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Risk of Cutaneous Carcinoma in Patients Treated with Oral Methoxsalen Photochemotherapy for Psoriasis

List of authors.
  • Robert S. Stern, M.D.,
  • Lawrence A. Thibodeau, Ph.D.,
  • Ruth A. Kleinerman, A.B.,
  • John A. Parrish, M.D.,
  • Thomas B. Fitzpatrick, M.D.,
  • and 22 Participating Investigators

Abstract

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. (N Engl J Med 300:809–813, 1979)

Funding and Disclosures

Supported by a contract (NO1-AM-7–220) with the National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, and by a grant (HS-00188) from the National Center for Health Services Research, U.S. Public Health Service.

Centers and investigators were as follows: Stanford University School of Medicine, E. M. Farber, M.D., and E. Abel, M.D.; University of California Medical School, San Francisco, D. Cram, M.D., and J. H. Epstein, M.D.; Baylor College of Medicine, J. M. Knox, M.D., and M. Jarratt, M.D.; Washington Hospital Center, T. P. Nigra, M.D.; University of Michigan Medical School, J. Voorhees, M.D., and T. F. Anderson, M.D.; Columbia University College of Physicians and Surgeons, L. Harber, M.D.; Mayo Graduate School of Medicine, S. Muller, M.D.; University of Miami, G. Weinstein, M.D.; Mount Sinai Medical Center, P. Frost, M.D.; Temple University School of Medicine, F. Urbach, M.D.; Harvard Medical School, K. A. Arndt, M.D.; Dartmouth Medical School, R. D. Baughman, M.D.; Yale University School of Medicine, D. M. Carter, M.D., and I. M. Braverman, M.D.; Duke University Medical Center, R. Gilgor, M.D.; University of Pennsylvania Hospitals, A. M. Kligman, M.D., and J. Petrozzi, M.D.; and Massachusetts General Hospital, E. Gonzales, M.D.

We are indebted to Dr. Frederick Urbach for advice, to Mr. Daniel Geer, Dr. John Melski and Dr. Howard Bleich for assistance with computer programming, to Dr. Martin Mihm for reviewing histologic specimens and to the PUVA technicians at the 16 collaborating centers.

Author Affiliations

From the Department of Dermatology, Harvard Medical School, Massachusetts General Hospital and Beth Israel Hospital, the Center for the Analysis of Health Practices and the Department of Biostatistics, Harvard School of Public Health, and the Department of Computer Medicine, Beth Israel Hospital (address reprint requests to Dr. Stern at the Department of Dermatology, Beth Israel Hospital, Boston, MA 02215).

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