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.
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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
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