Malignant Melanoma in Association with Phototherapy

Bergner, Thomas; Przybilla, B.

doi:10.1159/000247501

Cited by 17 publications

(7 citation statements)

References 16 publications

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“…This form of cancer is often fast‐growing and fatal. The literature contains a number of case reports on invasive cutaneous malignant melanomas 20 –28 but it has been difficult to determine whether these melanomas were induced by PUVA or were coincidental. Only one population‐based study has been published, 29 and for the first time it has shown an increased risk for malignant melanoma in patients treated with high cumulative doses of PUVA and, most important, after a latency period of at least 15 years.…”

Section: Discussionmentioning

confidence: 99%

PUVA and cancer risk: the Swedish follow-up study

et al. 1999

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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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Section: Discussionmentioning

confidence: 99%

PUVA and cancer risk: the Swedish follow-up study

et al. 1999

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“…280 Melanoma developed after 15 years and was more common in patients of skin types I/II and who had received at least 250 exposures. There have been a number of case reports of melanoma occurring following PUVA, [294][295][296][297][298][299][300][301][302] but an increased incidence of melanoma has not been observed in European follow-up studies. 265,273,282,303 So, while there is no doubt that an association between PUVA and melanoma was detected in this one study it is uncertain that PUVA causes melanoma.…”

Section: Psoralen-ultraviolet a Therapy-induced Skin Cancermentioning

confidence: 99%

British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

et al. 2016

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“…Previous case reports concern patients who have been treated for psoriasis [18,[24][25][26][27], pustular psoriasis [28][29][30] or vitiligo [31]. This observation indicates the need for a careful follow-up of PUVA-treated patients.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Malignant Melanoma Appearing during Photochemotherapy of Mycosis fungoides

et al. 1994

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We report a case of malignant melanoma that appeared in a 56-year-old man with mycosis fungoides (stage la) during treatment with PUVA. The cumulative UVA dose was 1 177 J/cm2. The pigmented lesion was removed and PUVA therapy discontinued. Histological examination revealed a superficial spreading malignant melanoma (1.77 mm thick, Clark level IV). The delayed-type cutaneous hypersensitivity was studied. The presence of a second malignancy after mycosis fungoides and PUVA therapy may have been coincidental. Nevertheless, this case suggests that the immunosuppression induced by mycosis fungoides and by PUVA therapy might be a pathogenetic factor in the development of malignant melanoma.

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Malignant Melanoma in Association with Phototherapy

Cited by 17 publications

References 16 publications

PUVA and cancer risk: the Swedish follow-up study

PUVA and cancer risk: the Swedish follow-up study

British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

Cutaneous Malignant Melanoma Appearing during Photochemotherapy of Mycosis fungoides

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