Clinical Challenge: Flesh-Colored Papule With Pigmented Speckles - MPR

Clinical Challenge: Flesh-Colored Papule With Pigmented Speckles

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A 70-year-old woman presents for evaluation of an asymptomatic growth on her right wrist, which was noted approximately 2 months ago. She provides a history of longstanding severe psoriasis now well maintained on ustekinumab. She had previously received treatment with both etanercept and efalizumab, the latter during a Phase 2 clinical trial. She denies history of skin cancer. Examination revealed a 0.8-cm, flesh-colored papule with pigmented speckles.

Biopsy of the lesion revealed a nodular basal cell carcinoma, which was subsequently removed by excision.Biologic therapies have revolutionized treatment of psoriasis with a highly acceptable risk-to-benefit ratio.1,2 Long-term extension of data gleaned from patients enrolled in clinical studies did not...

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Biopsy of the lesion revealed a nodular basal cell carcinoma, which was subsequently removed by excision.

Biologic therapies have revolutionized treatment of psoriasis with a highly acceptable risk-to-benefit ratio.1,2 Long-term extension of data gleaned from patients enrolled in clinical studies did not reveal an increased rate of skin cancers.3,4 However, an association with both squamous and basal cell carcinomas to tumor necrosis factor-inhibitor therapy has been suggested by additional clinical studies.5,6 Whether this patient’s basal cell carcinoma is related to previous biologic therapy is open to conjecture.

Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College. 

References

  1. 1. Nast A, Jacobs A, Rosumeck S, Werner RN. Efficacy and safety of systemic long-term treatments for moderate-to-severe psoriasis: a systematic review and meta-analysisJ Invest Dermatol. 2015;24(11):2641-2648.
  2. 2. Jabbar-Lopez ZK, YIU ZZN, Ward V, et al. Quantitative evaluation of biologic therapy options for psoriasis: a systematic review and network meta-analysisJ Invest Dermatol. 2017;137(8):1646-1654.
  3. 3. Papp KA, Poulin Y, Bissonnette R, et al. Assessment of the long-term safety and effectiveness of etanercept for the treatment of psoriasis in an adult populationJ Am Acad Dermatol. 2012;66(2):e33-e45
  4. 4. Gordon KB, Papp KA, Langley RG, et al. Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (part II of II): results from analyses of infections and malignancy from pooled phase II and III clinical trialsJ Am Acad Dermatol. 2012;66:742-751
  5. 5. Brewer JD, Hoverson Schott AR, Roenigk RK. Multiple squamous cell carcinomas in the setting of psoriasis treated with etanercept: a report of four cases and review of the literatureIntl J Dermtol. 2011;50(12):1555-1559.
  6. 6. Raaschou P, Simard JF, Hagelberg A, Askling J; ARTIS Study Group. Rheumatoid arthritis, anti-tumour necrosis factor treatment, and risk of squamous cell and basal cell skin cancer: cohort study based on nationwide prospectively recorded data from SwedenBMJ. 2016;352:i262.