Chuang T Y, Heinrich L A, Schultz M D, Reizner G T, Kumm R C, Cripps D J
Dermatology Section, William S. Middleton Memorial Veterans Hospital, Madison.
J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):173-7. doi: 10.1016/0190-9622(92)70021-7.
The safety of psoralen plus ultraviolet A (PUVA) light therapy has been an issue of debate. A few multiple-center cooperative studies have reported an increase of basal cell and squamous cell carcinomas among PUVA-treated patients. In our institute, more than 1000 patients have been treated with PUVA since 1975.
We investigated the incidence of skin cancer among patients who received high doses of PUVA to see whether such incidence increased.
This is a historical cohort study of two comparison groups of patients. Subjects under study were 492 psoriasis patients who received PUVA treatments between 1975 and 1989. One group of 103 patients, defined as the high-dose group, received an accumulated PUVA dose of 1000 joules/cm2 or more; another group of 389 patients, as the low-dose group, received 200 joules/cm2 or less. The occurrence of skin cancer in the two comparison groups is analyzed.
In the high-dose group we observed an increased number of patients with squamous cell carcinoma, keratoacanthoma, and actinic keratosis. We did not see any patients with genital cancer, melanoma, or an increased number of patients with basal cell carcinoma.
The risk of squamous cell carcinoma developing in patients who received a high dose of PUVA is confirmed. We speculate a combination of factors, including PUVA, may contribute to this risk.
补骨脂素加紫外线A（PUVA）光疗的安全性一直是一个有争议的问题。一些多中心合作研究报告称，接受PUVA治疗的患者中基底细胞癌和鳞状细胞癌的发病率有所增加。自1975年以来，我院已有1000多名患者接受了PUVA治疗。
我们调查了接受高剂量PUVA治疗的患者中皮肤癌的发病率，以确定这种发病率是否增加。
这是一项对两组患者进行比较的历史性队列研究。研究对象为1975年至1989年间接受PUVA治疗的492例银屑病患者。一组103例患者被定义为高剂量组，累积接受的PUVA剂量为1000焦耳/平方厘米或更高；另一组389例患者为低剂量组，接受的剂量为200焦耳/平方厘米或更低。分析两组患者皮肤癌的发生情况。
在高剂量组中，我们观察到鳞状细胞癌、角化棘皮瘤和光化性角化病患者数量增加。我们没有发现任何生殖器癌、黑色素瘤患者，也没有发现基底细胞癌患者数量增加。
接受高剂量PUVA治疗的患者发生鳞状细胞癌的风险得到证实。我们推测包括PUVA在内的多种因素可能导致了这种风险。
