A 5.7-year prospective study of 1380 patients treated for psoriasis with oral methoxsalen (8-methoxypsoralen) and ultraviolet A photochemotherapy (PUVA) revealed that after adjustment for exposures to ionizing radiation and topical tar preparations, the risk that cutaneous squamous-cell carcinoma would develop at least 22 months after the first exposure to PUVA was 12.8 times higher in patients exposed to a high dose than in those exposed to a low dose (95 per cent confidence interval, 5.8 to 28.5). No substantial dose-related increase was noted for basal-cell carcinoma. The dose-dependent risk of cutaneous squamous-cell carcinoma suggests that PUVA can act as an independent carcinogen. In our study, morbidity associated with these tumors has been limited, but further follow-up is needed. Meanwhile, patients treated with PUVA should be followed closely for the possible development of cutaneous squamous-cell carcinoma.
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Stern, R. S., Lunder, E. J.
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134: 1582-1585
[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.
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134: 595-598
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Stern, R. S., Nichols, K. T., Vakeva, L. H., The PUVA Follow-up Study,
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