Dermatology
Clinical and Laboratory Investigation
Skin Tumors in Photochemotherapy for Psoriasis: A Single-Center Follow-Up of 496 PatientsMaier H.a · Schemper M.b · Ortel B.a · Binder M.c · Tanew A.a · Hönigsmann H.aaDivision of Special and Environmental Dermatology, bSection of Clinical Biometrics, Department of Medical Computer Sciences, and cDivision of General Dermatology, University of Vienna Medical School, Vienna, Austria
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Article / Publication Details
Received: July 05, 1995
Accepted: March 14, 1996
Published online: October 06, 2009
Issue release date: 1996
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 0
ISSN: 1018-8665 (Print)
eISSN: 1421-9832 (Online)
For additional information: https://www.karger.com/DRM
Abstract
Background: The significance of oral psoralen photochemotherapy (PUVA) for the development of nonmelanoma skin cancers (NMSC) is still controversial. Objective: We evaluated 496 psoriatics, who received PUVA treatment according to the European PUVA protocol in order to reassess the influence of the cumulative UVA dose on the development of NMSC and to answer the question if there is a UVA threshold dose above which the carcinogenic risk is increased. Methods: The study was conducted as a retrospective investigation. All patients were seen personally. Age, sex, skin type, cumulative UVA dose and carcinogenic risk factors (arsenic, X-rays, tar, UVB, methotrexate) were recorded and investigated by marginal (MA) and partial effects analyses (PA) according to the Cox regression model. Results: In 14 patients (2.8%), one or multiple histologically confirmed NMSC were diagnosed. Nine patients (1.8%) had squamous cell carcinoma (SCC), 5 patients (1.0%) had basal cell carcinoma (BCC). No patient had both types of NMSC. None of the SCC had metastasized. By taking the appearance of BCC and SCC as the endpoint, arsenic [MA: relative risk (RR) = 7.62; PA: RR = 5.36], tar (MA: RR = 4.51; PA: RR = 3.83) and methotrexate (MTX; MA: RR = 4.97; PA: RR = 4.07) appear to produce strong and significant effects (p < 0.05), both in MA and PA. Using the endpoint SCC only, the effect of the natural logarithm of UVA (In UVA; RR = 2.47), arsenic (RR = 11.2), tar (RR = 9.92) and MTX (RR = 7.1) is significant (p < 0.05) in MA. In PA, only the effect of arsenic (RR = 5.19) is strong and significant (p < 0.05) while the effects of tar (RR = 7.85), MTX (RR = 3.22) and In UVA (RR = 2.77) are strong but of borderline significance (p = 0.05–0.11). Nonlinear effects of In UVA on the risk of SCC were far from significant (p > 0.2). Conclusion: PUVA with the European treatment protocol appears to be only a weak carcinogen by itself for SCC with a linear increase in tumor risk but not for BCC development.
© 1996 S. Karger AG, Basel
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Article / Publication Details
Received: July 05, 1995
Accepted: March 14, 1996
Published online: October 06, 2009
Issue release date: 1996
Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 0
ISSN: 1018-8665 (Print)
eISSN: 1421-9832 (Online)
For additional information: https://www.karger.com/DRM
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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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