Cutaneous malignancies in patients treated with psoralen photochemotherapy (PUVA) for vitiligo

Halder, Rebat M.

doi:10.1001/archderm.131.6.734

Cited by 17 publications

(12 citation statements)

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“…Twelve of our patients have had PUVA therapy for more than 2 years. The results of our study are in agreement with a recent study of a 5-year follow-up by Halder et al [22]. Hence, it appears that patients with vitiligo may not develop this proliferation of hyperactive melanocytes.…”

Section: Resultssupporting

confidence: 93%

“…Since this treatment modality is also widely used for vitiligo, one would expect that this patient group shows an even higher risk for those skin cancers. There was no evidence of skin cancer in patients with vitiligo including children after PUVA therapy in a recent study of a 5-year follow-up [22]. To the best of our knowledge, there are no reports on PUVA-induced skin cancer in vitiligo.…”

Section: Introductionmentioning

confidence: 99%

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Decreased Photodamage and Low Incidence of Non-Melanoma Skin Cancer in 136 Sun-Exposed Caucasian Patients with Vitiligo

2002

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Background: It is well established that ultraviolet radiation is related to non-melanoma skin cancer (NMSC) in Caucasians. Considering that patients with vitiligo have often no protective pigment in sun-exposed depigmented/white skin together with severe oxidative stress due to accumulation of millimolar epidermal hydrogen peroxide (H₂O₂), it would be expected that these patients develop a higher risk for early photodamage and NMSC. However, scattered reports on low patient numbers documented no increased risk for sun-induced skin cancers in this disease. Objective: The aim of this study was to validate the possible photodamage and the development of epidermal neoplasia in a randomly selected larger patient group with emphasis on each patient’s sun sensitivity and the history of solar habits. Furthermore we wished to compare histological signs for epidermal photodamage in a random representative patient group (mean age >30 years) and age-matched healthy controls. Methods: One hundred and thirty-six randomly selected patients (females n = 93; males n = 43; mean age 42.4 years, range 14–70 years) were included in this study. To assess signs of photodamage and skin cancer, all patients underwent a thorough full-body examination by Wood’s light and dermatoscopy. In order to learn about each patient’s individual sun sensitivity and solar habits, a direct questionnaire was used. In addition full skin punch biopsies of sun-exposed depigmented/pigmented skin were taken under local anaesthesia and evaluated by light microscopy. Results: There was no evidence for sun-related damage in the entire patient group, despite a significant number of positive cases with a history of sunburns in early childhood and continuous accumulation of epidermal H₂O₂. Histological examination of the epidermis showed no signs of increased photo-ageing and confirmed the absence of apoptosis in these patients. Furthermore surprisingly there was no increased risk for photosensitivity disorders, i.e. polymorphous light reaction, solar urticaria and acute actinic dermatitis. Conclusion: The results of this study confirm in a large group of patients with vitiligo the absence of an expected high risk for sun-induced damage and skin cancer. Based on these results together with a recent report on increased functional wild-type p53 expression in these patients we would like to propose that in vitiligo there may be a direct association between this important tumour suppressor and the absence of photodamage and NMSC.

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Section: Resultssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Decreased Photodamage and Low Incidence of Non-Melanoma Skin Cancer in 136 Sun-Exposed Caucasian Patients with Vitiligo

2002

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“…Although 3 previous studies, published in 1992, 16 1995, 15 and 1997,failed to show the development of skin cancer in patients with vitiligo, there have been more recent case reports of SCCs and keratoacanthomas in such patients. 6–11 Our findings suggest that there may be an increased or equal risk of NMSC in patients with vitiligo.…”

