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Harris HR, Korkes KMN, Li T, Kvaskoff M, Cho E, Carvalho LF, Qureshi AA, Abrao M, Missmer SA. Endometriosis, Psoriasis, and Psoriatic Arthritis: A Prospective Cohort Study. Am J Epidemiol 2022; 191:1050-1060. [PMID: 35029650 PMCID: PMC9393059 DOI: 10.1093/aje/kwac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/16/2023] Open
Abstract
Endometriosis, psoriasis, and psoriatic arthritis (PsA) are chronic inflammatory disorders whose etiologies remain poorly understood but may be correlated, as endometriosis has been associated with other inflammatory disorders. We investigated the bidirectional associations between laparoscopically confirmed endometriosis and physician-diagnosed psoriasis and PsA in the Nurses' Health Study II cohort (n = 116,429, United States, 1991-2013). We confirmed 4,112 incident cases of laparoscopically confirmed endometriosis (mean age at diagnosis = 40.3 years) and 697 validated physician-diagnosed cases of psoriasis (mean age at diagnosis = 43.6 years), 110 of which presented with concomitant PsA. A history of psoriasis with concomitant PsA was associated with a 2-fold higher risk of endometriosis (hazard ratio (HR) = 2.01, 95% CI: 1.23, 3.30); however, no association was observed between psoriasis without PsA and endometriosis risk (HR = 0.93, 95% CI: 0.68, 1.26). When endometriosis was the exposure, it was not associated with a risk of subsequent psoriasis (HR = 1.28, 95% CI: 0.95, 1.72). The risk of psoriasis with PsA was notably higher; however, the sample size was small and the confidence intervals wide (HR = 1.77, 95% CI: 0.89, 3.52). Our findings suggest that psoriasis with concomitant PsA is associated with greater risk of laparoscopically confirmed endometriosis. In addition, there was a suggestive association between endometriosis diagnosis and subsequent risk of psoriasis with PsA.
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Affiliation(s)
- Holly R Harris
- Correspondence to Dr. Holly Harris, Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., M4-B859, Seattle, WA 98109-1024 (e-mail: )
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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Kubanov AA, Zhilova MB. Revisited the potential risks of carcinogenicity of phototherapy in patients with psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-5-60-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents published data on the assessment of the risk of cancerogenicity of multiple courses of phototherapy methods such as PUVA therapy and UVB-311 in psoriatic patients. The authors analyzed the incidence of malignant skin neoplasms (squamous cell carcinoma, basal cell carcinoma, malignant skin melanoma) among psoriatic patients from different population groups taking into account the cumulative radiation doses and number of procedures.
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Archier E, Devaux S, Castela E, Gallini A, Aubin F, Le Maître M, Aractingi S, Bachelez H, Cribier B, Joly P, Jullien D, Misery L, Paul C, Ortonne JP, Richard MA. Carcinogenic risks of Psoralen UV-A therapy and Narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:22-31. [DOI: 10.1111/j.1468-3083.2012.04520.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Matz H. Phototherapy for psoriasis: what to choose and how to use: facts and controversies. Clin Dermatol 2010; 28:73-80. [DOI: 10.1016/j.clindermatol.2009.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PUVA and UVB phototherapy are very effective and popular treatments for a variety of dermatological problems. This article gives an overview of the possible acute and chronic adverse effects of these therapies.
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Affiliation(s)
- S Laube
- Department of Dermatology, South Buckinghamshire NHS Trust, Amersham Hospital, Amersham, Buckinghamshire, UK
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Kimball AB, Gladman D, Gelfand JM, Gordon K, Horn EJ, Korman NJ, Korver G, Krueger GG, Strober BE, Lebwohl MG. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol 2008; 58:1031-42. [PMID: 18313171 DOI: 10.1016/j.jaad.2008.01.006] [Citation(s) in RCA: 399] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 01/01/2008] [Accepted: 01/10/2008] [Indexed: 11/27/2022]
Abstract
There have been several articles and reports in recent months about comorbidities and risks that affect psoriasis patients in addition to their underlying disease. This piece reviews the current literature and begins to address what should be done with this new information by updating the clinician about what health screening tests, preventative exams, and referrals should be considered in this population.
