A 2.1-year prospective study of 1373 patients given oral 8-methoxypsoralen photochemotherapy for psoriasis revealed 30 patients with a total of 48 basal-cell and squamous-cell carcinomas. The observed incidence of cutaneous carcinoma was 2.63 (95 per cent confidence limits = 1.91 to 3.90) times that expected for an age, sex and geographically matched population. Relative risk to patients with history of ionizing radiation was 3.68 (99 per cent confidence limits, 2.42 to 8.69). Patients with a previous cutaneous carcinoma had a relative risk of 10.22 (99 per cent confidence limits, 4.78 to 37.08). A higher than expected proportion of squamous-cell carcinomas and an excess of squamous-cell carcinomas in areas not exposed to sun were seen. New patients with known histories of ionizing-radiation exposure or of skin tumors should be given 8-methyoxypsoralen photochemotherapy only if they understand the risks and have disabling psoriasis untreatable by other means.
This article has been cited by other articles:
Nijsten, T., Looman, C. W. N., Stern, R. S.
(2007). Clinical Severity of Psoriasis in Last 20 Years of PUVA Study. Arch Dermatol
143: 1113-1121
[Abstract][Full Text]
Gelfand, J. M.
(2007). Long-term Treatment for Severe Psoriasis: We're Halfway There, With a Long Way to Go. Arch Dermatol
143: 1191-1193
[Full Text]
Stern, R. S.
(2007). Psoralen and Ultraviolet A Light Therapy for Psoriasis. NEJM
357: 682-690
[Full Text]
Schiener, R., Brockow, T., Franke, A., Salzer, B., Peter, R. U., Resch, K. L.
(2007). Bath PUVA and Saltwater Baths Followed by UV-B Phototherapy as Treatments for Psoriasis: A Randomized Controlled Trial. Arch Dermatol
143: 586-596
[Abstract][Full Text]
Morison, W. L., Baughman, R. D., Day, R. M., Forbes, P. D., Hoenigsmann, H., Krueger, G. G., Lebwohl, M., Lew, R., Naldi, L., Parrish, J. A., Piepkorn, M., Stern, R. S., Weinstein, G. D., Whitmore, S. E.
(1998). Consensus Workshop on the Toxic Effects of Long-term PUVA Therapy. Arch Dermatol
134: 595-598
[Abstract][Full Text]
Wolff, K.
(1997). Should PUVA Be Abandoned?. NEJM
336: 1090-1091
[Full Text]
Weinstock, M. A., Coulter, S., Bates, J., Bogaars, H. A., Larson, P. L., Burmer, G. C.
(1995). Human Papillomavirus and Widespread Cutaneous Carcinoma After PUVA Photochemotherapy. Arch Dermatol
131: 701-704
[Abstract]
Licata, A. G., Wilson, L. D., Braverman, I. M., Feldman, A. M., Kacinski, B. M.
(1995). Malignant Melanoma and Other Second Cutaneous Malignancies in Cutaneous T-Cell Lymphoma: The Influence of Additional Therapy After Total Skin Electron Beam Radiation. Arch Dermatol
131: 432-435
[Abstract]
Woo, T. Y., Wong, R. C., Wong, J. M., Anderson, T. F., Lerman, S.
(1985). Lenticular Psoralen Photoproducts and Cataracts of a PUVA-Treated Psoriatic Patient. Arch Dermatol
121: 1307-1308
[Abstract]
Ramsay, D. L., Parnes, R. E., Dubin, N.
(1984). Response of Mycosis Fungoides to Topical Chemotherapy With Mechlorethamine. Arch Dermatol
120: 1585-1590
[Abstract]
Diette, K. M., Momtaz-T, K., Stern, R. S., Arndt, K. A., Parrish, J. A.
(1984). Psoralens and UV-A and UV-B Twice Weekly for the Treatment of Psoriasis. Arch Dermatol
120: 1169-1173
[Abstract]
Stern, R. S., Momtaz, K.
(1984). Skin Typing for Assessment of Skin Cancer Risk and Acute Response to UV-B and Oral Methoxsalen Photochemotherapy. Arch Dermatol
120: 869-873
[Abstract]
Pearlman, D. L., Burns, J., Cannon, T. C., Engelhard, C. S.
(1984). Paper-Tape Occlusion of Anthralin Paste: A New Outpatient Therapy for Psoriasis. Arch Dermatol
120: 625-630
[Abstract]
Roelandts, R.
