Figure 2.

Cancer immunoediting in mycosis fungoides. Each phase of cancer immunoediting can be associated with specific cellular and cytokine profiles. In the elimination phase (A), the immune system, depicted here by cytotoxic CD8+ T-lymphocytes and Natural Killer (NK) cells, controls the proliferation of malignant T-cells, keeping them occult/incognito. Several evidences suggest that HMF remains in the equilibrium phase (B). Specifically, CD8+ tumor-infiltrating cells (TILs) secrete TIA1, granzyme B, and granulysin, which are cytotoxic granules that induce apoptosis in malignant T-cells. The production of Tumor Necrosis Factor-α TNF-α by keratinocytes and TILs induce an active antitumor immune response. A low level of regulatory T-cell (Treg) infiltration reported in HMF suggests that TILs are able to induce apoptosis in malignant T-cells. Finally, in the escape phase (C), a shift to Th2 cytokine profile allows malignant cells to overcome immune recognition and proliferate in the skin and beyond. Figure created with BioRender.com.