Skin Cancer Risk of Narrow-Band UV-B (TL-01) Phototherapy: A Multi-Center Registry Study with 4,815 Patients
DOI:
https://doi.org/10.2340/actadv.v104.39927Keywords:
basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, narrow band UVB radiation, skin cancer risk, TL-01 phototherapyAbstract
Narrow-band TL-01 ultraviolet B phototherapy (TL-01) is an effective and widely used treatment for many skin diseases. The purpose of the investigation was to assess the risk of skin cancers in patients treated with TL-01 phototherapy who have not received any other phototherapy modalities. This cohort study included 4,815 TL-01 treated patients in Finland with psoriasis or atopic dermatitis. Clinical information was collected from the hospital records and linked with Finnish Cancer Registry data. The follow-up started from the first TL-01 treatment and the mean follow-up time was 8.4 years. Standardized incidence ratios were calculated for basal cell carcinoma, cutaneous melanoma, and squamous cell carcinoma. The standardized incidence ratio for basal cell carcinoma was 2.5 (95% confidence interval 1.8–3.5), for cutaneous melanoma 4.0 (95% confidence interval 2.1–6.8) and for squamous cell carcinoma 3.7 (95% confidence interval 1.7–7.0). For basal cell carcinoma and squamous cell carcinoma, the standardized incidence ratios remained similar during the whole follow-up time while the standardized incidence ratio for cutaneous melanoma was markedly higher during the first 5 years of follow-up. In conclusion, an increased incidence of skin cancers was observed among TL-01 treated patients. It should be confirmed in the future whether the skin cancer risk of TL-01 phototherapy will remain high in a longer follow-up.
Downloads
References
Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol 1981; 76: 359-362.
https://doi.org/10.1111/1523-1747.ep12520022 DOI: https://doi.org/10.1111/1523-1747.ep12520022
Hönigsmann H. History of phototherapy in dermatology. Photochem Photobiol Sci 2013; 12: 16-21.
https://doi.org/10.1039/c2pp25120e DOI: https://doi.org/10.1039/c2pp25120e
Solar and ultraviolet radiation. IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man, Vol. 55. International Agency for Research on Cancer, 1992.
Flindt-Hansen H, McFadden N, Eeg-Larsen T, Thune P. Effect of a new narrow-band UVB lamp on photocarcinogenesis in mice. Acta Derm Venereol 1991; 71: 245-248.
https://doi.org/10.2340/0001555571245248 DOI: https://doi.org/10.2340/0001555571245248
Wulf HC, Hansen AB, Bech-Thomsen N. Differences in narrow-band ultraviolet B and broad-spectrum ultraviolet photocarcinogenesis in lightly pigmented hairless mice. Photodermatol Photoimmunol Photomed 1994; 10: 192-197.
Gibbs NK, Traynor NJ, MacKie RM, Campbell I, Johnson BE, Ferguson J. The phototumorigenic potential of broad-band (270-350 nm) and narrow-band (311-313 nm) phototherapy sources cannot be predicted by their edematogenic potential in hairless mouse skin. J Invest Dermatol 1995; 104: 359-363.
https://doi.org/10.1111/1523-1747.ep12665385 DOI: https://doi.org/10.1111/1523-1747.ep12665385
Stern RS, Laird N, Melski J, Parrish JA, Fitzpatrick TB, Bleich HL. Cutaneous squamous-cell carcinoma in patients treated with PUVA. N Engl J Med 1984; 310: 1156-1161.
https://doi.org/10.1056/NEJM198405033101805 DOI: https://doi.org/10.1056/NEJM198405033101805
Hannuksela-Svahn A, Pukkala E, Läärä E, Poikolainen K, Karvonen J. Psoriasis, its treatment, and cancer in a cohort of Finnish patients. J Invest Dermatol 2000; 114: 587-590.
https://doi.org/10.1046/j.1523-1747.2000.00898.x DOI: https://doi.org/10.1046/j.1523-1747.2000.00898.x
Stern RS. PUVA follow-up study: the risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study. J Am Acad Dermatol 2012; 66: 553-562.
https://doi.org/10.1016/j.jaad.2011.04.004 DOI: https://doi.org/10.1016/j.jaad.2011.04.004
Stern RS, Nichols KT, Väkevä LH. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). N Engl J Med 1997; 336: 1041-1045.
https://doi.org/10.1056/NEJM199704103361501 DOI: https://doi.org/10.1056/NEJM199704103361501
Stern RS. The risk of melanoma in association with long-term exposure to PUVA. J Am Acad Dermatol 2001; 44: 755-761.