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Affiliation(s)
- Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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KOH HOWARDK, KLIGLER BENJAMINE, LEW ROBERTA. SUNLIGHT AND CUTANEOUS MALIGNANT MELANOMA: EVIDENCE FOR AND AGAINST CAUSATION. Photochem Photobiol 2008. [DOI: 10.1111/php.1990.51.6.765] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lassacher A, Worda M, Kaddu S, Heitzer E, Legat F, Massone C, Cerroni L, Kerl H, Ananthaswamy HN, Wolf P. T1799A BRAF mutation is common in PUVA lentigines. J Invest Dermatol 2006; 126:1915-7. [PMID: 16557238 DOI: 10.1038/sj.jid.5700250] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
INTRODUCTION The benefits of PUVAtherapy in many dermatological affections are well known. Its carcinogenic role in the long term has been assessed varyingly in American and European series. OBJECTIVE The aim of this study was to assess the role of PUVA in the onset of cancers of the skin. METHODS Retrospective study of patients presenting with psoriasis and followed-up in the phototherapy unit of the Michallon Hospital in Grenoble since 1976 and having received more than 150 sessions of PUVA. The parameters studied were: age, gender, phototype, age at the time of the first irradiation, type of phototherapy administered, total number of sessions, concomitant treatments, administration of retinoids and the appearance of skin cancers with the interval before their onset after the first session, their localization and their histological type. RESULTS One hundred six patients were retained among the 152 who replied to the inclusion criteria. Having died or been lost to follow-up, forty-six patients were excluded. Fourteen patients had presented at least one cutaneous tumor with a total number of 35. Excluding the keratoacanthomas, 13 patients had a non-melanic cutaneous cancer with a total number of 32 tumors. Ten out of the 14 were phototype III, 3 were phototype II and one was phototype IV. Nine out of 14 had received PUVAtherapy alone and 5 PUVAtherapy and broad spectrum UVB. The number of sessions of PUVA received in all the cases was more than 200 (220 to 780), corresponding to a total dose of UVA comprised between 1460 and 3882 Joules. The delay before onset of the tumors varied from 6 to 27 years after the first PUVAtherapy. The mean age at the time of the first irradiation was of 50.2 years (14-75 years). The mean duration of phototherapy was of 10 years (2.23 years).
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Affiliation(s)
- M Raiss
- Service de Dermatologie, CHU Grenoble, BP 217X, 38043 Grenoble, France
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Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol 2004; 195:298-308. [PMID: 15020192 DOI: 10.1016/j.taap.2003.08.019] [Citation(s) in RCA: 708] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2003] [Accepted: 08/27/2003] [Indexed: 01/25/2023]
Abstract
Ultraviolet (UV) irradiation present in sunlight is an environmental human carcinogen. The toxic effects of UV from natural sunlight and therapeutic artificial lamps are a major concern for human health. The major acute effects of UV irradiation on normal human skin comprise sunburn inflammation (erythema), tanning, and local or systemic immunosuppression. At the molecular level, UV irradiation causes DNA damage such as cyclobutane pyrimidine dimers and (6-4) photoproducts, which are usually repaired by nucleotide excision repair (NER). Chronic exposure to UV irradiation leads to photoaging, immunosuppression, and ultimately photocarcinogenesis. Photocarcinogenesis involves the accumulation of genetic changes, as well as immune system modulation, and ultimately leads to the development of skin cancers. In the clinic, artificial lamps emitting UVB (280-320 nm) and UVA (320-400 nm) radiation in combination with chemical drugs are used in the therapy of many skin diseases including psoriasis and vitiligo. Although such therapy is beneficial, it is accompanied with undesirable side effects. Thus, UV radiation is like two sides of the same coin--on one side, it has detrimental effects, and on the other side, it has beneficial effects.
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Affiliation(s)
- Yasuhiro Matsumura
- Department of Dermatology, Kansai Medical University, Osaka 570-8507, Japan.
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Abstract
BACKGROUND The increased risk of second malignancies, including nonmelanoma skin cancers, in cutaneous T-cell lymphoma (CTCL) patients has been well documented. However, relatively few studies of malignant melanoma in CTCL patients have been reported. METHODS A database of 250 CTCL patients registered over a 3-year period was searched to identify patients with diagnoses of both mycosis fungoides (MF) and malignant melanoma. RESULTS We identified six cases of MF associated with malignant melanoma and one associated with dysplastic nevus syndrome, which is a marker of increased risk of melanoma. In four patients, melanoma was diagnosed along with or before MF. In the remaining two patients, MF was diagnosed prior to melanoma, although dysplastic nevi were noted at the time MF was diagnosed. These two patients received treatment for their MF (one with topical nitrogen mustard and another with radiation therapy and nitrogen mustard) prior to the histologic confirmation of melanoma. Six patients had early stages of MF (IA or IB), while one patient presented with simultaneous erythrodermic mycosis fungoides involving the lymph nodes as well as melanoma metastatic to the lymph nodes from an unknown primary. CONCLUSION There is an elevated prevalence of malignant melanoma in MF patients compared to the general US population (P < 0.00001) with a relative risk of 15.3 for observing malignant melanoma in MF patients (95% confidence interval 7.0-33.8). Possible pathologic links between the two diagnoses include effects of mycosis fungoides therapies, immunosuppression secondary to mycosis fungoides, and genetic alterations in the p16 tumor suppressor protein.
