Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review.
ABSTRACT Oral 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB or UVB TL-01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB-UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime.
To assess the respective cutaneous carcinogenic risks of PUVA or NB-UVB in psoriasis; to estimate the respective dose-relationship between skin cancers and PUVA or NB-UVB; to estimate a maximum number of sessions for PUVA or NB-UVB not to be exceeded in a lifetime.
A systematic literature search was carried out in Medline, Embase and Cochrane Library databases from1980 to December 2010 in English and French, with the keywords 'Psoriasis' AND 'UVB therapy' AND 'UVA therapy' AND 'cancer' AND 'skin' OR 'neoplasm' OR 'cutaneous carcinoma' OR 'melanoma'.
Of 243 identified references, 49 published studies were included. Most of them (45/49) concerned PUVA therapy, with 41 assessing the risk of non-melanoma skin cancers (NMSC) following PUVA. All publications referring to the US prospective PUVA follow-up study revealed an increased risk of NMSC with the following characteristics: risk most pronounced for squamous cell carcinomas developing even with low exposures and increasing linearly with the number of sessions, tumors occurring also on non-exposed skin including invasive penile tumors, risk persisting after cessation of treatment. An increased risk of basal cell carcinomas was observed in patients receiving more than hundred PUVA sessions. The four prospective European studies selected in our review and most of the pre-1990 European and US retrospective studies failed to find a link between exposure to PUVA and skin cancer. Only the most recent cohorts, including three large long-term retrospective European studies comparing records with their respective national cancer registries reported on an independent increased risk of NMSC with PUVA, The risk was lower as compared to the US prospective PUVA follow-up study. Six studies assessed the risk of melanoma following PUVA therapy: two of the three US publications coming from the same PUVA prospective follow-up study revealed an increased risk with more than doubled incidence of both invasive and in situ melanoma among patients exposed to at least 200 PUVA treatments compared with patients exposed to lower doses, whereas the three retrospectives European studies, comparing the incidence of melanoma in PUVA users with national cancer registers, did not find any increased risk of melanoma. No increased risk of skin cancer was evidenced in the four studies specifically assessing the potential carcinogenic risk of NB-UVB.
There is an increased risk of skin cancer following PUVA, shown by both US and European studies. The greater risk measured by the US studies may be at least partly explained by high UVA dose exposure and the lighter phototypes of the treated patients. The lack of prospective studies in psoriasis patients treated with NB-UVB constitutes a barrier to the robust assessment of carcinogenic risk of this phototherapy technique.
Article: Phototherapie und Karzinogenese[Show abstract] [Hide abstract]
ABSTRACT: Phototherapie nutzt mit Erfolg die kurzfristige antiproliferative und antientzündliche Wirkung von ultraviolettem Licht. Wegen seiner längerfristigen Wirkung jedoch ist ultraviolettes Licht als Karzinogen anerkannt. Die Wellenlängen der Phototherapie zeigen pathomechanistisch verschiedene karzinogene Wirkungen, zuvorderst Mutationen der Keratinozyten-DNS. Klinisch zeigt PUVA besonders nach 350 Sitzungen auf Lebenszeit ein deutlich erhöhtes Risiko für spinozelluläre Karzinome der Haut. Melanom und genitaler Hautkrebs jedoch sind nicht durch alleinige PUVA erhöht. Vorbestehende UV-Belastung, Immunsuppression und weitere systemische Behandlung erhöhen die Karzinogenese durch PUVA. UVB-Breitband, -Schmalband (,,narrow band“) und UVA1 zeigen bisher keine klinische Erhöhung der Karzinogenese, müssen aber in ihren Spätfolgen weiter überwacht werden. Phototherapie ist weiterhin eine sichere Behandlungsmodalität, sofern die Indikation gut begründet ist, Vorbehandlungen sowie Begleitmedikation und -umstände berücksichtigt, eher kurze und dosisintensive Protokolle gewählt werden, PUVA als Zweitlinienbehandlung eingesetzt wird und 250 bis 300 Sitzungen Phototherapie auf Lebenszeit nicht überschritten werden.Der Hautarzt 05/2013; 64(5). · 0.54 Impact Factor
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ABSTRACT: Background Psoriasis is associated with several comorbidities and behavioral risk factors.Objectives To evaluate demographic and disease characteristics in patients enrolled in PSOLAR.Patients and MethodsPSOLAR is a global, prospective, longitudinal, disease-based registry that includes a post-marketing commitment to evaluate safety in patients with psoriasis. Enrolled patients had to be receiving, or be eligible to receive, conventional systemic or biologic agents. Demographic/disease characteristics, medical histories, life-style risk factors, and previous treatments are collected at enrollment. Efficacy and safety data are collected every 6 months for 8 years, and data are extracted annually. Selected parameters are evaluated by age quartile using post hoc analyses.ResultsAs of August 23, 2012, a total of 11900 were enrolled at 301 sites in North America, Europe, and Latin America. Over half of the PSOLAR population (54.7%) is male, with mean age of 48.6 years and mean body mass index of 30.9 kg/m2 at enrollment. Mean duration of disease at enrollment was 17.5 years, and mean Physician's Global Assessment score was 2.0. Psoriatic arthritis (35.5%) and cardiovascular diseases (38.2%) were highly prevalent. Diabetes mellitus type II was reported in 11.4% of patients. Depression and anxiety were noted in 14.7% and 11.1% of patients, respectively; 79.0% reported any alcohol use and 56.7% reported smoking or a history of smoking. The occurrence of most comorbidities, including cardiovascular disease and risk factors, increased with age.Conclusions Multiple and age-appropriate comorbidities are associated with psoriasis in the PSOLAR population and may impact the selection of psoriasis treatments.This article is protected by copyright. All rights reserved.British Journal of Dermatology 03/2014; · 3.76 Impact Factor
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ABSTRACT: Background: Cellular combinations in the same neoplasm can have intriguing physiopathological implications, which may be useful to better understand the biology of the diseases. Main observations: Urticaria pigmentosa in association with eruptive melanocytic nevi was observed in a female patient. Maculopapular lesions extended at the base of different melanocytic nevi and the histopathological examination revealed the presence of a mast cell population in the papillary and reticular dermis combined with overlying melanocytic nevi. The re-evaluation of a melanoma removed three years before revealed the presence of the same pathological features. Immunohistochemical assays showed a strong positivity to Giemsa, Toluidine blue and CD-117 in the mast cells, while a S-100 reaction was observed in the melanocytic population. Conclusions: We discuss possible pathogenetic linkage between cutaneous mastocytosis and melanoma.Journal of Dermatological Case Reports 09/2014; 8(3):70-74.