Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey.
Faculty of Medicine, Dermatology Department, Zonguldak Bulent Ecevit University, 67600, Zonguldak, Turkey.
Photodermatol Photoimmunol Photomed. 2023 Sep;39(5):428-434. doi: 10.1111/phpp.12872. Epub 2023 Mar 26.
Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. Skin-directed therapies, including phototherapy, are the first-line treatment modalities. Psoralen plus ultraviolet A light photochemotherapy (PUVA) is quite effective in controlling the disease; however, long-term adverse effects, particularly carcinogenesis, are the cons of this treatment.
There are various studies on the negative impact of PUVA on skin cancer in patients with autoimmune skin diseases. The data on the long-term effects of phototherapy on MF patients are scarce.
All MF cases that received PUVA alone or combined with other treatments at a single tertiary center were analyzed. This study compared the development of non-melanoma skin cancers, melanoma, and solid organ tumors in MF patients with at least 5-year follow-up data with age- and sex-matched controls.
A total of 104 patients were included in the study. Ninety-two malignancies were detected in 16 (15.4%) patients, and six developed multiple malignancies. Skin cancers consisted of 56 basal cell carcinomas, 16 Bowen's disease, four squamous cell carcinomas, three melanomas, two basosquamous cell carcinomas, one Kaposi sarcoma, and one keratoacanthoma were found in nine (8.7%) patients. Eight patients developed three solid cancers and six lymphomas. The risk of developing skin cancer was associated with the total number of PUVA sessions (<250 vs ≥250 sessions; hazard ratio (HR) 4.44, 95% confidence interval (CI) 1.033-19.068; p = .045). 9 (13.2%) of 68 patients who had follow-ups for at least 5 years developed skin cancer. Compared to an age- and sex-matched cohort, the prevalence of new skin cancer was considerably greater (p = .009).
Patients with MF are predisposed to develop secondary malignancies, and continual exposure to PUVA may potentiate this risk. Annual digital dermoscopic follow-up in MF patients treated with UVA is advised for early diagnosis and treatment of secondary cutaneous malignancies.
蕈样肉芽肿（MF）是最常见的皮肤 T 细胞淋巴瘤。皮肤导向治疗，包括光疗，是一线治疗方法。补骨脂素加紫外线 A 光化学疗法（PUVA）在控制疾病方面非常有效；然而，长期的不良反应，特别是致癌作用，是这种治疗方法的缺点。
有许多关于 PUVA 对自身免疫性皮肤病患者皮肤癌的负面影响的研究。关于光疗对 MF 患者长期影响的数据很少。
分析了在一家三级中心单独接受 PUVA 或联合其他治疗的所有 MF 病例。本研究比较了至少有 5 年随访数据的 MF 患者与年龄和性别匹配的对照组中非黑色素瘤皮肤癌、黑色素瘤和实体器官肿瘤的发展情况。
共有 104 例患者纳入研究。在 16 例（15.4%）患者中发现了 92 例恶性肿瘤，其中 6 例发生了多种恶性肿瘤。皮肤癌包括 56 例基底细胞癌、16 例鲍文病、4 例鳞状细胞癌、3 例黑色素瘤、2 例基底鳞状细胞癌、1 例卡波西肉瘤和 1 例角化棘皮瘤，在 9 例（8.7%）患者中发现。8 例患者发生了 3 种实体癌和 6 种淋巴瘤。皮肤癌的发病风险与 PUVA 总次数有关（<250 次与≥250 次；危险比（HR）4.44，95%置信区间（CI）1.033-19.068；p=0.045）。68 例随访至少 5 年的患者中有 9 例（13.2%）发生皮肤癌。与年龄和性别匹配的队列相比，新发皮肤癌的患病率明显更高（p=0.009）。
MF 患者易发生继发性恶性肿瘤，持续接触 PUVA 可能会增加这种风险。建议对接受 UVA 治疗的 MF 患者进行年度数字皮肤镜随访，以便早期诊断和治疗继发性皮肤恶性肿瘤。