(1984). Mutagenicity and Carcinogenicity of Methoxsalen Plus UV-A. Arch Dermatol
120: 662-669
[Abstract]
Niemi, K.-M., Niemi, A., Kanerva, L.
(1983). Morphologic Changes in Epidermis of PUVA-Treated Patients With Psoriasis With or Without a History of Arsenic Therapy. Arch Dermatol
119: 904-909
[Abstract]
Trosko, J. E., Chang, C.-c.
(1983). Potential Role of Intercellular Communication in the Rate-Limiting Step in Carcinogenesis. International Journal of Toxicology
2: 5-22
[Abstract]
Farber, E. M., Abel, E. A., Cox, A. J.
(1983). Long-term Risks of Psoralen and UV-A Therapy for Psoriasis. Arch Dermatol
119: 426-431
[Abstract]
(1983). Dermatology: An Annotated Bibliography of Recent Literature: References to Journal Articles and Other Papers. ANN INTERN MED
98: 117-118
[Abstract]
Kornhauser, A, Wamer, W., Giles, A. Jr
(1982). Psoralen phototoxicity: correlation with serum and epidermal 8-methoxypsoralen and 5-methoxypsoralen in the guinea pig. Science
217: 733-735
[Abstract]
Stern, R. S., Melski, J. W.
(1982). Long-term Continuation of Psoralen and Ultraviolet-A Treatment of Psoriasis. Arch Dermatol
118: 400-403
[Abstract]
Melski, J. W., Stern, R. S.
(1982). Annual Rate of Psoralen and Ultraviolet-A Treatment of Psoriasis After Initial Clearing. Arch Dermatol
118: 404-408
[Abstract]
Frank, J., Williams, JR
(1982). X-ray induction of persistent hypersensitivity to mutation. Science
216: 307-308
[Abstract]
Farber, E. M., Abel, E. A., Epstein, J. H., Cram, D. A.
(1982). Cost-effectiveness of PUVA Therapy: Further Considerations. JAMA
247: 1808-1808
[Abstract]
Ivie, G., Holt, D., Ivey, M.
(1981). Natural toxicants in human foods: psoralens in raw and cooked parsnip root. Science
213: 909-910
[Abstract]
Pittelkow, M. R., Perry, H. O., Muller, S. A., Maughan, W. Z., O'Brien, P. C.
(1981). Skin Cancer in Patients With Psoriasis Treated With Coal Tar: A 25-Year Follow-up Study. Arch Dermatol
117: 465-468
[Abstract]
Pearson, R. W.
(1981). Dermatology. JAMA
245: 2183-2184
[Abstract]
Stern, R. S., Thibodeau, L. A., Kleinerman, R. A., Parrish, J. A., Fitzpatrick, T. B., Bleich, H. L.
(1981). Effect of Methoxsalen Photochemotherapy on Cost of Treatment for Psoriasis: An Example of Technological Assessment. JAMA
245: 1913-1918
[Abstract]
Roenigk, H. H. Jr
(1981). Cost-effectiveness of PUVA. JAMA
245: 1941-1941
[Abstract]
Elias, P. M., Williams, M. L.
(1981). Retinoids, Cancer, and the Skin. Arch Dermatol
117: 160-180
[Abstract]
Abel, E. A., Goldberg, L. H., Farber, E. M.
(1980). Treatment of Palmoplantar Psoriasis With Topical Methoxsalen Plus Long-Wave Ultraviolet Light. Arch Dermatol
116: 1257-1261
[Abstract]
DUBROFF, L. M.
(1980). Psoralen and Photoactivation. ANN INTERN MED
92: 439-440
[Abstract]
PERLMAN, S. G., GERBER, L. H., ROBERTS, R. M., NIGRA, T. P., BARTH, W. F.
(1979). Photochemotherapy and Psoriatic Arthritis: A Prospective Study. ANN INTERN MED
91: 717-722
[Abstract]
DERMATOLOGY COMMITTEE,
(1979). Dermatology: An Annotated Bibliography of Recent Literature: References to Journal Articles and Other Papers. ANN INTERN MED
91: 804-805
[Abstract]
Verdich, J.
(1979). Squamous Cell Carcinoma: Occurrence in Mycosis Fungoides Treated With Psoralens Plus Long-Wave Ultraviolet Radiation. Arch Dermatol
115: 1338-1339
[Abstract]
Gilchrest, B. A.
(1979). Some Gerontologic Considerations in the Practice of Dermatology. Arch Dermatol
115: 1343-1346
[Abstract]
