Malignant melanoma in situ in two patients treated with psoralens and ultraviolet A

Marx, Jeffrey L.; Auerbach, Robert; Possick, Paul; Myrow, Ralph; Gladstein, Arthur H.; Kopf, Alfred W.

doi:10.1016/s0190-9622(83)70207-0

Cited by 45 publications

(16 citation statements)

References 41 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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“…Our patient was treated with UVB and tar preparations at the same time in 1983 during 5 weeks; this short duration is probably not a risk factor for the development of a malignant melanoma [13]. Most cases of malignant melanoma were observed after UV therapy combined with oral intake of 8-MOP or methotrexate, respectively [14][15][16].…”

Section: Discussionmentioning

confidence: 78%

Malignant Melanoma in Association with Phototherapy

Bergner

Przybilla²

1992

Dermatology

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A 54-year-old Caucasian male suffering from psoriasis had been treated in 1978 and 1980 with PUVA (cumulative UVA dose 492.5 J/cm²) and from 1980 to 1989 with UVB (cumulative UVB dose 264.5 J/cm²). Other occasional treatment had comprised the topical administration of glucocorticosteroids, dithranol or tar. In 1989 on the upper part of the patient’s back a newly developed pigmented skin lesion was excised under the clinical diagnosis of a pigmented, dysplastic nevus. Histological examination revealed a superficial spreading malignant melanoma (0.4 mm thick, Clark level II). In this case, exposure to high cumulative doses of therapeutic UV irradiation might have played an etiological role for the development of malignant melanoma.

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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 situ in two patients treated with psoralens and ultraviolet A

Cited by 45 publications

References 41 publications

PUVA and cancer risk: the Swedish follow-up study

PUVA and cancer risk: the Swedish follow-up study

Malignant Melanoma in Association with Phototherapy

Cutaneous Malignant Melanoma Appearing during Photochemotherapy of Mycosis fungoides

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