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Affiliation(s)
- J A Pielop
- Baylor College of Medicine, Houston, TX, USA
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Boffetta P, Gridley G, Lindelöf B. Cancer risk in a population-based cohort of patients hospitalized for psoriasis in Sweden. J Invest Dermatol 2001; 117:1531-7. [PMID: 11886519 DOI: 10.1046/j.0022-202x.2001.01520.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies of clinical series of psoriasis patients have suggested an increased risk of nonmelanoma skin cancer and melanoma; the risk of other neoplasms has rarely been studied. In order to assess the incidence of cancer in a nationwide series of psoriasis patients from Sweden, we followed up, for the years 1965-89, 9773 patients with a hospital discharge diagnosis of psoriasis made during 1965-83, who were alive and free from malignancy 1 y after first discharge. We compared their incidence of neoplasms with that of the national population by computing standardized incidence ratios (SIR). We observed a total of 789 neoplasms [SIR 1.37, 95% confidence interval (CI) 1.28, 1.47]. There was an increase in the risk of cancers of the oral cavity and pharynx (SIR 2.80, 95% CI 1.96, 3.87), liver (SIR 1.91, 95% CI 1.28, 2.74), pancreas (SIR 1.56, 95% CI 1.02, 2.23), lung (SIR 2.13, 95% CI 1.71, 2.61), skin (squamous cell carcinoma, SIR 2.46, 95% CI 1.82, 3.27), female breast (SIR 1.27, 95% CI 1.00, 1.58), vulva (SIR 3.24, 95% CI 1.18, 7.06), penis (SIR 4.66, 95% CI 1.50, 10.9), bladder (SIR 1.43, 95% CI 1.03, 1.92), and kidney (SIR 1.56, 95% CI 1.04, 2.25). The risk of malignant melanoma was decreased (SIR 0.32, 95% CI 0.10, 0.74). Despite some limitations (possible diagnostic misclassification, lack of data on treatment, relatively short follow-up), our study provides evidence against an increased risk of melanoma among patients hospitalized for psoriasis. In addition to nonmelanoma skin and genital cancers, patients hospitalized for psoriasis were at increased risk of several malignancies, in particular those associated with alcohol drinking and tobacco smoking.
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Affiliation(s)
- P Boffetta
- Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, Lyon, France.
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Abstract
BACKGROUND Oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is a highly effective therapy for psoriasis and many other skin conditions. It is carcinogenic. Previously we reported an increased risk of melanoma that first emerged 15 years after first treatment. OBJECTIVE Our purpose is to present additional data concerning the associations of previous exposure to PUVA, the passage of time, and the risk of malignant melanoma. METHODS We have prospectively studied a cohort of 1380 patients first treated with PUVA in 1975 and 1976. We have documented the occurrence of melanoma and in this report compare the observed and expected incidence of melanoma in this cohort, particularly melanomas developing since our earlier report (ie, after March 1996). RESULTS Since 1975, 23 patients have developed 26 invasive or in situ cutaneous melanomas. In an average of 2.25 years since our last report, we detected 7 additional invasive melanomas (incidence rate ratio, 8.4; 95% confidence interval, 3.4-17.3). CONCLUSION Beginning 15 years after first exposure to PUVA, an increased risk of melanoma is observed in our cohort of PUVA-treated patients. This risk is greater in patients exposed to high doses of PUVA, appears to be increasing with the passage of time, and should be considered in determining the risks and benefits of this therapy.
