Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada; Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
J Am Acad Dermatol. 2024 Apr;90(4):759-766. doi: 10.1016/j.jaad.2023.11.053. Epub 2023 Dec 7.
Psoralen + ultraviolet-A (PUVA) is associated with photocarcinogenesis. However, carcinogenic risk with other ultraviolet phototherapies remains unclear.
Evaluate whether phototherapy without psoralens increases skin cancer risk.
Retrospective cohort study of patients treated at a teaching-hospital phototherapy center (1977-2018). Skin cancer records were validated against pathology reports. Age-standardized incidence rates (ASIRs) of skin cancer were evaluated for gender, skin phototype, diagnosis, ultraviolet modality, anatomical site; and compared to provincial population incidence rates (2003).
In total, 3506 patients treated with broadband-ultraviolet-B, narrowband-UVB and/or combined UVAB were assessed with a mean follow-up of 7.3 years. Majority of patients had psoriasis (60.9%) or eczema (26.4%). Median number of treatments was 43 (1-3598). Overall, 170 skin cancers (17 melanoma, 33 squamous cell carcinoma and 120 basal cell carcinoma) occurred in 79 patients. Patient-based and tumor-based ASIR of skin cancer was 149 (95% CI: 112-187)/100,000 and 264 (219-309)/100,000 person-years, respectively. There was no significant difference between tumor-based ASIRs for melanoma, squamous cell carcinoma, and basal cell carcinoma compared to the general population; or in phototherapy patients with-psoriasis or eczema; or immunosuppressants. No cumulative dose-response correlation between UVB and skin cancer was seen.
Treatment and follow-up duration.
No increased risk of melanoma and keratinocyte cancer was found with phototherapy.
补骨脂素加紫外线 A（PUVA）与光致癌有关。然而，其他紫外线光疗的致癌风险尚不清楚。
评估不使用补骨脂素的光疗是否会增加皮肤癌风险。
对一家教学医院光疗中心（1977-2018 年）接受治疗的患者进行回顾性队列研究。皮肤癌记录与病理报告进行了验证。评估了性别、皮肤光型、诊断、紫外线模式、解剖部位的皮肤癌年龄标准化发病率（ASIR）；并与省级人群发病率（2003 年）进行了比较。
共评估了 3506 例接受宽谱紫外线-B、窄谱 UVB 和/或联合 UVAB 治疗的患者，平均随访 7.3 年。大多数患者患有银屑病（60.9%）或湿疹（26.4%）。中位数治疗次数为 43 次（1-3598 次）。共有 79 例患者发生了 170 例皮肤癌（17 例黑色素瘤、33 例鳞状细胞癌和 120 例基底细胞癌）。基于患者和基于肿瘤的皮肤癌 ASIR 分别为 149（95%CI：112-187）/100,000 和 264（219-309）/100,000 人年。与普通人群相比，黑色素瘤、鳞状细胞癌和基底细胞癌的肿瘤 ASIR 之间无显著差异；或在患有银屑病或湿疹的光疗患者中；或在免疫抑制剂患者中。未观察到 UVB 与皮肤癌之间存在累积剂量反应关系。
治疗和随访时间。
光疗未发现黑色素瘤和角质形成细胞癌风险增加。
