Bowen's disease and squamous cell carcinoma. Occurrence in a patient with psoriasis after topical, systemic, and PUVA therapy

Abstract

Multiple lesions of Bowen's disease and squamous cell carcinoma on the penis and pubic areas developed in a 32-year-old patient with psoriasis who was undergoing treatment with psoralen and long-wave ultraviolet radiation (PUVA). A cumulative dose of more than 3,700 joules/sq cm of UVA had been administered over a three-year period. This case may be an early warning of possible carcinogenicity of PUVA therapy, alone or as part of sequential therapy with other agents.

Hyperpigmentation and Hypopigmentation of the Skin after Long Term PUVA Therapy

“…After an interval of 2 months without PUVA treatment, one patient showed a normal biopsy, while another patient with bowenoid lesion developed Bowen's disease in the following 30 months (Hofmann et al 1979). Recently possible PUVA-indueed basocellular and spinocellular eareinomas have been reported (Stern et al 1979, Tam et al 1979). This stresses the importance of conservatism in PUVA therapy and an efficient follow-up.…”

“…Several acute side effects such as erythema, pruritus, nausea and Kobner phenomenon were reported. In addition, morphological changes in the skin after long term PUVA treatment have recently been reported (Cox & Abel 1979, Hofmann et al 1979, Stern et al 1979, Tam et al 1979, Verdich 1979.…”

Bowen's Disease

“…BD is also known to arise following ionizing radiation, thermal skin injury, inflammatory dermatoses such as chronic lupus erythematosus, lupus vulgaris, and following Psoralens and Ultraviolet-A radiation. [ 2 9 13 ] BD has been reported in a person who was involved in arc welding. [ 14 ] The incidence of aneuploidy and DNA instability is high in lesional skin of BD.…”

Case reports in dermatology: loved by clinicians, loathed by editors, and occasionally important

“…[5][6][7] Case reports on advances in therapy include fumaric acid esters in the treatment of psoriasis in 1959; 8 clearance of psoriasis with ciclosporin A in a pilot study assessing drug efficacy in treating inflammatory arthritis; 9 infantile haemangiomas; 10 infliximab for hidradenitis suppurativa 11 and omalizumab for chronic urticaria. 12 Case reports of rare but important adverse effects in dermatology include Kaposi sarcoma in early transplant recipients; 13 skin cancer in patients with psoriasis treated with psoralen-ultraviolet A; 14 pancytopenia caused by azathioprine in the context of thiopurine S-methyltransferase deficiency; 15 progressive multifocal leucoencephalopathy complicating efalizumab 16 and dimethylfumarate treatment of psoriasis. 17,18 Occasionally, side-effects of drugs can provide therapeutic opportunities, as was the case for latanoprost and eyelash growth.…”