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Affiliation(s)
- R S Stern
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lindelöf B, Sigurgeirsson B, Tegner E, Larkö O, Johannesson A, Berne B, Ljunggren B, Andersson T, Molin L, Nylander-Lundqvist E, Emtestam L. PUVA and cancer risk: the Swedish follow-up study. Br J Dermatol 1999; 141:108-12. [PMID: 10417523 DOI: 10.1046/j.1365-2133.1999.02928.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) for treatment of skin disorders. Many authors have found an increased risk for cutaneous squamous cell carcinoma (SCC). Except in anecdotal reports, malignant melanoma had not been observed in patients treated with PUVA until recently. In the U.S.A., a 16-centre prospective study of 1380 patients showed for the first time that there might also be an increased risk for malignant melanoma in patients treated with high cumulative dosages of PUVA. We have therefore followed up the Swedish PUVA cohort until 1994. This cohort had previously been followed up until 1985. Information from 4799 Swedish patients (2343 men, 2456 women) who had received PUVA between 1974 and 1985 was linked to the compulsory Swedish Cancer Registry in order to identify individuals with cancer. The average follow-up period was 15.9 years for men and 16.2 for women. We did not find any increased risk for malignant melanoma in our total cohort of 4799 patients treated with PUVA or in a subcohort comprising 1867 patients followed for 15-21 years. For cutaneous SCC there was an increase in the risk: the relative risk was 5.6 (95% confidence interval, CI 4. 4-7.1) for men and 3.6 (95% CI 2.1-5.8) for women. Significant (P < 0.05) increases were also found in the incidence of respiratory cancer in men and women and of kidney cancer in women. In conclusion, we did not find any increased risk for malignant melanoma in our patients treated with high doses of PUVA and followed up for a long time. We confirm previous reports of an increase in the incidence of cutaneous SCC in patients treated with PUVA, and recommend that patients should be carefully selected for PUVA and rigorously followed up.
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Affiliation(s)
- B Lindelöf
- Division of Dermatology, Karolinska Institute, Danderyd Hospital, S-182 88 Stockholm, Sweden.
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Wolf P, Schöllnast R, Hofer A, Smolle J, Kerl H. Malignant melanoma after psoralen and ultraviolet A (PUVA) therapy. Br J Dermatol 1998; 138:1100-1. [PMID: 9747390 DOI: 10.1046/j.1365-2133.1998.02295.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
In 1974 a new photobiologic principle i.e. light + drug, called photochemotherapy was discovered in Boston and immediately confirmed in Vienna. Psoralen + UVA (PUVA) photochemotherapy has now been applied to the treatment of more than 24 heterogeneous groups of diseases, especially psoriasis and mycosis fungoides. After 24 years of experience in thousands of patients with psoriasis and 23 other skin disorders, virtually the only risk is the development of squamous-cell carcinomas. This risk is low with two exceptions: previous history of treatment with ionizing radiation or inorganic trivalent arsenic, and patients with recalcitrant psoriasis who require continuous treatment for many years. In a recent report from a large USA clinical trial, melanoma developed in a few patients with psoriasis treated with PUVA. This prospective clinical trial did not have a control population, and therefore, the conclusion that PUVA can cause melanoma is tentative.
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Affiliation(s)
- K Momtaz
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Sun exposure is a known cause of melanoma, and there are several reasons for concern that tanning lamp use may also cause melanoma, especially because of the spectral output of the lamps,the similarity of tanning lamp use to natural sun exposure (particularly sunbathing), the reported association of melanoma with PUVA therapy, and the positive results in several case-control studies of melanoma risk and tanning lamp use. We have reviewed the epidemiologic literature relevant to the relation between tanning lamp use and melanoma and have discussed methodologic issues that should be considered in interpreting these reports and designing improved studies. Although several investigations have found a positive relation between tanning lamp use and melanoma, in some instances including dose-response or duration-response effects, the methodologic limitations preclude any firm conclusion regarding a causative relation. Meta-analysis of existing data may provide better information, but several limitations could only be overcome by new studies collecting more precise exposure data. The popularity of tanning lamp use, especially in young persons, adds urgency to the quest for elucidation of the relation between the use of these devices and melanoma risk.
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Affiliation(s)
- A J Swerdlow
- Epidemiological Monitoring Unit, London School of Hygiene & Tropical Medicine, England
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Stern RS, Nichols KT, Väkevä LH. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). The PUVA Follow-Up Study. N Engl J Med 1997; 336:1041-5. [PMID: 9091799 DOI: 10.1056/nejm199704103361501] [Citation(s) in RCA: 421] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can cause irregular, pigmented skin lesions. We studied the occurrence of melanoma among patients treated with PUVA. METHODS We prospectively identified cases of melanoma and documented the extent of exposure to PUVA among 1380 patients with psoriasis who were first treated with PUVA in 1975 or 1976. Using incidence data, we calculated the expected incidence of melanoma in this cohort and compared it with the observed incidence. Using regression models, we assessed the risks of melanoma associated with a long time (> or = 15 years) since the first treatment and with a large number of PUVA treatments (> or = 250). RESULTS From 1975 through 1990, we detected four malignant melanomas, about the number expected in the overall population (relative risk, 1.1). From 1991 through 1996, we detected seven malignant melanomas (relative risk, 5.4; 95 percent confidence interval, 2.2 to 11.1). The risk of melanoma was higher in the later period than in the earlier one (incidence-rate ratio, 3.8) and higher among patients who received at least 250 PUVA treatments than among those who received fewer treatments (incidence-rate ratio, 3.1). CONCLUSIONS About 15 years after the first treatment with PUVA, the risk of malignant melanoma increases, especially among patients who receive 250 treatments or more.
