Trovato Emanuele, Dragotto Martina, Capalbo Eugenio, Cartocci Alessandra, Rubegni Pietro, Calabrese Laura
Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.
Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy.
J Clin Med. 2024 Apr 23;13(9):2452. doi: 10.3390/jcm13092452.
The risk of developing non-melanoma skin cancers (NMSCs) in patients with psoriasis is highly debated, and, to date, there is no unambiguous consensus opinion. Psoriasis is known to be related to an increased likelihood of other comorbidities such as psoriatic arthritis, obesity, metabolic syndrome, depression, and cardiovascular disease. Regarding cancer risk, previous studies have reported a greater tendency for the development of cutaneous T-lymphomas and colon, breast, kidney, and lung cancers. Furthermore, data from network meta-analyses have shown that patients with psoriasis have a higher risk of developing squamous cell carcinomas (SCCs) and/or basal cell carcinomas (BCCs). Multiple factors may contribute to the development of NMSCs in psoriatic patients, ranging from immunosuppression induced by biologic agents to previous phototherapy. However, the extent to which each factor may impact this risk has not been entirely assessed. The aim of this study was to evaluate the risk of developing NMSCs in patients with psoriasis observed for at least 5 years, by directly comparing patients only treated with phototherapy and patients treated with anti-tumor necrosis factor α (TNFα) agents, naive to other systemic treatments or phototherapy. We conducted a single-center retrospective study at Siena University Hospital, Italy, on 200 adult patients with psoriasis divided into two groups: (i) group 1, including 100 patients treated with narrow-band UVB phototherapy (nb-UVB), and (ii) group 2, including 100 patients treated with anti-TNFα. The patients included in group 2 had to be naive to cDMARDs and biologics and treated with anti-TNFα continuously for 5 years without loss of efficacy. All patients were observed for 5 years and underwent annual dermatologic examinations to assess for the occurrence of BCC or SCC. A total of 34 out of 100 patients treated with phototherapy had one BCC or one SCC and 10 out of 34 developed two skin cancers. In particular, five had both types (one BCC and one SCC), and five had two BCCs. The results of our study highlight how the risk of developing NMSCs is greater in patients undergoing phototherapy compared to those treated with anti-TNFα. It also draws attention to the consideration that patients with scalp psoriasis might need closer follow-up as they could be more at risk of developing NMSCs.
银屑病患者发生非黑色素瘤皮肤癌（NMSC）的风险备受争议，迄今为止，尚无明确的共识意见。已知银屑病与其他合并症的发生可能性增加有关，如银屑病关节炎、肥胖、代谢综合征、抑郁症和心血管疾病。关于癌症风险，先前的研究报告称，皮肤T细胞淋巴瘤以及结肠癌、乳腺癌、肾癌和肺癌的发生倾向更大。此外，网络荟萃分析的数据表明，银屑病患者发生鳞状细胞癌（SCC）和/或基底细胞癌（BCC）的风险更高。多种因素可能导致银屑病患者发生NMSC，从生物制剂诱导的免疫抑制到先前的光疗。然而，每个因素对这种风险的影响程度尚未完全评估。本研究的目的是通过直接比较仅接受光疗的患者和接受抗肿瘤坏死因子α（TNFα）药物治疗、未接受其他全身治疗或光疗的患者，评估观察至少5年的银屑病患者发生NMSC的风险。我们在意大利锡耶纳大学医院进行了一项单中心回顾性研究，对200名成年银屑病患者进行分组：（i）第1组，包括100名接受窄带UVB光疗（nb-UVB）的患者，以及（ii）第２组，包括100名接受抗TNFα治疗的患者。第2组纳入的患者必须未使用过传统改善病情抗风湿药（cDMARD）和生物制剂，且连续接受抗TNFα治疗5年且疗效未丧失。所有患者均观察5年，并每年接受皮肤科检查以评估是否发生BCC或SCC。接受光疗的100名患者中共有34人发生了1例BCC或1例SCC，其中10人发生了两种皮肤癌。具体而言，5人同时患有两种类型（1例BCC和1例SCC），5人患有2例BCC。我们的研究结果突出表明，与接受抗TNFα治疗的患者相比，接受光疗的患者发生NMSC的风险更大。它还提请注意，头皮银屑病患者可能需要更密切的随访，因为他们发生NMSC的风险可能更高。
