Drerup Katharina, Bohne Ann-Sophie, Gläser Regine
Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus C, 24105, Kiel, Deutschland.
Z Rheumatol. 2023 Apr;82(3):195-205. doi: 10.1007/s00393-022-01312-3. Epub 2023 Jan 23.
Epithelial tumors differ in cellular origin, risk factors, incidence, and treatment. This article discusses the extent to which the use of disease-modifying antirheumatic drugs (DMARD) is associated with an increased risk for the development of skin tumors and for which substances the risk may be increased. In addition, some practical dermatological recommendations for rheumatologists are presented.
The most frequent tumors of the skin are classified according to their cellular origin into malignant melanoma (MM) and so-called keratinocyte cancer (KC). The clinical presentation of these tumors differs and also the risk for the development of these epithelial skin tumors under DMARD treatment varies depending on the drug and tumor entity. As rheumatologists frequently see these patients for follow-up, it is essential to know the clinical findings as well as the corresponding risk factors of the specific tumor entities.
A generally valid and reliable estimation of the risk for the development of epithelial skin tumors under DMARD treatment can only be formulated in the form of tendencies at the present time due to the lack of data. The relevant literature shows that regular intensive dermatological screening is recommended.
Patients undergoing immunosuppressive or immune-modulating treatment should be instructed in self-inspection of the skin, receive regular dermatological check-ups and be instructed in strict UV protection methods. Lesions that do not heal or recurrently bleed should be referred for a punch biopsy to rule out or diagnose an epithelial skin tumor, as should atypical inflammatory lesions that do not heal with the use of topical glucocorticoids. An interdisciplinary approach in patient management is the key to success in ensuring the maximum quality of life with the lowest possible risk of developing epithelial skin tumors for these patients.
上皮性肿瘤在细胞起源、危险因素、发病率和治疗方面存在差异。本文讨论了使用改善病情抗风湿药（DMARD）与皮肤肿瘤发生风险增加之间的关联程度，以及哪些药物可能会增加这种风险。此外，还为风湿病学家提供了一些实用的皮肤科建议。
根据细胞起源，将最常见的皮肤肿瘤分为恶性黑色素瘤（MM）和所谓的角质形成细胞癌（KC）。这些肿瘤的临床表现各不相同，并且在DMARD治疗下发生这些上皮性皮肤肿瘤的风险也因药物和肿瘤类型而异。由于风湿病学家经常对这些患者进行随访，因此了解特定肿瘤类型的临床发现以及相应的危险因素至关重要。
由于缺乏数据，目前只能以趋势的形式对DMARD治疗下上皮性皮肤肿瘤发生风险进行普遍有效的可靠估计。相关文献表明，建议进行定期的强化皮肤科筛查。
接受免疫抑制或免疫调节治疗的患者应接受皮肤自我检查指导，定期进行皮肤科检查，并接受严格的紫外线防护方法指导。不愈合或反复出血的皮损应进行钻孔活检以排除或诊断上皮性皮肤肿瘤，使用外用糖皮质激素治疗不愈合的非典型炎症性皮损也应如此。患者管理中的多学科方法是确保这些患者在尽可能低的发生上皮性皮肤肿瘤风险下获得最大生活质量的关键。
