Entwicklung eines Keratoakanthoms fünf Jahre nach malignem Melanom unter prolongierter Psoriasis-Therapie mit TNF-alpha-Antagonisten^[1]

Zusammenfassung

Wir berichten über einen 56-jährigen Patienten, der ein spinozelluläres Karzinom vom Typ des Keratoakanthoms gut fünf Jahre nach De-novo-Entstehung eines kutanen Malignen Melanoms unter einer 30-monatigen Behandlung mit TNF-alpha-Antagonisten entwickelte. Wegen einer therapierefraktären mittelschweren Plaque-Psoriasis erhielt er nacheinander Infliximab, Adalimumab und zuletzt Etanercept. Vorher war der Patient über einen Zeitraum von gut 4 Jahren mit Fumaraten, Ciclosporin A und Methotrexat behandelt worden. Vor bzw. zwischen den systemischen Medikamentenbehandlungen waren zwei Serien mit Creme-PUVA bzw. Sole-UVB angewendet worden. Seit der Diagnosestellung des Malignen Melanoms wurde auf weitere UV- und immunsuppressive Systemtherapien der Psoriasis verzichtet und topisch mit Calcipotriol und Betamethasonvalerat behandelt. Der mögliche Zusammenhang zwischen der Entstehung eines Keratoakanthoms und der immunsuppressiven Therapie wird anhand der aktuellen Literatur diskutiert.

Abstract

We report on a male caucasian 56-year-old patient who developed squamous cell carcinoma of the keratoacanthoma type five years after de novo occurrence of cutaneous malignant melanoma at the end of a 30 month period of treatment with TNF-alpha-antagonists. Because of a recalcitrant moderate to severe plaque psoriasis he consecutively received infliximab, adalimumab and etanercept. The patient before was treated over a period of 4 years with fumarates, and for 2 months with ciclosporine A and for 5 weeks with methotrexate. Two cycles of cream PUVA and UVB radiations have been applied before, respectively between systemic medications. Since the diagnosis of malignant melanoma further UV- and systemic immunosuppressive therapy was abolished and the psoriasis treated topically with calcipotriol and betamethasonvalerate. A possible causal connection between development of keratoacanthoma and immunosuppressive treatments is discussed in the light of recent literature.

¹ Herrn Prof. Dr. Theodor Nasemann zum 90. Geburtstag gewidmet.

• Literatur

• 1 Askling J, Fored CM, Brandt L et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumor necrosis factor antagonists. Ann Rheum Dis 2005; 64: 1421-1426
• 2 Chakravarty EF, Michaud K, Wolfe F. Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors. J Rheumatol 2005; 32: 2130-2135
• 3 Esser AC, Abril A, Fayne S et al. Acute development of multiple squamous cell carcinomas after treatment with infliximab. J Am Acad Dermatol 2004; 50: 75-77
• 4 Fulchiero GJ, Salvaggio H, Drabick JJ et al. Eruptive latent metastatic melanomas after initiation of antitumor necrosis factor therapies. J Am Acad Dermatol 2007; 56: S65-S67
• 5 Gordon KB, Papp KA, Langley RG et al. Long-term safety of ustekinumab in patients with moderate to severe psoriasis (part II of II): results from analysis of infections and malignancy from pooled phase II and III clinical trials. J Am Acad Dermatol 2012; 66: 742-751
• 6 Kowalzick L, Eickenscheid L, Seidel C et al. Long term treatment of psoriasis with TNF-alpha antagonists. Occurrence of malignant melanoma. Hautarzt 2009; 60: 655-657
• 7 Ly L, Czarnecki D. The rapid onset of multiple squamous cell carcinomas during etanercept treatment for psoriasis. Br J Dermatol 2007; 157: 1076-1078
• 8 Marcil I, Stern RS. Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: Nested cohort crossover study. Lancet 2001; 358: 1042-1045
• 9 Papp KA, Griffiths CE, Gordon K et al. Long-term safety of ustekinumab in patients with moderate-to-severe psoriasis: final results from 5 years of follow-up. Br J Dermatol 2013; 168: 844-854
• 10 Tyring S, Gordon KB, Poulin Y et al. Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol 2007; 143: 719-726
• 11 Watson KD, Dixon WG, Hyrich KL et al. The influence of anti-TNF therapy and previous malignancy on cancer incidence in patients with rheumatoid arthritis (RA): results from the BSR Biologics register (BSRBR). Rheumatol 2006; 45: i10-i12