table-entry " align="left" valign="top">(mild infiltration %TBSA<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(moderate infiltration %TBSA<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">×</span><span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">(tumor or ulcer %TBSA<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1862922.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Calculation of mSWAT Scores.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome - Update 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Trautinger" 1 => "J. Eder" 2 => "C. Assaf" 3 => "M. Bagot" 4 => "A. Cozzio" 5 => "R. Dummer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2017.02.027" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2017" "volumen" => "77" "paginaInicial" => "57" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28365528" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying skin disease burden in mycosis fungoides-type cutaneous T-cell lymphomas: The severity-weighted assessment tool (SWAT)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.R. Stevens" 1 => "M.S. Ke" 2 => "E.J. Parry" 3 => "J. Mark" 4 => "K.D. 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Morris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.12403" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2013" "volumen" => "169" "paginaInicial" => "260" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23621659" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: A consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "International Society for Cutaneous Lymphomas; United States Cutaneous Lymphoma Consortium; Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer" "etal" => true "autores" => array:6 [ 0 => "E.A. Olsen" 1 => "S. Whittaker" 2 => "Y.H. Kim" 3 => "M. Duvic" 4 => "H.M. Prince" 5 => "S.R. Lessin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2010.32 0630" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "2598" "paginaFinal" => "2607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21576639" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000008/v1_201810020631/S1578219018302580/v1_201810020631/en/main.assets" "Apartado" => array:4 [ "identificador" => "34945" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Resident's Forum" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000008/v1_201810020631/S1578219018302580/v1_201810020631/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302580?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 33 | 15 | 48 |
| 2024 October | 192 | 86 | 278 |
| 2024 September | 238 | 90 | 328 |
| 2024 August | 200 | 122 | 322 |
| 2024 July | 192 | 80 | 272 |
| 2024 June | 155 | 76 | 231 |
| 2024 May | 163 | 75 | 238 |
| 2024 April | 159 | 49 | 208 |
| 2024 March | 159 | 50 | 209 |
| 2024 February | 162 | 53 | 215 |
| 2024 January | 203 | 81 | 284 |
| 2023 December | 150 | 48 | 198 |
| 2023 November | 171 | 50 | 221 |
| 2023 October | 160 | 47 | 207 |
| 2023 September | 159 | 60 | 219 |
| 2023 August | 162 | 50 | 212 |
| 2023 July | 177 | 60 | 237 |
| 2023 June | 183 | 52 | 235 |
| 2023 May | 193 | 63 | 256 |
| 2023 April | 151 | 62 | 213 |
| 2023 March | 170 | 55 | 225 |
| 2023 February | 118 | 44 | 162 |
| 2023 January | 118 | 35 | 153 |
| 2022 December | 85 | 59 | 144 |
| 2022 November | 88 | 52 | 140 |
| 2022 October | 75 | 42 | 117 |
| 2022 September | 72 | 70 | 142 |
| 2022 August | 58 | 60 | 118 |
| 2022 July | 46 | 66 | 112 |
| 2022 June | 40 | 59 | 99 |
| 2022 May | 92 | 75 | 167 |
| 2022 April | 131 | 73 | 204 |
| 2022 March | 124 | 106 | 230 |
| 2022 February | 147 | 66 | 213 |
| 2022 January | 199 | 92 | 291 |
| 2021 December | 136 | 93 | 229 |
| 2021 November | 149 | 79 | 228 |
| 2021 October | 173 | 84 | 257 |
| 2021 September | 138 | 76 | 214 |
| 2021 August | 143 | 63 | 206 |
| 2021 July | 148 | 59 | 207 |
| 2021 June | 151 | 89 | 240 |
| 2021 May | 165 | 137 | 302 |
| 2021 April | 332 | 168 | 500 |
| 2021 March | 170 | 66 | 236 |
| 2021 February | 216 | 62 | 278 |
| 2021 January | 178 | 71 | 249 |
| 2020 December | 190 | 60 | 250 |
| 2020 November | 172 | 62 | 234 |
| 2020 October | 132 | 34 | 166 |
| 2020 September | 175 | 38 | 213 |
| 2020 August | 139 | 36 | 175 |
| 2020 July | 146 | 38 | 184 |
| 2020 June | 106 | 60 | 166 |
| 2020 May | 83 | 50 | 133 |
| 2020 April | 76 | 25 | 101 |
| 2020 March | 46 | 21 | 67 |
| 2020 February | 3 | 0 | 3 |
| 2019 May | 0 | 1 | 1 |
| 2019 April | 0 | 1 | 1 |
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