title: The persistent risk of genital tumors among men treated with psoralen plus ultraviolet A (PUVA) for psoriasis.
abstract: BACKGROUND
  In the general population, squamous cell carcinomas (SCCs) of the male genitalia are rare. Ten years ago, we documented a significant dose-dependent increase in the risk of malignant genital neoplasms among men treated with psoralen plus ultraviolet A (PUVA). Since that time, fewer cohort patients have used PUVA, and genital protection among PUVA users is likely to be frequent.
  
  
  OBJECTIVE
  Our aim was to determine the incidence and risk factors for genital neoplasms since 1989 and risk factors for these neoplasms among patients treated with PUVA.
  
  
  METHODS
  We conducted a prospective cohort study of 892 men first treated with PUVA in 1975-1976.
  
  
  RESULTS
  Twenty-four men (2.7%) had 51 genital neoplasms, including 10 patients with a first tumor after May 1, 1989 (the ending date for our 1990 report). Since May 1, 1989, the incidence of invasive penile and scrotal SCCs was elevated 52.6-fold (95% confidence interval, 19.3-114.6) compared with that expected for the general white population. Multivariate models revealed the highest genital tumor risk among men with high-dose exposure to both PUVA and topical tar/ultraviolet B, with an incidence rate ratio of 4.5 (95% confidence interval, 1.3-16.1) compared with the low-dose exposure group.
  
  
  CONCLUSIONS
  Although use of PUVA has decreased and genital shielding in our cohort has increased, the dose-dependent increase in the risk of genital tumors in men treated with PUVA has persisted. Particularly high risks occur among those with high-dose exposures to both PUVA and topical tar/ultraviolet B.
authors.affiliation: Department of Dermatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA..
authors.forename: Robert S
authors.initials: RS
authors.lastname: Stern
authors.forename: Sepideh
authors.initials: S
authors.lastname: Bagheri
authors.forename: Khanh
authors.initials: K
authors.lastname: Nichols
mesh_terms: D000328:Adult; D017677:Age Distribution; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000209:etiology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D005363:Ficusin / Q000008:administration & dosage / Q000009:adverse effects*; D005834:Genital Neoplasms, Male / Q000453:epidemiology / Q000209:etiology*; D005837:Genitalia, Male / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects* / Q000379:methods; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology
chemical_list: D005363:Ficusin