PUVA Carcinogenesis — SCE Dermatology MCQ

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ModerateSkin CancerPUVA CarcinogenesisSCE Dermatology

A 50-year-old man with mycosis fungoides has been treated with PUVA. He asks about the risk of secondary skin cancers from PUVA. Which skin cancer type is most associated with cumulative PUVA exposure?

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Correct answer: A — Squamous cell carcinoma

Squamous cell carcinoma is the skin cancer most strongly associated with cumulative PUVA exposure. The risk is dose-dependent and increases significantly after >200 PUVA treatments or cumulative UVA dose >1000 J/cm². PUVA-related SCCs may occur in non-sun-exposed sites (covered skin). There is also an increased risk of melanoma, but this appears 15+ years after first PUVA exposure. BAD guidelines recommend lifelong skin surveillance for patients with high cumulative PUVA exposure. This carcinogenic risk was a major driver for the transition to NB-UVB as the preferred phototherapy modality.

Reference: BAD 2019 Phototherapy Guidelines