Oral Psoralen and Ultraviolet-A Light (PUVA) Treatment of Psoriasis and Persistent Risk of Nonmelanoma Skin Cancer

Stern, Robert S.; Liebman, Elissa J.; Väkevä, Liisa

doi:10.1093/jnci/90.17.1278

Cited by 258 publications

(163 citation statements)

References 27 publications

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“…12 An estimated 27% of early-onset BCCs could be avoided with the elimination of tanning beds. 13 Additional risk factors include fair skin, 14 immunosuppression, 15,16 environmental exposure to ionizing radiation, arsenic, UV radiation, psoralen plus UVA (PUVA), [17][18][19] and a past history of BCC. Patients with a history of BCC are 10 times more likely to develop subsequent tumours.…”

Section: Introductionmentioning

confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 4: Management of Basal Cell Carcinoma

et al. 2015

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Background: Basal cell carcinoma (BCC) is the most common malignancy. Growth of BCCs leads to local destruction of neighbouring healthy skin and underlying tissue and can result in significant functional and cosmetic morbidity. Objective: To provide guidance to Canadian health care practitioners regarding management of BCCs. Methods: Literature searches and development of graded recommendations were carried out as discussed in the accompanying Introduction. Results: Although BCCs rarely metastasize, they can be aggressive and disfiguring. This chapter describes the natural history and prognosis of BCCs. Risk stratification is based on clinical features, including the site and size of the tumour, its histologic subtype (nodular vs sclerosing), and its history of recurrence. Conclusions: Various options should be considered for BCC treatment, including cryosurgery, curettage, and topical or photodynamic approaches, as well as fixed-margin surgery and Mohs micrographic surgery. Stratification of recurrence risk for individual BCCs determines the most appropriate therapeutic course. RésuméContexte : Le carcinome basocellulaire (CBC) est le cancer le plus répandu. La croissance d'un CBC mène à la destruction locale de la peau saine environnante et des tissus sous-jacents et peut causer une morbidité fonctionnelle et cosmétique importante. Objectif : Fournir des conseils aux professionnels canadiens de la santé au sujet de la gestion des CBC. Méthode : Nous avons procédé à une étude documentaire et à l'élaboration de catégories de recommandations, comme on peut le lire dans l'introduction connexe. Résultats : Le CBC forme rarement des métastases, mais il peut être agressif et défigurant. Ce chapitre décrit l'évolution et le pronostic du CBC. La stratification du risque est fondée sur les caractéristiques cliniques, y compris l'emplacement et la taille de la tumeur, et son sous-type histologique (nodulaire ou sclérosant), et sur les antécédents de récurrence. Conclusion : Diverses options devraient être envisagées dans le traitement du CBC, y compris la cryochirurgie, le curetage et les approches topiques ou photodynamiques, ainsi que la chirurgie à marge déterminée et la chirurgie micrographique de Mohs. La stratification du risque de récurrence de chaque CBC individuel détermine le traitement thérapeutique le plus approprié.

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Section: Introductionmentioning

confidence: 99%

Non-melanoma Skin Cancer in Canada Chapter 4: Management of Basal Cell Carcinoma

et al. 2015

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“…The results showed 100-fold increase in the risk of squamous cell cancer (SCC) compared to that expected from the popular incidence rates [33]. An exposure to PUVA had a far smaller effect on the risk of basal cell carcinoma (BCC).…”

Section: Puva Therapy and Phototherapy In Psoriasis: Pros And Consmentioning

confidence: 95%

Melanoma and other malignant skin cancers in psoriatic patients treated with phototherapy. Role of the p16 protein in psoriasis

Szponar-Bojda¹,

Pietrzak

Sobczyńska-Tomaszewska

et al. 2012

Folia Histochem Cytobiol.

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Abstract:Recently, the potential risk of malignant cancer development in psoriatic patients has been highlighted. However, the relationship between the therapeutic schemes in psoriasis and possible neoplastic transformation has not been so far clearly explained. Phototherapy is considered a very effective therapeutic method in psoriasis, however, the pathogenesis of some malignancies may be associated with the exposure to UV radiation. p16 protein belongs to the defense mechanisms that protect cells from damage and mutagenic factors, such as UV radiation. In recent years, the altered expression of the p16 protein in the diseases not related to malignant transformation, including psoriasis, has been observed. These new observations suggest participation of the p16 protein in the mechanisms of psoriatic plaque formation.

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“…PUVA is associated with , as well as Merkel cell carcinoma) and melanoma -, also in non-exposed skin areas, with a clear dose-effect relationship. [8][9][10][11][12][13][14][15][16][17][18] About 15 years after the first treatment with PUVA, the risk of malignant melanoma increases, especially among patients receiving 250 or more treatments. 12 This effect is apparent even with lowdose exposures and may persist for many years after cessation of treatment.…”

Section: Puva Therapymentioning

confidence: 99%

“…12 This effect is apparent even with lowdose exposures and may persist for many years after cessation of treatment. [8][9][10][11][12][13][14][15][16][17][18] …”

Section: Puva Therapymentioning

confidence: 99%

The dark side of the light: Phototherapy adverse effects

Coelho

Apetato

2016

Clinics in Dermatology

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Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis. Despite concerns over the carcinogenic potential of ultraviolet radiation, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy. These are therefore considered reasonably safe treatment modalities concerning the development of skin neoplasms, although caution and further investigation are warranted. Photoprotective measures, such as avoidance of concurrent sunlight exposure and covering skin areas not afflicted with disease, or more modern strategies, including phytochemical antioxidants and exogenous DNA repair enzymes, can minimize the hazards of phototherapy. Patients submitted to phototherapeutic regimens should undergo complete, careful dermatologic examination regularly and lifelong.

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Oral Psoralen and Ultraviolet-A Light (PUVA) Treatment of Psoriasis and Persistent Risk of Nonmelanoma Skin Cancer

Cited by 258 publications

References 27 publications

Non-melanoma Skin Cancer in Canada Chapter 4: Management of Basal Cell Carcinoma

Non-melanoma Skin Cancer in Canada Chapter 4: Management of Basal Cell Carcinoma

Melanoma and other malignant skin cancers in psoriatic patients treated with phototherapy. Role of the p16 protein in psoriasis

The dark side of the light: Phototherapy adverse effects

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