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Affiliation(s)
- R S Stern
- Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Kikuchi-Numagami K, Kato T, Tagami H. Malignant melanoma in situ in a Japanese psoriatic patient treated with phototherapy. Int J Dermatol 1996; 35:225-6. [PMID: 8655250 DOI: 10.1111/j.1365-4362.1996.tb01653.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Rockley PF, Trieff N, Wagner RF, Tyring SK. Nonsunlight risk factors for malignant melanoma. Part I: Chemical agents, physical conditions, and occupation. Int J Dermatol 1994; 33:398-406. [PMID: 8056470 DOI: 10.1111/j.1365-4362.1994.tb04038.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- P F Rockley
- Departments of Dermatology, University of Texas Medical Branch, Galveston 77555-0783
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Abstract
This article reviews the English-language literature on the risk of nonmelanoma skin cancer from phototherapy (UVB) or photochemotherapy (PUVA) in the treatment of psoriasis. The evolution of the debate on the carcinogenic potential of these treatment is discussed, particularly with reference to PUVA. Available data indicate that therapeutic UVB has a low risk of producing cutaneous cancers, with the possible exception of those on male genital skin. However, there is a definite cutaneous carcinogenic risk from oral PUVA. The major associated risk factors are reviewed. We provide recommendations for the assessment and treatment of patients to minimize this risk.
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Greene MH. The prevention of cutaneous malignant melanoma: high-risk groups, chemoprevention, education, and screening. Cancer Treat Res 1993; 65:103-40. [PMID: 8104019 DOI: 10.1007/978-1-4615-3080-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Melanoma is a disease that need not be deadly. Advances in our understanding of the etiology and biology of melanoma over the past 20 years have brought us to the brink of a new era in which the twin goals of primary and secondary prevention may be within our grasp. There is ample reason to be optimistic that this can and will be accomplished.
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Affiliation(s)
- M H Greene
- Department of Medicine, Mayo Clinic Scottsdale, AZ 85259
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Calzavara-Pinton P, Ortel B, Carlino A, Hönigsmann H, De Panfilis G. 8-MOP vs 5-MOP. Exp Dermatol 1992; 1:206. [PMID: 1365321 DOI: 10.1111/j.1600-0625.1992.tb00190.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Malignant melanoma of the female genitalia is rare. A patient who regularly used a sunbed developed a malignant melanoma after 4 years. The possible aetiological role of sunbeds in the development of such a malignancy is discussed.
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Affiliation(s)
- E M Higgins
- Department of Dermatology, King's College Hospital, London, UK
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Affiliation(s)
- M A Weinstock
- Dermatoepidemiology Unit, VA Medical Center, Providence, Rhode Island 02908
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Todd P, Garioch J, Seywright M, Rademaker M, Thomson J. Malignant melanoma and systemic mastocytosis--a possible association? Clin Exp Dermatol 1991; 16:455-7. [PMID: 1806323 DOI: 10.1111/j.1365-2230.1991.tb01235.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lymphoproliferative and myeloproliferative malignancies have been noted in patients with systemic mastocytosis and urticaria pigmentosa. However, to our knowledge an association between mastocytosis and malignant melanoma has not been reported previously.
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Affiliation(s)
- P Todd
- Department of Dermatology, Glasgow Royal Infirmary, UK
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Abstract
Although psoralen photochemotherapy (PUVA) is one of the most effective forms of therapy for psoriasis, the risk of potential long-term side-effects is, as yet, not clearly determined. Chronic degenerative and pigmentary skin changes similar to those of chronic solar exposure occur after long-term PUVA treatment; PUVA also causes non-melanoma skin cancers in man, although there is, as yet, no consensus as to what cumulative phototoxic PUVA dose is carcinogenic. Long-term multicentre studies from the U.S.A. indicate a definite risk of squamous cell carcinoma for long-term PUVA-treated patients, whereas European studies reveal no overall increase in skin cancers in similar patients except for those exposed to other carcinogens. Assignment to PUVA should be based on the risk:benefit ratio for the individual patient. Careful patient selection is therefore mandatory and should be limited to those who can be monitored and controlled by informed, competent and conscientious physicians.
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Affiliation(s)
- K Wolff
- Department of Dermatology I, University of Vienna, Austria
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