Nijsten Tamar E C, Stern Robert S
Department of Dermatology, Beth Israel Deaconess, Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Invest Dermatol. 2003 Aug;121(2):252-8. doi: 10.1046/j.1523-1747.2003.12350.x.
Psoralen+ultraviolet A-treated psoriasis patients are at increased risk for nonmelanoma skin cancer. To assess the persistence of cancer risk among patients who have discontinued psoralen+ultraviolet A and the risk of a first tumor with the passage of time, we prospectively studied the incidence in a cohort of 1,380 psoriasis patients treated with psoralen+ultraviolet A. We observed a total of 27,840 person-years of which 59.4% were considered years without psoralen+ultraviolet. No significant decrease in risk was noted during the first 15 years after psoralen+ultraviolet A was discontinued. Subsequently, the risk of squamous cell carcinoma was reduced (incidence rate ratio=0.79; 95%CI=0.62, 1.01 on treatment vs >15 years off). After 25 years, about 7% of patients with < or =200 psoralen+ultraviolet A treatments and more than half of the patients with > or =400 treatments develop at least one squamous cell carcinoma. After 25 years, almost one third of the patients exposed to > or =200 treatments developed at least one basal cell carcinoma. In conclusion, substantial exposure to psoralen+ultraviolet A dramatically increases the risk of nonmelanoma skin cancer and prior exposure to psoralen+ultraviolet A remains an important issue in the management of patients because the cancer risk associated with psoralen+ultraviolet A is persistent.
补骨脂素加紫外线A治疗的银屑病患者患非黑色素瘤皮肤癌的风险增加。为了评估停止补骨脂素加紫外线A治疗的患者中癌症风险的持续性以及随着时间推移首次发生肿瘤的风险，我们对一组1380例接受补骨脂素加紫外线A治疗的银屑病患者的发病率进行了前瞻性研究。我们共观察到27840人年，其中59.4%被认为是未接受补骨脂素加紫外线治疗的年份。在停止补骨脂素加紫外线A治疗后的前15年中，未观察到风险有显著降低。随后，鳞状细胞癌的风险降低（治疗时与停止治疗超过15年时的发病率比值=0.79；95%置信区间=0.62，1.01）。25年后，接受补骨脂素加紫外线A治疗≤200次的患者中约7%以及接受治疗≥400次的患者中超过一半至少发生了1例鳞状细胞癌。25年后，接受治疗≥200次的患者中近三分之一至少发生了1例基底细胞癌。总之，大量暴露于补骨脂素加紫外线A会显著增加患非黑色素瘤皮肤癌的风险，既往暴露于补骨脂素加紫外线A在患者管理中仍然是一个重要问题，因为与补骨脂素加紫外线A相关的癌症风险具有持续性。