https://doi.org/10.1067/mjd.2001.114576 DOI: https://doi.org/10.1067/mjd.2001.114576
Weischer M, Blum A, Eberhard F, Röcken M, Berneburg M. No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol 2004; 84: 370-374.
https://doi.org/10.1080/00015550410026948 DOI: https://doi.org/10.1080/00015550410026948
Black RJ, Gavin AT. Photocarcinogenic risk of narrowband ultraviolet B (TL-01) phototherapy: early follow-up data. Br J Dermatol 2006; 154: 566-567.
https://doi.org/10.1111/j.1365-2133.2005.07085.x DOI: https://doi.org/10.1111/j.1365-2133.2005.07085.x
Man I, Crombie IK, Dawe RS, Ibbotson SH, Ferguson J. The photocarcinogenic risk of narrowband UVB (TL-01) phototherapy: early follow-up data. Br J Dermatol 2005; 152: 755-757.
https://doi.org/10.1111/j.1365-2133.2005.06537.x DOI: https://doi.org/10.1111/j.1365-2133.2005.06537.x
Hearn RMR, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol 2008; 159: 931-935.
https://doi.org/10.1111/j.1365-2133.2008.08776.x DOI: https://doi.org/10.1111/j.1365-2133.2008.08776.x
Archier E, Devaux S, Castela E, Gallini A, Aubin F, Le Maître M, et al. Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26: 22-31.
https://doi.org/10.1111/j.1468-3083.2012.04520.x DOI: https://doi.org/10.1111/j.1468-3083.2012.04520.x
Pukkala E, Engholm G, Højsgaard Schmidt LK, Storm H, Khan S, Lambe M, et al. Nordic Cancer Registries: an overview of their procedures and data comparability. Acta Oncol 2018; 57: 440-455.
https://doi.org/10.1080/0284186X.2017.1407039 DOI: https://doi.org/10.1080/0284186X.2017.1407039
Wang X, Liu Q, Wu L, Nie Z, Mei Z. Risk of non-melanoma skin cancer in patients with psoriasis: an updated evidence from systematic review with meta-analysis. J Cancer 2020; 11: 1047-1055.
https://doi.org/10.7150/jca.37015 DOI: https://doi.org/10.7150/jca.37015
Chiesa Fuxench ZC, Shin DB, Ogdie Beatty A, Gelfand JM. The risk of cancer in patients with psoriasis: a population-based cohort study in the Health Improvement Network. JAMA Dermatol 2016; 152: 282-290.
https://doi.org/10.1001/jamadermatol.2015.4847 DOI: https://doi.org/10.1001/jamadermatol.2015.4847
Jensen AO, Svaerke C, Körmendiné Farkas D, Olesen AB, Kragballe K, Sørensen HT. Atopic dermatitis and risk of skin cancer: a Danish nationwide cohort study (1977-2006) Am J Clin Dermatol 2012; 13: 29-36.
https://doi.org/10.2165/11593280-000000000-00000 DOI: https://doi.org/10.2165/11593280-000000000-00000
Wang L, Bierbrier R, Drucker AM, Chan AW. Noncutaneous and cutaneous cancer risk in patients with atopic dermatitis: a systematic review and meta-analysis. JAMA Dermatol 2020; 156: 158-171.
https://doi.org/10.1001/jamadermatol.2019.3786 DOI: https://doi.org/10.1001/jamadermatol.2019.3786
Hedderson MM, Asgari MM, Xu F, Quesenberry CP, Sridhar S, Geier J, et al. Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study. BMJ Open 2023; 13: e071172.
https://doi.org/10.1136/bmjopen-2022-071172 DOI: https://doi.org/10.1136/bmjopen-2022-071172
Reichrath J, Rass K. Ultraviolet damage, DNA repair and vitamin D in nonmelanoma skin cancer and in malignant melanoma: an update. Adv Exp Med Biol 2014; 810: 208-233.
https://doi.org/10.1007/978-1-4939-0437-2_12 DOI: https://doi.org/10.1007/978-1-4939-0437-2_12
Benjamin CL, Ananthaswamy HN. p53 and the pathogenesis of skin cancer. Toxicol Appl Pharmacol 2007; 224: 241-248.
https://doi.org/10.1016/j.taap.2006.12.006 DOI: https://doi.org/10.1016/j.taap.2006.12.006
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Petra Åkerla, Eero Pukkala, Mika Helminen, Niina Korhonen, Toni Karppinen
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
Funding data
-
European Academy of Dermatology and Venereology
Grant numbers n° PPRC-2017-8 -
Suomen Ihotautilääkäriyhdistys
