title: Multiple squamous cell carcinomas in the setting of psoriasis treated with etanercept: a report of four cases and review of the literature.
abstract: BACKGROUND
  Psoriasis is a common, chronic, hyperproliferative disease of the skin characterized by overexpression of type 1 cytokines, including tumor necrosis factor α. There is concern that antitumor necrosis factor agents such as etanercept may increase the incidence of cutaneous malignancies; however, the data are conflicting. Our objective was to further understand the characteristics and association of squamous cell carcinoma (SCC) development in patients with psoriasis who used etanercept.
  
  
  METHODS
  Four patients with psoriasis were identified as having SCCs in the setting of etanercept. The histories of these patients were reviewed retrospectively.
  
  
  RESULTS
  All four patients had lifelong psoriasis. The mean time of SCC onset was 11 months after etanercept therapy was begun (range, 1-17 months), and the number of SCCs in each patient ranged from five to more than 50.
  
  
  CONCLUSIONS
  Currently, reports are conflicting about the effect of etanercept on SCC development. We present the first case series of patients in whom SCC developed in the setting of etanercept therapy. More research is needed to better characterize the effects of etanercept on the development and behavior of SCC in patients with psoriasis.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN 55095, USA. brewer.jerry@mayo.edu
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Brewer
authors.forename: Alyssa R
authors.initials: AR
authors.lastname: Hoverson Schott
authors.forename: Randall K
authors.initials: RK
authors.lastname: Roenigk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D003879:Dermatologic Agents / Q000627:therapeutic use; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000209:etiology* / Q000473:pathology; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology
chemical_list: D003879:Dermatologic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept