Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA)
Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA)
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DOI：
10.1056/nejm199704103361501
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发表时间：
1997-04-10
影响因子：
158.5
通讯作者：
Vakeva, LH
中科院分区：
文献类型：
--
作者：
Stern, RS;Nichols, KT;Vakeva, LH
背景甲氧沙林（甲氧沙林）口服联合长波紫外线（PUVA）光化学疗法是治疗银屑病的有效方法。然而，PUVA是致突变的，增加了鳞状细胞皮肤癌的风险，并可引起不规则的色素沉着皮肤病变。我们研究了黑色素瘤的发生与PUVA.Methods治疗的患者中，我们前瞻性地确定了黑色素瘤的情况下，并记录了暴露于PUVA的1380例银屑病患者谁是第一次治疗PUVA在1975年或1976年的程度。使用发病率数据，我们计算了该队列中黑色素瘤的预期发病率，并将其与观察到的发病率进行了比较。使用回归模型，我们评估了黑色素瘤的风险与一个很长的时间（大于或等于15年），因为第一次治疗和大量的PUVA治疗（大于或等于250）。结果从1975年到1990年，我们检测到4个恶性黑色素瘤，预计在总人口的数量（相对危险度，1.1）。从1991年到1996年，我们检测到7例恶性黑色素瘤（相对危险度为5.4; 95%置信区间为2.2~11.1）。晚期患黑色素瘤的风险高于早期（发生率比，3.8），接受至少250次PUVA治疗的患者高于接受较少治疗的患者（发病率比，3.1）。结论在首次PUVA治疗后约15年，恶性黑色素瘤的风险增加，特别是在接受250次或更多治疗的患者中。(C)1997年，马萨诸塞州医学会。
Background Photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation (PUVA) is an effective treatment for psoriasis. However, PUVA is mutagenic, increases the risk of squamous-cell skin cancer, and can cause irregular, pigmented skin lesions. We studied the occurrence of melanoma among patients treated with PUVA.Methods We prospectively identified cases of melanoma and documented the extent of exposure to PUVA among 1380 patients with psoriasis who were first treated with PUVA in 1975 or 1976. Using incidence data, we calculated the expected incidence of melanoma in this cohort and compared it with the observed incidence. Using regression models, we assessed the risks of melanoma associated with a long time (greater than or equal to 15 years) since the first treatment and with a large number of PUVA treatments (greater than or equal to 250).Results From 1975 through 1990, we detected four malignant melanomas, about the number expected in the overall population (relative risk, 1.1). From 1991 through 1996, we detected seven malignant melanomas (relative risk, 5.4; 95 percent confidence interval, 2.2 to 11.1). The risk of melanoma was higher in the later period than in the earlier one (incidence-rate ratio, 3.8) and higher among patients who received at least 250 PUVA treatments than among those who received fewer treatments (incidence-rate ratio, 3.1).Conclusions About 15 years after the first treatment with PUVA, the risk of malignant melanoma increases, especially among patients who receive 250 treatments or more. (C) 1997, Massachusetts Medical Society.