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Genital squamous-cell carcinoma after PUVA therapy
1Department of Dermatology, University of Liège, Belgium.
Dermatology (Basel, Switzerland)
|January 1, 1992
Summary
High-dose PUVA therapy for psoriasis may increase the risk of genital squamous-cell carcinoma. This risk persists even years after treatment cessation in patients with prior arsenic and tar exposure.
Area of Science:
- Dermatology
- Oncology
- Phototherapy Research
Background:
- Psoriasis is a chronic inflammatory skin condition often treated with phototherapy.
- Psoralen plus ultraviolet A (PUVA) is a common phototherapy for severe psoriasis.
- Previous studies have linked PUVA to non-melanoma skin cancers, particularly on sun-exposed areas.
Observation:
- This study observed three cases of genital squamous-cell carcinoma (SCC) in patients treated with very high cumulative doses of PUVA (>1,500 J/cm2).
- All observed tumors were located on the genitalia, specifically the scrotum in all three patients.
- One patient developed penile SCC multiple times, indicating a localized susceptibility.
Findings:
- Genital squamous-cell carcinoma developed in patients with recalcitrant disseminated psoriasis treated with very high-dose PUVA.
- Tumor development occurred more than two years after cessation of PUVA therapy.
- A history of prior arsenic and tar treatment was noted in all affected patients, suggesting a potential synergistic risk.
Implications:
- Very high-dose PUVA may pose a specific risk for genital SCC, especially in patients with a history of genotoxic exposures.
- Long-term surveillance for genital malignancies may be warranted in patients receiving high-dose PUVA, particularly those with prior arsenic or tar treatment.
- These findings underscore the importance of considering cumulative dose and patient history in risk-benefit assessments for phototherapy.