Medical Health Encyclopedia

Special Warning on PUVA and Skin Cancers. It has been known for some time that PUVA can modify DNA and cause genetic mutations. PUVA is known to increase the risk for squamous cell skin cancer and slightly increases the risk for basal cell skin cancer, both of which are nearly always curable. The risk for skin cancers is higher in the following patients:

• Patients who have had over 200 treatments.
• Patients with a family or personal history of skin cancer.
• Patients with light skin and fair or red hair.
• Patients who have had radiation or x-ray treatments or taken immunosuppressant drugs.

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Even more worrisome was a study reporting an increased risk of melanoma, a very serious skin cancer. Discussions are under way, in fact, about discontinuing PUVA for psoriasis. The arguments generally are as follows:

• Opponents of PUVA argue that studies suggest a long-term risk for melanoma, starting about 15 years after treatment, particularly in people who receive more than 250 treatments. Of note, in one 15-year study only nine out of 1,380 patients developed melanoma. However, seven of these cases occurred in the last five years of the study, indicating that the danger persists and more patients in this study are likely to develop this serious skin cancer as time goes on.
• Supporters of PUVA argue that it is not yet known if the people who developed melanoma experienced sunburn during the procedures or if they already had risk factors for skin cancers. If so, then properly administered treatments could still be considered safe for patients without risk factors. They also argue that PUVA is still the most effective treatment for severe psoriasis, and the alternatives are usually very powerful and relatively new drugs that may have even more serious side effects. Furthermore, the addition of retinoids may protect against skin cancers while proving to be a very effective combination.