Section: Discussionmentioning

confidence: 98%

“…13 Conversely, PUVA was reported for the treatment of vitiligo in 1976, 14 and two subsequent studies, involving 326 and 59 patients, failed to show an association of skin cancer in patients with vitiligo treated with PUVA. 15,16 An initial case report of SCC in vitiligo after prolonged PUVA therapy was not reported until 2 decades later. 17 It is commonly believed that patients with vitiligo do not have an increased risk, and perhaps have even a lower incidence of skin cancer than the general population.…”

mentioning

confidence: 99%

Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo

Hexsel

Eide

Johnson

et al. 2009

Journal of the American Academy of Dermatology

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Background Nonmelanoma skin cancer (NMSC) incidence in patients with vitiligo has not been studied. Objective We sought to quantify the incidence of NMSC in patients with vitiligo. Methods A cohort of 477 patients with vitiligo and no history of NMSC seen in an outpatient academic center between January 2001 and December 2006 was established. All charts for patients with vitiligo were reviewed for incident NMSC, and histopathology verified. Age-adjusted (2000 US Standard Million) incidence rates were calculated and compared to US rates. Results Six patients with NMSC were identified; all were Caucasian (>61 years).‘Age-adjusted incidence rates were: basal cell carcinoma, male 1382/100,000; basal cell carcinoma, female 0; squamous cell carcinoma, male 465/100,000; squamous cell carcinoma, female 156/100,000. Except for basal cell carcinoma in females, all rates were higher than US rates but not statistically significant. Limitations Comparison incidence rates from the general patient population during the same time period were unavailable. Conclusion Health care providers should be aware of the possible risk of NMSC in Caucasian patients with vitiligo.

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“…Cutaneous carcinogenicity is the major concern for long-term PUVA treatment [24]. Although Stern et al documented that oral PUVA therapy is associated with a persistent, dose-related increase in the risk of squamous cell cancer [43], similar documentation has not occurred in patients with vitiligo expect two case reports [44,45,46] Halder et al investigated cutaneous malignancies in 326 patients treated with PUVA for vitiligo and failed to document actinic keratoses or skin cancer during an observation period of 4 years [47]. Before beginning PUVA therapy it is essential to avoid prolonged treatment and educate patients to protect from unnecessary sun exposure.…”

Section: Oral Puvamentioning

confidence: 99%

Photo (Chemo) Therapy and Vitiligo

2015

J Turk Acad Dermatol

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Background: Vitiligo is an acquired idiopathic pigmentary skin disorder characterized by sharply demarcated milky white macules with variable size and shape. It has an estimated worldwide incidence of 0.5-4% and occurs in half of the patients before the age of 20 years. Since exact pathogenic mechanism is unknown, several proposed hypotheses are alternation of cellular and humoral immunity, melanocyte damage stimulated by chemicals released from nerve endings, structural aberration of melanocytes, melanocytorrhagia, epidermal cytokines, metabolic dysregulations and convergence theory depended on combination of these etiologic factors. Treatment of vitiligo depends on viable melanocyte reservoirs which induce repigmentation during various therapies. Although melanocyte reservoir mainly shown as hair follicle unit, repigmentation arise from three main sources. These are hair follicle unit, melanocytes located at the edge of vitiligo lesion and unaffected melanocytes within areas of depigmented epidermis. Treatment modalities for vitiligo therapy divided in three main groups as medical therapy, phototherapy and surgical therapy. Vitiligo lesions should be initially treated with topical medical therapy or localized phototherapy. If depigmentation is larger than 10-20% of body surface area, systemic medical therapy or phototherapy should be sought. When depigmentations do not regress in spite of appropriate interventions, surgical therapies should be considered as the lesions become refrectory and stable. In this review, we discuss the literature and evidence base for phototherapy in vitiligo and summarized previous studies.

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Cutaneous malignancies in patients treated with psoralen photochemotherapy (PUVA) for vitiligo

Cited by 17 publications

References 0 publications

Decreased Photodamage and Low Incidence of Non-Melanoma Skin Cancer in 136 Sun-Exposed Caucasian Patients with Vitiligo

Decreased Photodamage and Low Incidence of Non-Melanoma Skin Cancer in 136 Sun-Exposed Caucasian Patients with Vitiligo

Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo

Photo (Chemo) Therapy and Vitiligo

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