Topical corticosteroids are widely used as first-line therapy for early-stage mycosis fungoides (MF), yet standardized treatment protocols remain lacking. This retrospective cohort study evaluated early-stage MF patients treated at Dartmouth Health with a 12-week alternating regimen of high-potency and medium-potency topical steroids. Clinical response rates were high (94.5%), with significant reductions in body surface area involvement, particularly among stage IB patients. Lesion morphology emerged as the strongest predictor of recurrence; individuals with mixed patch-and-plaque morphology demonstrated a 4.4-fold higher recurrence hazard relative to patch-only lesions. Although adverse events were mild and infrequent (12.3%), stage IB patients had higher risk of requiring subsequent treatment. Findings support the safety and effectiveness of alternating steroid regimens while highlighting the importance of morphology-driven counseling and tailored follow-up strategies.