BRIEF COMMUNICATION Bcl-2 expression in mycosis fungoides before and after PUVA therapy Hani Weshahy 1 , Doa Mahgoub 1 , Nermine El-Eishy 1 , Amira Mohamed El-Tawdy 1 , Dalia Ahmed Bassiouny 1 , Nahla Hunter 1 & Ali Hindawi 2 The Departments of 1 Dermatology and 2 Pathology, Kasr El-Aini University Hospital, Cairo University, Cairo, Egypt Key words: apoptosis; bcl-2; mycosis fungoides; PUVA Correspondence: Dalia Ahmed Bassiouny, MD, 51b Damascus Street, Mohandessien, Cairo, Egypt. Tel/Fax: 1202 749 6759 e-mail: daliabas73@yahoo.com Accepted for publication: 15 December 2009 Conflicts of interest: None declared. Summary PUVA is the first therapeutic choice in early stages of mycosis fungoides (MF). In this study the effect of PUVA on bcl-2 expression in MF was assessed in 15 patients (three stage Ia and 12 stage Ib) and 10 controls. Two biopsies were taken from each patient before and after 24 sessions of PUVA therapy. Histopathological assessment and immunohistochemical staining for bcl-2 was performed and showed positive bcl-2 staining of lymphocytes in 53% of MF cases (8/15) before PUVA, with no statistically significant difference in the bcl-2 level before and after PUVA therapy (P value 0.3). A statistically significant difference was found in the bcl-2 level between control samples and MF patients’ biopsies before (P value 0.02) and after PUVA therapy (P value 0.011). In conclusion, a lack of decline in the bcl-2 level and the absence of clinical or histopathological correlation with the bcl-2 level before and after PUVA therapy in MF patients suggest that PUVA-induced apoptosis in MF cases may occur through pathways other than bcl-2 inhibition. O ver-expression of bcl-2 by a variable subset of T cells in both early and advanced mycosis fungoides (MF) skin lesions was reported (1). Induction of apoptosis of the dermal lymphocytes in cases of MF is an important event for the therapeutic efficacy of PUVA (2). In the present study, we investigated the bcl-2 expression in MF patients before and after PUVA to determine its possible role in PUVA-induced apoptosis. Patients and methods This study included 15 MF patients and 10 controls selected from the Dermatology Outpatient Clinic of Kasr El-Aini Teaching Hospital (Cairo University). Local ethical committee approval was obtained and an informed consent was signed by all patients before enrollment in the study. Each patient was subjected to full history taking. Skin examination and staging of MF was carried out before therapy. The control group was composed of 10 patients with nonspecific chronic inflammation (spongiotic dermatitis). PUVA therapy Each patient received systemic psoralen (0.7 mg/kg) 2 h before PUVA session three times weekly on alternate days. The starting dose of UVA was 0.5 J/cm 2 and was increased every other session by 0.5 J/cm 2 . The machine used was a UV1000 Waldmann lighting (Waldmann GmbH, Villingen-Schwenningen, Germany) equipped with 26–100 W fluorescent – UVA lamps emitting a radiation spectrum of 315–400 nm with a peak of 365 nm. Two biopsies were taken from each patient before and after 24 sessions of PUVA therapy. The biopsy was divided into two parts, one for histopathological assessment and the other for immunohistochemical staining for bcl-2. Histopathological assessment MF cases were classified into:  Very good: only sparse inflammatory infiltrate in dermis.  Good: minimal epidermotropism, sparse dermal infiltrate and no atypical cells.  Fair: moderate epidermotropism, dense band-like dermal infiltrate  atypical cells.  Poor: dense epidermotropism, dense deep dermal infiltrate and atypical cells. Immnohistochemical staining Skin biopsies were fixed in 10% phosphate buffered formaline and processed routinely. Tissue sections (5 mm thick) were obtained from paraffin blocks and treated with mouse antihuman monoclonal antibody against the bcl-2 protein (Clone 100/Ds, Neomarker’s cat # MS-123-PO Weshinghouse, Drive Fremont, CA, USA) according to standard procedures. Cells 107 r 2010 John Wiley & Sons A/S  Photodermatology, Photoimmunology & Photomedicine 26, 107–109