NBUVB y Cancer de piel

Incidence of Skin Malignancies Among Patients With Vitiligo or Psoriasis Receiving Narrowband UVB Phototherapy

Abstract 

BACKGROUND

Previous studies regarding the risk of skin malignancy with NBUVB have been performed in Caucasian patients but few studies have been conducted in Asians.

AIMS

To determine the risk of skin cancer in Asian patients with psoriasis and vitiligo receiving NBUVB phototherapy.

METHODS

We performed a 9-year retrospective study including all patients with psoriasis and vitiligo receiving NBUVB (either 311nm wavelength through cabin phototherapy or 308nm through excimer lamp phototherapy) at the National Skin Centre. We matched the identification numbers of patients to the National Registry of Diseases Office database and collected data on all skin cancers diagnosed RESULTS: A total of 3730 patients were included. During the course of the study, 12 cases of skin cancer were diagnosed, of which 10 were basal cell carcinomas, and 2 were squamous cell carcinomas. No cases of melanoma were detected in the study. The age-standardized incidence of skin cancer in psoriasis and vitiligo patients who received phototherapy was 47.5 and 26.5 respectively, which is higher than the incidence of skin cancers in the general population. Risk of skin malignancy was positively correlated with the cumulative (p=0.008) and maximum dose of phototherapy (p=0.011) as well as previous systemic treatments (p=0.006).

LIMITATIONS

Limitations include a relatively short follow-up period as well as the lack of quantification of solar exposure.

CONCLUSIONS

NBUVB phototherapy in Asian skin increases the risk of skin malignancy. The risk of skin malignancy is higher with psoriasis patients, greater cumulative and maximal dose of phototherapy as well as use of systemic therapy. Despite the increased risk, the absolute number of skin malignancies remains low, especially for vitiligo patients, with no cases of melanoma diagnosed - a reassuring finding that phototherapy remains a safe alternative in the treatment of psoriasis and vitiligo.

TAKE-HOME MESSAGE

• In this retrospective study from Singapore involving 3730 patients with vitiligo or psoriasis who received narrowband ultraviolet B (NBUVB) phototherapy, fewer than 1% were diagnosed with non-melanoma skin cancer. There were zero cases of melanoma during the 12-year study period. The rate of incident skin cancer was higher among patients with psoriasis treated with NBUVB than among the general population. The risk of skin cancer increased with cumulative and maximum doses of phototherapy and prior systemic treatments.
• NBUVB phototherapy may marginally increase the risk of non-melanoma skin cancer in the Asian population.

–  Katherine M. Stiff, MD

Photodermatology, Photoimmunology & Photomedicine

Incidence of skin malignancies in patients with vitiligo or psoriasis who received narrowband ultraviolet B phototherapy (308nm/311nm): a retrospective review of 3730 patients

Photodermatol Photoimmunol Photomed 2022 Nov 07;[EPub Ahead of Print], BKY Chia, YW Yew, X Zhao, WS Chong, TGS Thng 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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